Sister Mary Joseph's nodule: Three case reports
© Larentzakis et al; licensee BioMed Central Ltd. 2008
Received: 31 May 2008
Accepted: 24 September 2008
Published: 24 September 2008
An umbilical metastatic lesion is called 'Sister Mary Joseph's nodule'. It is an uncommon clinical or radiographic finding, and it is rare as the first sign of a malignant disease.
We report three cases of Sister Mary Joseph's nodule. In the three cases presented, the primary tumor was an adenocarcinona of the sigmoid colon, a carcinoma of the bladder, and an adenocarcinoma of the gallbladder, respectively.
The differential diagnosis of an umbilical lesion should always include metastatic disease apart from benign lesions and primary neoplasms.
An umbilical lesion can be either benign or malignant. A malignant umbilical mass can represent a primary or metastatic lesion. The term 'Sister Mary Joseph's nodule' was first used by Sir Hamilton Bailey, in 1949 , in order to describe the entity of metastatic umbilical lesions. We present three cases of Sister Mary Joseph's nodule.
The occurrence of Sister Mary Joseph's nodule is uncommon, and as first sign of malignancy is rare . The intestinal and genitourinary tracts represent the most common, but not the only ones, primary malignant sites . However, the study of an umbilical mass as unique clinical finding should be directed by the suspicion of being a metastatic deposit , having also in mind the potential of a primary malignant umbilical lesion or a benign disease . In addition, an umbilical mass in a patient with known malignancy, especially of the abdomen, should be evaluated as potential spreading of the primary disease, a fact that can influence the therapeutic decision making [4, 6]. Finally, the approach of surgery should be under careful consideration in these cases, because Sister Mary Joseph's nodule represents the spreading of a neoplasm, which is accompanied by low survival rates .
An umbilical mass can represent a benign lesion, such as a cyst or an abscess, but also a primary or metastatic malignant tumor. Although not common, the last two entities should be considered in the evaluation and management of the umbilical masses.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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