An 89-year-old woman presented at an emergency outpatient service owing to bleeding from the umbilicus induced by abrasion. She had an umbilical hernia with a recent history of occasional bleeding. However, the bleeding stopped spontaneously, and no specific treatment was administered. The patient had an oval-shaped protruding umbilicus (major axis=45 mm; minor axis=25 mm) with a purple lesion caused by abrasion and palpable plate-like nodules in the subcutaneous area (Picture 1). The bleeding stopped with pressure, but computed tomography confirmed end-stage pancreatic carcinoma with multiple hepatic metastases, peritoneal metastasis, and multiple seedings in the hernia (Pictures 2-4). The diagnosis was Sister Mary Joseph's nodule (SMJN) associated with pancreatic cancer. SMJN is an umbilical metastasis of internal malignancies, such as cancer of the stomach (23%), ovary (17%), colon and rectum (15%), pancreas (9%), and uterus (6%) (1,2). The patient chose to remain at home and ultimately died within six months of the cancer presentation.
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The authors state that they have no Conflict of Interest (COI).
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