Metastatic carcinoma of umbilicus: "Sister Mary Joseph's nodule"

A 72-year-old woman presented with a progressively enlarging, painful umbilical nodule. A biopsy specimen of the lesion showed focally mucin-producing adenocarcinoma, and the patient was diagnosed to have metastatic carcinoma of umbilicus: Sister Mary Joseph's nodule. Search for the primary tumor revealed adenocarcinoma of the splenic flexure of colon with metastasis to liver, spleen, and periaortic lymph nodes. Sister Mary Joseph's nodule is a well-known entity. It is a rare form of cutaneous umbilical metastases, can present as the first sign of intra-abdominal malignancy, carries very poor prognosis, and generally is inoperable. This report emphasizes the need for careful evaluation of any umbilical lesion and the importance of histologic diagnosis in case of doubt.