Work

The umbilical clue: recognizing Sister Mary Joseph’s nodule

Year: 2025

Type: article

Abstract: Background: Sister Mary Joseph's nodule (SMJN) is a rare manifestation of intra-abdominal malignancy presenting as a metastatic umbilical lesion. Case report: An 82-year-old woman with no prior medical history presented with a violaceous, ulcerated umbilical lesion. Imaging revealed peritoneal carcinomatosis, pelvic lymphadenopathy, and suspicious endometrial mass. Biopsies of both the cutaneous and endometrial lesions identified a serous endometrial adenocarcinoma with umbilical metastasis, confirmed by immunohistochemical markers (CK7+, PAX8+, CK20-, CDX2-). Given the extent of lymphatic and peritoneal spread, the patient was referred to palliative care. Conclusion: SMJN accounts for approximately 10% of cutaneous metastases and often signifies advanced disease with a poor prognosis. Although rare, it may be the first visible sign of a hidden malignancy. This case highlights the importance of considering SMJN in differential diagnoses of umbilical lesions and underscores the need for prompt investigation to determine the underlying pathology. Early recognition can aid in appropriate management, although treatment is typically palliative due to the advanced stage at diagnosis. LEARNING POINTS: Heightened awareness of umbilical lesions among clinicians is essential, particularly in elderly patients presenting with nonspecific systemic symptoms such as weight loss, asthenia, or abdominal pain.Early diagnosis of SMJN is essential, as it frequently signifies advanced metastatic disease. Prompt recognition allows timely initiation of appropriate therapy or palliative care to optimize patient outcomes.

Source: European Journal of Case Reports in Internal Medicine

DOI: 10.12890/2025_006004

Authors: João Lança Pereira, Elisa Veigas, Catarina Rodrigues da Silva, Nídia Oliveira, Vitor Oliveira, Eurico Oliveira

Institution: Unidade Local de Saúde de Viseu Dão-Lafões

Language: English

Topic: Metastasis and carcinoma case studies

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $323