Sister Mary Joseph nodule
In medicine, the Sister Mary Joseph nodule or more commonly node, also called Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen.
Gastrointestinal malignancies account for about half of underlying sources (most commonly gastric cancer, colonic cancer or pancreatic cancer, mostly of the tail and body of the pancreas), and men are even more likely to have an underlying cancer of the gastrointestinal tract. Gynecological cancers account for about 1 in 4 cases (primarily ovarian cancer and also uterine cancer). Nodules will also, rarely, originate from appendix cancer Pseudomyxoma peritonei. Unknown primary tumors and rarely, urinary or respiratory tract malignancies cause umbilical metastases. How exactly the metastases reach the umbilicus remains largely unknown. Proposed mechanisms for the spread of cancer cells to the umbilicus include direct transperitoneal spread, via the lymphatics which run alongside the obliterated umbilical vein, hematogenous spread, or via remnant structures such as the falciform ligament, median umbilical ligament, or a remnant of the vitelline duct. Sister Mary Joseph nodule is associated with multiple peritoneal metastases and a poor prognosis.
Sister Mary Joseph Dempsey (born Julia Dempsey ; 1856-1939) was the surgical assistant of William J. Mayo at St. Mary's Hospital in Rochester, Minnesota from 1890 to 1915. She drew Mayo's attention to the phenomenon, and he published an article about it in 1928. The eponymous term Sister Mary Joseph nodule was coined in 1949 by Hamilton Bailey.
- Yendluri V, Centeno B, Springett G. Pancreatic cancer presenting as a Sister Mary Joseph's nodule: case report and update of the literature. Pancreas. 2007;34(1):161-4. PMID 17198200
- Galvañ VG. Sister Mary Joseph's nodule. Ann Intern Med. 1998 ;128(5):410. PMID 9490607 Free full text
- Cohen, DC. A Man With an Umbilical Ulcer. Medscape J Med. 2008;10(1):11.
- Harrison's Principles of Internal Medicine, 16th ed. page 241
- doctor/2984 at Who Named It?
- H. Bailey: Demonstration of physical signs in clinical surgery. 11th edition, Baltimore, Williams & Wilkins, 1949, p 227.