Images in Clinical Medicine

Sister Mary Joseph's Nodule

Edythe A. Albano, M.D., and Julie Kanter, M.D.

N Engl J Med 2005; 352:1913May 5, 2005

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A 12-year-old girl presented with a one-month history of decreased appetite, vomiting, and weight loss. The patient had had no fevers or night sweats. Physical examination revealed a distended abdomen with a fluid wave, a palpable pelvic mass, and a tumor protruding through the umbilicus (Panel A). Computed tomographic scanning showed a large pelvic mass probably originating from the ovary, omental and hepatic metastases, ascites, and a mass through the umbilicus (Panel B). Pathological evaluation of a biopsy specimen showed a desmoplastic small round-cell tumor. The patient received vincristine, doxorubicin, and cyclophosphamide alternating with etoposide and ifosfamide. After two courses of therapy, the primary tumor and metastatic lesions remained unchanged, but the amount of ascites was decreased. Eight months after diagnosis, the patient is clinically well with stable disease.

Metastatic cancer of the umbilicus, known as Sister Mary Joseph's nodule, is typically associated with adult cancers of the gastrointestinal tract and ovary. This condition was named for Sister Mary Joseph (1856 –1939), a surgical assistant for Dr. William Mayo, who noted the association between paraumbilical nodules observed during skin preparation for surgery and metastatic intraabdominal cancer confirmed at surgery.

Edythe A. Albano, M.D.
Julie Kanter, M.D.
The Children's Hospital, Denver, CO 80218

Citing Articles (5)

Citing Articles

1. 1

   Consolación Rosado Rubio, Verónica Álvarez Álamo, María Clara Ortiz Sierra, Francisco Domínguez Moronta. (2010) Nódulo de la hermana María José secundario a adenocarcinoma de recto. Revista Española de Geriatría y Gerontología 45:4, 241-242
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2. 2

   Masamoto Nakamura, Jiro Tamura, Ryo Takaki, Masaru Ohshiro, Morikazu Akamine, Yui Naha, Tetsuo Hirata, Fukunori Kinjo, Jiro Fujita. (2009) Sister Mary Joseph's Nodule. Internal Medicine 48:19, 1775-1775
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3. 3

   Leslie Doros, Sue C. Kaste, Carlos Rodriguez-Galindo. (2008) Sister Mary Joseph's nodule as presenting sign of a desmoplastic small round cell tumor. Pediatric Blood & Cancer 50:2, 388-390
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4. 4

   (2007) Umbilical endometriosis. Journal of the European Academy of Dermatology and Venereology 21:2,
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5. 5

   M. N. Kundranda, A. H. Daw. (2006) Sister Mary Joseph nodule: an important sign of an ominous diagnosis. Internal Medicine Journal 36:9, 617-617
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