Sister Mary Joseph nodule
A Sister Mary Joseph nodule is a metastatic lesion involving the umbilicus. The most common primary source is an intra-abdominal adenocarcinoma.
Epidemiology
Umbilical metastases are uncommon, reportedly present in 1-3% of all intra-abdominal and/or pelvic malignancy .
Clinical presentation
Patients may present clinically with a palpable mass in the region of the umbilicus, either in the setting of known malignancy or potentially, as a first presentation. The mass may variably be painful, ulcerating, discharging - or asymptomatic.
Alternatively, the diagnosis may be made initially on imaging.
Pathology
The most common primary sites of Sister Mary Joseph nodules include the stomach, ovary, colon and pancreas , although many others are described in the literature, including lymphoma , RCC and prostate .
Multiple modes of spread may be implicated in the development of an umbilical metastasis from an anatomical perspective. After all, the periumbilical area not only has a rich anastomotic, vascular, and lymphatic supply but is also a point of convergence for multiple peritoneal folds (ligamentum teres, medial umbilical ligaments, median umbilical ligament). Direct peritoneal spread is most commonly implicated.
Radiographic features
An umbilical lesion may be assessed with ultrasound or cross-sectional imaging.
Findings may be of a solid subcutaneous or dermal nodule or focal umbilical thickening, generally in the context of widespread malignancy.
An umbilical nodule is amenable to ultrasound guided fine needle aspirate biopsy.
Historical and etymology
Sister Mary Joseph Dempsey (1856-1939) was the surgical assistant to William Mayo in the early days of the Mayo Clinic . She pointed out to him the frequent finding of a nodule in the umbilicus of patients with advanced malignancy, and he subsequently published a paper on the topic.
It is said to be the only sign in clinical medicine named after a nurse .
Differential diagnosis
For a lesion involving the umbilicus consider:
- paraumbilical hernia
- surgical scar (e.g. laparoscopy)
- endometriosis
- granuloma
- primary umbilical tumor
- omphalith
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