Findings: Axial CT images demonstrate a polypoid soft tissue mass projecting into the cecum. There is as well, a high attenuation focus involving the superficial skin in the right umbilical region.
Diagnosis: Cecal carcinoma with Sister Mary Joseph's nodule.
Discussion: Sister Mary Joseph's nodule is a collective term for any metastatic deposit at the umbilicus originating from a primary malignancy which is frequently intra-abdominal. Appearance of this lesion usually heralds advanced disease and portends a poor prognosis.
Histopathologic results depend upon the site of primary origin of malignancy, but in most cases the lesion is adenocarcinoma. When the primary site could be detected, the stomach was found to be the most common site of origin (20-30%), followed by ovary (10-12%), large bowel (10-14%) and pancreas (7-11%). In nearly 20 to 30% of cases, the primary cannot be found.
The prognostic relevance of the umbilical lesion is attributed to Sister Mary Joseph Dempsey who herself became the first surgical assistant to William Mayo (of the Mayo Clinic). During this period, while preparing patients with gastric cancer for surgical resection, Sister Joseph noted the presence of a firm mass at the umbilicus in individuals who invariably had a poor outcome and succumbed relatively early post-operatively. Sister Joseph drew these observations to the attention of Dr. Mayo and subsequently had the sign named for her.
References:
Khan AJ. Cook B. Metastatic Carcinoma of Umbilicus:
"Sister Mary Joseph's nodule". Cutis. 60(6):297-298, 1997
Benson JR, Singh S, Thomas JM. Sister Joseph's Nodule:
A Case Report and Review. Eur J Surg Oncol 1997; 23(5):451-454.
Harrison TR. Harrison's Principles of Internal Medicine, 13th Edition.
McGraw-Hill, New York; 1994:1384.
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