Sister Mary Joseph nodule

In medicine, the Sister Mary Joseph nodule or more commonly node, also called Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen.[1] Sister Mary Joseph nodules can be painful to palpation.[2]

A periumbilical mass is not always a Sister Mary Joseph nodule. Other conditions that can cause a palpable periumbilical mass include umbilical hernia, infection, and endometriosis. Medical imaging, such as abdominal ultrasound, may be used to distinguish a Sister Mary Joseph nodule from another kind of mass.[2]

Gastrointestinal malignancies account for about half of underlying sources (most commonly gastric cancer, colonic cancer or pancreatic cancer, mostly of the tail and body of the pancreas[3]), and men are even more likely to have an underlying cancer of the gastrointestinal tract. Gynecological cancers account for about 1 in 4 cases (primarily ovarian cancer and also uterine cancer). Nodules will also, rarely, originate from appendix cancer spillage and pseudomyxoma peritonei. Unknown primary tumors and rarely, urinary or respiratory tract malignancies can cause umbilical metastases.[4] How exactly the metastases reach the umbilicus remains largely unknown.[5] Proposed mechanisms for the spread of cancer cells to the umbilicus include direct transperitoneal spread, via the lymphatics which run alongside the obliterated umbilical vein, hematogenous spread, or via remnant structures such as the falciform ligament, median umbilical ligament, or a remnant of the vitelline duct.[6] Sister Mary Joseph nodule is associated with multiple peritoneal metastases and a poor prognosis.[7][6]

History

Sister Mary Joseph Dempsey (born Julia Dempsey) was a Catholic nun and surgical assistant of William J. Mayo at St. Mary's Hospital in Rochester, Minnesota from 1890 to 1915.[8][9] She drew Mayo's attention to the phenomenon, and he published an article about it in 1928. The eponymous term Sister Mary Joseph nodule was coined in 1949 by Hamilton Bailey.[10][2]

References
  1. Smyth, Elizabeth; Cunningham, David (2014). "Pancreatic cancer". Harrison's Principles of Internal Medicine (19th ed.). McGraw-Hill Education.
  2. Debardeleben, J.; Cohen, M.; Rodgers, S. K. (2017). "Peritoneal Carcinomatosis Presenting as a Sister Mary Joseph Nodule". Ultrasound Quarterly. 33 (4): 300–302. doi:10.1097/RUQ.0000000000000314. PMID 29112635. S2CID 38675142.
  3. Yendluri V, Centeno B, Springett G. Pancreatic cancer presenting as a Sister Mary Joseph's nodule: case report and update of the literature. Pancreas. 2007;34(1):161-4. PMID 17198200
  4. Galvañ VG. Sister Mary Joseph's nodule. Ann Intern Med. 1998; 128(5):410. PMID 9490607 Free full text
  5. Omura, T (April 2019). "Pancreatic cancer manifesting as Sister Mary Joseph nodule during follow up of a patient with type 2 diabetes mellitus: A case report". Geriatrics & Gerontology International. 19 (4): 363–64. doi:10.1111/ggi.13602. PMID 30932308. S2CID 89620536.
  6. Cohen, DC. A Man With an Umbilical Ulcer. Medscape J Med. 2008;10(1):11.
  7. Harrison's Principles of Internal Medicine, 16th ed. page 241
  8. Dorland, William Alexander Newman (2011). Dorland's Illustrated Medical Dictionary (32 ed.). Elsevier Health Sciences. p. 1722. ISBN 9781416062578.
  9. Anderson, Bryan E. (29 March 2012). The Netter Collection of Medical Illustrations. Elsevier Health Sciences. p. 58. ISBN 9781455726646.
  10. H. Bailey: Demonstration of physical signs in clinical surgery. 11th edition, Baltimore, Williams & Wilkins, 1949, p 227.
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