Sister Mary Joseph nodule: a diagnostic challenge

Area of Science:

• Oncology
• Dermatology
• Gynecologic Oncology

Background:

• Sister Mary Joseph nodule (SMJN) is a rare clinical sign involving umbilical metastasis.
• SMJNs are often associated with intra-abdominal malignancies, frequently indicating advanced disease and poor prognosis.
• Endometrial cancer is a common gynecologic malignancy, but omphalic metastasis is an uncommon presentation.

Observation:

• A 72-year-old woman presented with an exceptionally large Sister Mary Joseph nodule.
• The nodule's size was unprecedented in published literature.
• Initial presentation suggested advanced malignancy due to the lesion's size and location.

Findings:

• Histological examination confirmed the umbilical nodule was a metastasis from underlying endometrial cancer.
• The patient underwent wide local excision of the Sister Mary Joseph nodule.
• Following excision, the patient underwent a total hysterectomy and bilateral salpingo-oophorectomy.

Implications:

• This case demonstrates that even extensive Sister Mary Joseph nodules can be managed effectively with surgical intervention.
• Successful treatment and recovery suggest that SMJN, while a poor prognostic sign, does not preclude favorable outcomes in select cases.
• This case expands the understanding of SMJN presentation in endometrial cancer and emphasizes the importance of thorough investigation and tailored treatment approaches.