Sister Mary Joseph nodule revisited !
2 mins read

Sister Mary Joseph nodule revisited !

This case was Contributed by :
Dr Farooq A Qurashi. 
M.B.B.S. M.S (Advanced Fellowship in Laproscopic surgeries )
Laproscopic surgeon 
Omron General   Hospital  AlHafoof 
Saudi Arabia 

Clinical scenario: 
              A 65 yr old female presented with a discharging swelling  in the umbilical area of 2 months duration  .She had been to a local doctor who prescribed some antibiotics but the lesion continued to grow and didn’t heal .She had no jaundice , itching but complained of   anorexia and weight loss of 3 Kg in the same period.    

         She was conscious , oriented hemodynamically stable and  had no icterus or lymphadenopathy. Her abdominal examination revealed an umbIlical nodule around 4cms with serosanguinous discharge  and  it had  firm margins  Fig 1 

Fig 1 UmbIlical nodule SJN

  Her abdominal examination revealed hepatomegaly 2 cms below costal margin .There was no ascites .Her systemic examination was normal .
              The hemogram revealed hemoglobin of  10.8 gm/dl and her TLC and platelets were normal . Her renal functions and liver functions were normal .Keeping in view non healing nature of this umbilical swelling , biopsy was done from the edge of the nodule which  showed metastatic adenocarcinoma .Fig2 .Hence the nodule proved to be sister Mary Joseph nodule .

Fig 2 Biopsy from umbilical nodule

Later CT scan abdomen was done Fig 3 which revealed gallbladder mass .Patient had an inoperable carcinoma of gall bladder and she later developed progressive cholestasis and deep Jaundice and  succumbed   to her illness unfortunately .

Fig 3 CT abdomen showing carcinoma Gallbladder  (arrow )

Teaching message :   
          “Non healing ulcers must be biopsied” . 
Umbilical metastasis is named Sister Mary Joseph nodule (SJN) The name is after the  vigilant head nurse working in Mayo clinic nearly a century ago .She observed  patients with this findings were having advanced malignancy . Her observation was published in 1949 in Hamilton Baily  .
         Men  with SJN usually have GI malignancies while women with SJN have ovarian malignancies . It can occasionally occur due to lung malignancies even.
       The size may range few cms and even as long as 10 cms have been recorded . This finding reflects metastasis through lymphatic channels or through peritoneum or through embryological remnants . 

Further Reading:     Gall bladder cancer


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