Sister Mary Joseph Nodule
A 44-year-old man presented with a painless umbilical nodule 2 cm in diameter (Figure). The nodule had first come to his attention 2 months previously and had been getting progressively larger. The patient reported that he had been suffering from primarily biliary cholangitis for 2 years. Histopathological examination of a biopsy sample showed adenocarcinoma. Subsequent investigations identified the presence of metastasized cholangiocellular carcinoma. Despite swift commencement of chemotherapy, the patient died of his disease. Sister Mary Joseph Dempsey (1856–1939), a nun working as a nurse, repeatedly observed the rare phenomenon of umbilical metastasis and reported it to her departmental head physician W.J. Mayo, one of the founders of the Mayo Clinics. He then published a description of the association in 1928. In most cases the umbilical cutaneous metastasis termed Sister Mary Joseph nodule arises from a gastrointestinal tumor, less frequently from a genitourethral tumor. The metastasization usually occurs via an interface of the deep and superficial lymph drainage pathways with the skin of the umbilicus.
Dr. med. Jan-Malte Placke, Emmanouil Gratsias, Prof. Dr. med. Joachim Dissemond, Klinik für Dermatologie, Universitätsklinikum Essen, Jan-Malte.Placke@uk-essen.de
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite this as: Placke JM, Gratsias E, Dissemond J: Sister Mary Joseph nodule. Dtsch Arztebl Int 2019; 116: 798. DOI: 10.3238/arztebl.2019.0798