[Umbilical metastasis: Sister Mary Joseph's nodule]

Sister Mary Joseph (1856-1939), who was superintendent nurse at St. Mary's Hospital in Rochester, Minnesota, U.S.A. (at present Mayo Clinic), observed that patients with intra-abdominal or pelvic malignancy often had an umbilical nodule. In 1949 the English surgeon Hamilton Bailey, in his famous textbook "Demonstrations of Physical Signs in Clinical Surgery", coined the term "Sister Joseph's nodule" for umbilical metastases. To date, more than 400 cases of Sister Mary Joseph's nodule have been described in the literature. The nodule may be painful and ulcerated, sometimes with pus, blood, or serous fluid. It is usually a firm nodule measuring 0.5-2 cm, although some nodules may reach up to 10 cm in size. Tumor may spread to the umbilicus through lymph ducts, blood vessels, contiguous extension, and embryologic remnants. Sister Mary Joseph's nodule can be the first manifestation of an underlying malignancy or an indication of a recurrence in a patient with a previous malignancy. The most common origin of Sister Mary Joseph's nodule in women is ovarian carcinoma and in men--gastric carcinoma. Sister Mary Joseph's nodule has traditionally been considered a sign of advanced primary malignancy with an associated poor prognosis; the average survival time has been reported to be 11 months with < 15% of the patients surviving >2 years. In some patients, however, depending on the state of the primary neoplasm and the patient's general condition, surgery and/or chemotherapy may improve survival.