Sister Mary Joseph Nodule: An Unusual Case Report with Review of Literature

Abstract

Sister Mary Joseph Nodule or 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. Gastrointestinal malignancies account for about half of the underlying sources (gastric, colonic, pancreatic cancer), gynaecologic (ovarian, uterine cancer), unknown primary tumours & rarely bladder or respiratory malignancies cause umbilical metastasis. The mechanism of spread of cancer to the umbilicus is unknown but proposed mechanisms include direct transperitoneal spread via lymphatics running along the obliterated umbilical vein, hematogenous spread or via remnant structures like the falciform ligament, median umbilical ligament or a remnant of the umbilical duct.The Sister Mary Joseph Nodule is associated with multiple peritoneal metastasis and signifies a poor prognosis. A rare case of a Sister Mary Joseph Nodule manifesting as ascites, cachexia and bleeding per rectum from an unknown primary adenocarcinoma is presented.