Sister Joseph nodule

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This is a metastatic tumour deposit in the umbilicus, the anatomical region where the peritoneum is closest to the skin. It is rare.

  • the term "Sister Mary Joseph's nodule" was first introduced by Hamilton Bailey in 1949 in recognition of the superintendent nurse of St. Mary Hospital in Rochester, Minnesota, who predicted the presence of intra-abdominal malignancy by palpating a firm nodule in the umbilical region

Umbilical metastasis is a rare finding with the vast majority of cases involving intra-abdominal cancer

  • less common causes of an umbilical nodule include endometriosis, hypertrophic scar, pyogenic granuloma, mycosis, psoriasis inversa, eczema, Paget's disease and angioma

  • occurrence of cutaneous metastases from malignant neoplasms occurs in from 1% to up to 9% of individuals, as determined at autopsy
    • those metastases to the umbilicus are uncommon and represent only 10% of all secondary tumours which have spread to the skin (4)

  • tumours of the gastrointestinal tract and female internal genitalia are the more frequently reported primary lesions, whereas other malignancies are rarely associated with such kind of metastasis (2,3,4)
    • umbilical metastasis from urinary bladder is extremely rare (5)

  • Sister Mary Joseph's nodules usually present as a painful lump on the anterior abdominal wall
    • has irregular margins and a hard fibrous consistency
    • surface may be ulcerated and necrotic, with either blood, serous, purulent, or mucous discharge from it
    • size of the nodule usually ranges from 0.5 to 2 cm, although some nodules may reach up to 10 cm in size (4)

Umbilical metastasis is one of many characteristic signs of extensive neoplastic disease. It suggests advanced distant metastasis and is associated with poor prognosis; mean survival is approximately 10-12 months, although long-term survival has been reported, but only in the presence of solitary metastatic umbilicus nodule (6)

Reference:

  • Bailey H. Demonstrations of physical signs in clinical surgery. 11th ed. Baltimore: Williams & Wilkins; 1949. p. 227.
  • Chaffins ML, Altman DA, Balle MR, et al. Metastatic umbilical carcinoma. Cutis. 1993;52:37-39.
  • Shetty MR. Metastatic Tumours of the Umbilicus: A Review 1830-1989. Journal of Surgical Oncology. 1990;45:212-15.
  • Gabriele R, Conte M, Egidi F, Borghese M. Umbilical metastases: current viewpoint. World Journal of Surgical Oncology. 2005;3:13.
  • Larentzakis A, Theodorou D, Fili K, Manataki A, Bizimi V, et al. Sister Mary Joseph's nodule: three case reports. Cases Journal. 2008;1:182
  • Dubreuil A, Dompmartin A, Barjot P, Louvet S, Leroy D. Umbilical metastasis or Sister Mary Joseph's nodule. Int J Dermatol. 1998;37:70-73.

Last edited 11/2018 and last reviewed 12/2018