Gastrointestinal: Sister Mary Joseph nodule
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
23
Journal Issue
9
Pages
1462
Date Issued
2008
Author(s)
Abstract
Rarely, patients with advanced cancer develop a metastasis in the umbilicus. This has been called a Sister Mary Joseph nodule after Sister Mary Joseph, a Franciscan nun, who worked as head nurse and surgical assistant to Dr William Mayo. The term Sister Mary Joseph nodule may not have been widely used in her lifetime but was included in a textbook by Sir Hamilton Bailey in 1949 entitled ��Physical Signs in Clinical Surgery I��. The most common primary sites for umbilical metastases are stomach, ovary, pancreas and colon. The mode of spread to the umbilicus is debated but direct spread, perhaps along ligaments of embryonic origin, may be the most important. Other possible modes of spread include lymphatic spread and spread along persistent paraumbilical veins. The cardinal clinical feature is the development of a firm, mobile nodule or nodules in the umbilicus. The skin covering the nodule is usually of normal color but may be red or purple and can progress to a malignant ulcer. The sign almost always indicates advanced cancer and facilitates a histological diagnosis. Survival rates vary with the primary site but are usually less than 12 months. In the images shown below, umbilical metastases were associated with a malignant stromal cell tumor in the stomach. The patient was a 54-year-old man who was investigated because of lower abdominal pain and weight loss. There was a firm nodule in the umbilicus that was non-tender and relatively fixed (Figure 1). An abdominal computed tomography (CT) scan showed an irregular mass, 4 cm in diameter, with central calcification in the upper abdomen and numerous nodules in the peritoneum and mesentery. A sagittal, contrast-enhanced CT scan (Figure 2) showed both mesenteric nodules and the umbilical nodule (arrow). He was treated surgically by wedge resection of the stomach, debulking of mesenteric metastases and excision of the umbilical nodule. At histology, there were spindle cells with marked nuclear pleomorphism and increased mitotic activity that were positive for CD117 and CD34. He was diagnosed with a malignant stromal cell tumor of the stomach and is currently in remission after treatment with imatinib mesylate.
SDGs
Publisher
Blackwell Publishing
Type
journal article