Sister Mary Joseph's Nodule Research Articles

Sister Mary Joseph Nodule, Umbilical Sentinel for an Endometrioid Endometrial Carcinoma in Postmenopause-Challenges for a Multidisciplinary Approach

A 82 years old, hypertensive, obese, 1 delivery, menopause at 47 yrs, non-smoker, with history of vaginal bleeding in January 2018, is sent by the dermatologist for an irregular umbilical tumor of 2/1 cm, recurrent at 6 weeks post-ablation, microscopically considered as a carcinomatous metastasis. Abdomino-pelvic MRI rises the suspicion of uterine carcinoma, which is confirmed by endometrial biopsy. It is done extrafascial total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph dissection and ablation, plus ablation of a skin-adipose-conjunctive peri-and subumbilical area of 5/4 cm. There were no peritoneal metastases, or other viscera abnormalities. The optic microscopy shows moderate differentiated endometrioid endometrial carcinoma, with areas of squamous differentiation, invasion in external myometrial half, without peritoneal invasion, with vessels metastatic embolism, positive pelvic lymph nodes with moderate differentiated endometrioid endometrial carcinoma and desmoplastic reaction; left ovary with mature teratoma. Umbilical specimen has malignant invasion with cribriform and tubular pattern, areas of squamous differentiation, and malignant emboli in vessels. The patient suffered radiotherapy, under oncologic monitoring. The follow up at 6,12,18 and 36 months was with no recurrence in genital, pelvis, peritoneum, abdominal wall. Sister Mary Joseph Nodule (SMJN) has an old history: first observations of assistant catholic nun Mary Joseph Dempsey (Saint Mary’s Hospital, Rochester, Minnesota, USA), William Mayo (1928) description, Hamilton Bailley (1949) characterization. Literature associates SMJN to cancers originating in gastro-intestinal, colonic tract, respiratory, urinary and genital tract: primary ovarian and endometrial cancers; Romanian case is the 36th with endometrial origin. Umbilical invasion may be due to direct vessels’ embolization by malignant endometrial cells, via lymphatics which run along the obliterated umbilical vein, or via the remnant structures of the falciform and umbilical ligaments. Patient is under oncologic monitoring on hormone therapy (Megesin®), with good prognosis up to four years of follow up, different from literature mentioned bad prognosis.

Sister Mary Joseph Nodule (SMJN) – A Review

Sister Mary Joseph Nodule is an eponymous term referring to an umbilical nodule harbouring malignant metastatic cancer. It is a physical finding that is uncommon yet significant since it indicates the late manifestation of a variety of deep-seated abdominopelvic malignancies. This review article briefly revisits the historical background, epidemiology, anatomical routes of metastasis, clinical presentation, differential diagnosis, diagnostic work-up, clinical significance and prognosis of Sister Mary Joseph’s nodule.

Case of a Sister Mary Joseph’s Nodule in Pancreatic Adenocarcinoma: a Diagnostic challenge

Background: Sister Mary Joseph Nodule (SMJN) is a rare metastatic umbilical nodule with primary tumor genital or gastrointestinal sites. Pancreas is rare primary location for umbilical metastases. Pancreatic adenocarcinoma associated with SMJN usually arise from the body and tail of the pancreas. We report a case of SMJ nodule’s as a cutaneous manifestation of metastatic pancreatic head cancer. Case Report: A 59-year-old man, presented with epigastric, back pain and weight loss. On examination, an umbilical nodule was noted. Investigations confirmed a nodule of sister Mary Joseph as a pancreatic head cancer metastasis. Discussion and Conclusion: SMJN nodule remains as a rare tumor with metastatic origin of cancer most commonly digestive. Due the poor prognosis, early detection and systematic biopsy of any nodule or umbilical mass is indispensable.

Sister Mary Joseph Nodule and Concomitant Pancreatitis as Initial Presentation of Pancreatic Adenocarcinoma – Case Report and Review of the Literature

Umbilical metastasis [Sister Mary Joseph Nodule (SMJN)] is a rare presentation of visceral abdominal/pelvic malignancy. It is less commonly seen in metastatic pancreatic adenocarcinoma and there are only over a hundred cases to date in the literature on this topic. This article highlights a case of metastatic pancreatic adenocarcinoma presenting as SMJN and concomitant pancreatitis (which to the best of our knowledge is the first such report to date) with discussions regarding the etiopathogenesis of this phenomenon and presents a brief literature review on pancreatic adenocarcinoma presenting as SMJN.

An Ominous Sign: Mucinous Ovarian Carcinoma with Sister Mary Joseph Nodule

Despite two centuries of progress in its surgical and oncological management, ovarian cancer remains the most lethal of the gynaecological cancers, claiming the lives of nearly 185,000 women globally each year. Historically considered a single disease, there is growing recognition that ovarian cancer is in fact a spectrum of malignancies with distinct cellular origins, molecular driver pathways and clinicopathological features. Mucinous ovarian carcinoma (mOC) is a rare histological subtype that presents a particular challenge in accurate diagnosis and management. Frequently confused with metastatic deposits from extra-ovarian mucinous tumours, the true incidence of primary mOC is estimated to be between 3-5%. Typically affecting younger women, prognosis for late-stage disease is abysmal with a median survival of <15 months. This case report describes a 38-year-old patient who presented with rapidly worsening abdominal distension. Subsequent debulking surgery removed a mass weighing 2.4kg, confirmed by histopathology as a high grade mucinous ovarian carcinoma with a mural nodule of anaplastic carcinoma. Evidence behind the current guidelines for management will be discussed, addressing our recent understanding of mOC as a separate disease from other histotypes and the consequent challenges in interpreting data from large multicentre trials in which patients with mOC are poorly represented. Moreover, using the Sister Mary Joseph nodule (SMJN) as an example, this case also highlights the importance of the physical examination and the value of subtle (and sometimes missed) clinical signs that provide important clues about the extent of a patient’s underlying disease and prognosis.

Sister Mary Joseph Nodule in a Patient With Advanced Prostate Cancer.

Prostate cancer is the second most common cause of cancer death among US men. Metastasis typically occurs in the bone, lymph nodes, liver, and thorax. This case highlights a patient who was suspected of having prostate cancer several years before presenting to the emergency department with back pain and an umbilical hernia of increasing size. Gross examination revealed fixed masses on the abdominal wall that appeared malignant on computed tomographic imaging. The umbilical mass was a Sister Mary Joseph nodule (SMJN), which is sometimes found in patients with advanced, metastatic abdominal cancer. An SMJN is most commonly suggestive of gastrointestinal or gynecologic cancer, but it is a rarely reported finding in the context of prostate cancer. SMJN is a frequently missed finding that may delay further investigation for malignant neoplasms. This case reinforces the importance of this physical examination finding and provides evidence for adding prostate cancer to the list of possible diagnoses for patients who have an SMJN.

Pancreatic tumor metastasis to the navel in a case with three primary tumors – case report and review of the literature

Introduction. Sister Mary Joseph nodule (SMJN) is a metastasis that can occur in the umbilical region due to many tumors in the abdomen. Most of the cases are of gastrointestinal system origin and are often an indicator of poor prognosis. It can be seen in 1-3% of intraabdominal and pelvic malignancies. In the literature, around 300 studies are presented, mostly in the form of case reports. Very few (7-9%) of the cases with SMJN are from pancreatic origin. In our literature review, we found that in the majority (>90%) of SMJN cases due to pancreatic tumors, the lesions originated from the pancreatic tail and/or body, and tumor marker Ca-19.9 was very high in most cases (>90%). Aim. Here, the case of SMJN seen in a patient with three different primary tumors was discussed in the light of the literature data. Description of the case. Here, our case, whose third primary malignancy was detected in the pancreas in the PET/CT examination performed to investigate the origin of SMJN in a 68-year-old female patient who had undergone surgery due to breast in 2011 and endometrium cancers in 2018 and came with umbilical metastasis, is presented in the light of the literature data. Conclusion. As a result, in our case, which was followed up due to two primary tumors, it became important to know the origin of the SMJN that occurred due to the third primary tumor detected during the CT and PET/CT examination due to the newly emerging SMJN. It is important to know the origin and histopathological features of the SMJN in order to determine the treatment to the patient.

Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imagıng in Pseudo Sister Mary Joseph's Nodule.

Sister Mary Joseph's nodule (SMJN) refers to umbilical metastatic lesions and indicates widespread intra-abdominal malignancy. The most common primary sites are gastrointestinal and genital tract. Benign umbilical nodules are called pseudo-SMJN (PSMJN) and have been also reported in nonmalignant lesions such as endometriosis, fibroma, papillomas, myxoma, keloid, omphalith, nevi, foreign-body granulomas, and epidermoid cysts. We report a case with PSMJN as an extremely rare manifestation of intra-abdominal tuberculosis.

An unusual presentation revealing pancreatic carcinoma: Sister Mary Joseph Nodule

Sister Mary Joseph Nodule (SMJN) is a cutaneous nodule resulting from metastasis of malignant tumors affecting the umbilicus; it had been reported in 0.7e10.4% of patients.

Importance of time-saving fine-needle aspiration cytology procedure in the diagnosis of sister Mary Joseph's nodule in the era of advanced technology

The umbilicus is an uncommon site of cutaneous metastasis called as Sister Mary Joseph's nodule (SMJN), which is associated with grave prognosis. The most common primaries are the colon and stomach in males and ovaries and endometrium in females. We present a case of an elderly male with indurated umbilical swelling, unguided fine-needle aspiration cytology (FNAC) of which revealed umbilical metastasis (SMJN). On subsequent extensive work-up, this case was diagnosed as primary gastric adenocarcinoma on relevant gastric biopsy. This highlights the cost-effectiveness, time-saving diagnosis with the usage of FNAC procedure in such umbilical nodule cases, which are later confirmed on histopathology.

Sister Mary Joseph Nodule in an Ovary Adenocarcinoma

Introduction:Sister Mary Joseph Nodule (SMJN) is a metastatic umbilical lesion secondary to a primary malignancy of any viscera, stomach and colon being most common in men, and ovary in women.Case report:In this article, we present the case of SMJN in a 54-year old female patient. An urgent diagnostic workup was performed with a computerized tomography of abdominal cavity and pelvis showing an expansive tumorous formation covering uterus with a carcinomatosis of peritoneum. After biopsy, immunohistochemical profile suggested adenocarcinoma of the ovarian origin. The patient was then referred to the Oncology Consilier of Gynecology Department and further continued followed by the Oncology team.

Dermoscopic characterization and image study of a Sister Mary Joseph nodule in a patient with esophageal cancer

Abstract A Sister Mary Joseph nodule (SMJN) is rare cutaneous metastasis spreading to the umbilicus. It originates mostly from an intra-abdominal or pelvic malignancy and is an ominous sign. In this paper, we report a case of a SMJN in a 64-year-old man with esophageal cancer. We recorded his clinical progression, radiologic and nuclear scintigraphic images, and histopathologic and dermoscopic findings. The image study provided information on the localization of the SMJN and dermoscopy showed a polymorphous vascular pattern. The patient received palliative therapy because of terminal disease.

Sister Mary Joseph Nodule as a First Manifestation of a Metastatic Ovarian Cancer.

A 76-year-old female presented to our hospital with a 2 cm firm, nontender, protuberant umbilical nodule. She received treatment with antibiotics for suspected granuloma, with no improvement after two months. High levels of CA125 as well as an ovarian cyst and intrathoracic and intra-abdominal lesions on imaging studies made us suspect an ovarian cancer with a Sister Mary Joseph nodule (SMJN) and other metastases. A bilateral salpingo-oophorectomy and umbilical and omentum tumor resections were performed and a metastatic ovarian serous adenocarcinoma was diagnosed by histopathology. After surgery, the patient received chemotherapy with paclitaxel, carboplatin, and bevacizumab; however paclitaxel allergy was observed. As a result, chemotherapy continued with carboplatin and bevacizumab every three weeks for a total of 6 courses. Currently, she is still undergoing treatment with bevacizumab and CA125 levels have been progressively decreasing. SMJN is a rare umbilical metastasis which needs to be considered as a differential diagnosis in the presence of an umbilical tumor for prompt treatment initiation.

Umbilical metastasis derived from early stage rectal cancer: a case report

BackgroundUmbilical metastasis, also called Sister Mary Joseph’s nodule (SMJN), is defined as the umbilical nodule associated with advanced metastatic intra-abdominal and pelvic malignancies. A patient with umbilical metastasis has been deemed to have a poor prognosis. Rectal cancer presenting with a SMJN is a rare phenomenon, especially in the early stage and in middle-low rectal cancer.Case presentationWe report a case of a 70-year-old male presenting with umbilical metastasis derived from rectal cancer (10 cm from the anal verge, T2N0).Discussion and conclusionFor rectal cancer with umbilical metastasis, the exact metastatic routes as well as the criterion of diagnosis and treatments are not very clear. Here we review the literature on rectal cancer and SMJN to deepen the understanding of this disease.

Sister mary joseph nodule as a clinical sign in a case of advanced gastric carcinoma

Sister Mary joseph nodule as a cutaneous marker of gastrointestinal and pelvic malignancies almost alw ays implies advanced stage of malignancy with poor survival rat es and palliative care as the only treatment modali ty in majority of cases.

Sister Mary Joseph nodule

1A 64-year-old female presented with a three-month history of decreased appetite, nausea and progressive abdominal distension. Physical examination revealed a distended abdomen with a fluid wave and a hard perium bilical bluish swelling (Fig. A). Because intra-abdominal malignancy was suspected, a contrastenhanced computed tomography of the abdomen was performed which showed a pelvic mass originating from the left ovary, omental and peritoneal metastases, ascites, and a lobulated mass through the umbilicus with infiltration of the surrounding subcutaneous fat (Fig. B, C). Diagnostic laparoscopy and histopathological analysis of the obtained ovarian samples confirmed the diagnosis of metastatic ovarian carcinoma. A Sister Mary Joseph nodule (SMJN) is a metastatic umbilical lesion originating from intra-abdominal or pelvic malignant disease. It can be a sign of undiagnosed malignancy or a symptom or sign of disease progression or recurrence in a patient with known disease. Its incidence is low,

Sister Mary Joseph nodule associated with pancreatic adenocarcinoma

A 64-year-old man presented with a 1-month history of painless nodule on the umbilicus (Fig. 1A). He had no history of abdominal pain, poor appetite, bowel habit change, or body weight loss. The skin biopsy of the umbilical nodule revealed dermal infiltration of tubuloglandular neoplastic cells, which were stained strongly positive for cytokeratin 7 and weakly positive for cytokeratin 20. All laboratory test results were within normal ranges, except a remarkable elevation in the tumor marker CA19-9 level of 12000 U/mL (normal: 37 U/mL). The abdominal computed tomography confirmed a 3.8 cm mass at the pancreatic tail (Fig. 1B, arrow), with pancreatic duct dilatation, multiple foci of liver metastasis, and peritoneal carcinomatosis. Gastrointestinal endoscopy, chest X-ray, and whole-body bone scan showed negative results for tumor surveillance. Under the diagnosis of pancreatic adenocarcinoma with multiple metastases, the patient was transferred to the oncology department for chemotherapy. Cutaneous metastases from an internal malignancy have been reported in 0.7e10.4% of patients. Sister Mary Joseph nodule (SMJN) is a cutaneous nodule resulting from metastasis of malignant tumors affecting the umbilicus. SMJN is commonly associated with a primary adenocarcinoma of the gastrointestinal or genitourinary tract. Umbilical involvement in an internal malignancy may result from lymphatic or hematogenous spread, direct invasion into the

Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery

Sister Mary Joseph's nodule (SMJN) is a rare umbilical nodule that develops secondary to metastatic cancer. Primary malignancies are located in the abdomen or pelvis. Patients with SMJN have a poor prognosis. An 83-year-old woman presented to our hospital with a 1-month history of a rapidly enlarging umbilical mass. Endoscopic findings revealed advanced transverse colon cancer. computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon, umbilicus, right inguinal lymph nodes, and left lung. The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels. Imaging findings of the left lung tumor allowed for identification of the primary lung cancer, and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made. The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection. Intra-abdominal dissemination to the mesocolon was confirmed during surgery. Histopathologically, the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma. We suspect that SMJN may occur via a hematogenous pathway. Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled, the patient and her family desired home hospice. Seven months after surgery, she died of rapidly growing lung cancer.

Sister Mary Joseph’s Nodule as the First Sign of Pancreatic Carcinoma

IntroductionMetastasis to the umbilicus from intra-abdominal malignantsolid tumors is not common, occurring mostly in patientswith advanced gastrointestinal and gynecologic carcinomasalthough it may sometimes be the first presentation of anoccult, underlying adenocarcinoma [1–4]. This condition isalso known as Sister Mary Joseph's nodule or sign, namedafter Sister Mary Joseph (1856–1939), the superintendentnurse and surgical assistant of Dr. William Mayo at St.Mary's Hospital in Rochester, Minnesota, USA, who no-ticed the association between umbilical nodules observedduring skin preparation for surgery and advanced intra-abdominal cancer found at surgery [5, 6]. Her name wasaccredited to this clinical feature in 1949 by Sir HamiltonBailey in his book “Physical Signs in Clinical Surgery”.Pancreatic carcinoma usually metastasizes to regionallymph nodes, liver, and peritoneum. However, 10 % ofumbilical metastases originate from a pancreatic carcinoma[7, 8] and sometimes they are the first sign of the disease [9,10]. In this report, we present a patient who had a previouslymesh-repaired umbilical hernia and presented with a SisterMary Joseph's nodule associated with an advanced, meta-static adenocarcinoma of the pancreas before diagnosing theprimary tumor.Case ReportA 64-year-old woman was admitted because of painlessobstructive jaundice of 3-days duration when she noticedyellow-colored scleras and dark-colored urine. Threemonths before presentation she noticed a gradually enlarg-ing, progressively painful and inflamed skin nodule in theumbilicus. She also reported loss of appetite and a 10-kgweight loss over this time period. She had no history of liverdisease and she denied having fever, gastrointestinal com-plaints, or any systemic symptoms. Her past medical historyincluded an umbilical hernia repair by using a prostheticmesh 3 years before.On physical examination the scleras and the skinappeared yellow. An abdominal scar of a midline surgicalincision was present above and below the umbilicus. Awell-circumscribed reddish mass measuring approximately 2 cmin diameter, with a slightly ulcerated surface, hard, andpainful on palpation, and fixed to the underlying tissueswas noted in the umbilicus (Fig. 1). Abdominal examinationrevealed mild tenderness localized in the right upper abdom-inal quadrant and the epigastrium, but no mass was palpa-ble. There were no enlarged cervical, axillary, or inguinallymph nodes.

Sister Mary Joseph's Nodule

Sister Mary Joseph's nodule (SMJN) represents an unusual clinical feature of metastatic deposit at the umbilicus originating from an intra-abdominal malignancy. To outline the paucity of such a condition, review the associated pathologies, and demonstrate the importance of clinical and histopathologic correlation. Case report of a 75-year-old man with vesical and prostatic cancers treated 2 years prior to presenting with an umbilical lesion. Histopathologic and radiologic examinations were performed to confirm the clinical diagnosis. Histopathology of the umbilical biopsy revealed a carcinoma of urothelial origin, but immunohistochemistry suggested a squamous cell carcinoma. Clinically, the lesion did not support a diagnosis of primary squamous cell carcinoma; in addition, the positron emission tomographic scan revealed a captation at the ureterovesical junction that was compatible with vesical cancer relapse. SMJN is a rare but typical cutaneous metastasis of internal malignancy, and its recognition is of great importance because it may be the first presenting sign in a patient with an unknown malignant disease.