North American Journal of Medical Sciences

: 2013  |  Volume : 5  |  Issue : 3  |  Page : 252-

Sister Mary Joseph's nodule: What lies beneath?

Saeed Ahmed, Saira Rashid, Pongsathorn Kue-A-Pai, Wisit Cheungpasitporn 
 Department of Medicine, Bassett Medical Center, Cooperstown, New York 13326, USA

Correspondence Address:
Wisit Cheungpasitporn
Department of Medicine, Bassett Medical Center, Cooperstown, New York 13326

How to cite this article:
Ahmed S, Rashid S, Kue-A-Pai P, Cheungpasitporn W. Sister Mary Joseph's nodule: What lies beneath?.North Am J Med Sci 2013;5:252-252

How to cite this URL:
Ahmed S, Rashid S, Kue-A-Pai P, Cheungpasitporn W. Sister Mary Joseph's nodule: What lies beneath?. North Am J Med Sci [serial online] 2013 [cited 2021 Jun 18 ];5:252-252
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Dear Editor,

We recently had a 79-year-old male with no significant medical history who was referred to our hospital for a pulmonary embolism. During examination a 5 cm × 5 cm fungating mass was discovered on his belly [Figure 1]. Patient reported that the mass has been present for months and gradually increasing in size. A computed tomography scan of chest, abdomen and pelvis revealed no other abnormality. The biopsy of mass revealed moderately differentiated adenocarcinoma with stain consistent with tumor of lower gastrointestinal tract. A colonoscopy confirmed adenocarcinoma of transverse colon.{Figure 1}

This rare manifestation of metastatic disease was recognized by a surgical assistant of Dr. William Mayo, Sister Mary Joseph, whose name has since been used to explain these umbilical nodules. [1] These metastatic lesions are mostly from gastrointestinal (52%) and gynecological neoplasms (28%), most commonly from the stomach (23%), colon (15%), pancreas (10%), and ovary (16%), and less frequently from the uterus, cervix, gallbladder, and small intestine. [2] Metastatic lesions can reach the umbilicus via spread through lymphatic ducts, the venous network, arterial spread, contiguous extension, or even through iatrogenic seeding with laparoscopy. These different pathways may help explain why there is such a wide group of malignant tumors that can produce these nodules. [3] The presence of these lesions is often a poor prognostic factor, as these patients have advanced metastatic disease at the time of initial diagnosis. In several studies, the average survival after the appearance of these nodules was approximately 10-11 months. [4] Sister Mary Joseph nodule is a rare first manifestation of colon cancer. Physicians should be aware of this unusual presentation of colon cancer.


1Key JD, Shephard DA, Walters W. Sister Mary Joseph's nodule and its relationship to diagnosis of carcinoma of the umbilicus. Minn Med 1976;59:561-6.
2Galvañ VG. Sister Mary Joseph's nodule. Ann Intern Med 1998;128:410.
3Zeligman I, Schwilm A. Umbilical metastasis from carcinoma of the colon. Arch Dermatol 1974;110:911-2.
4Dubreuil A, Dompmartin A, Barjot P, Louvet S, Leroy D. Umbilical metastasis or Sister Mary Joseph's nodule. Int J Dermatol 1998;37:7-13.