A 44-year-old man presented with a painless umbilical nodule 2 cm in diameter (Figure). The nodule had first come to his attention 2 months previously and had been getting progressively larger. The patient reported that he had been suffering from primarily biliary cholangitis for 2 years. Histopathological examination of a biopsy sample showed adenocarcinoma. Subsequent investigations identified the presence of metastasized cholangiocellular carcinoma. Despite swift commencement of chemotherapy, the patient died of his disease. Sister Mary Joseph Dempsey (1856–1939), a nun working as a nurse, repeatedly observed the rare phenomenon of umbilical metastasis and reported it to her departmental head physician W.J. Mayo, one of the founders of the Mayo Clinics. He then published a description of the association in 1928. In most cases the umbilical cutaneous metastasis termed Sister Mary Joseph nodule arises from a gastrointestinal tumor, less frequently from a genitourethral tumor. The metastasization usually occurs via an interface of the deep and superficial lymph drainage pathways with the skin of the umbilicus.
Figure.
Translated from the original German by David Roseveare.
Cite this as: Placke JM, Gratsias E, Dissemond J: Sister Mary Joseph nodule.
Footnotes
Conflict of interest statement:
The authors declare that no conflict of interest exists.