A hard umbilical lump

This is a computed tomography image of the abdomen of a woman in her late 60s who was referred for altered bowel habit, weight loss (2 kg), and a discoloured umbilical lump (fig 1, arrow). The mass had developed over nine months and was initially thought to represent a Sister Mary Joseph nodule—a metastatic lesion involving the umbilicus. The patient’s tumour markers were within normal range and a CT scan did not indicate intra-abdominal malignancy. Abdominal examination showed a 3 cm hard, non-tender, black navel stone, or umbolith, without discharge or evidence of infection.Navel stones form when sebum, keratin, and dirt accumulate in the depths of a concave umbilicus and blacken with oxidation, often due to poor hygiene. Small stones can be softened, broken up, and gently teased out, whereas longstanding stones may become calcified and may require surgical excision. Differential diagnoses for umbilical masses include granulomas, mesenteric or urinary…
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