Name this abdominal mass?

Name this abdominal mass?

A 78 year woman presents with weight loss, lethargy and abdominal pain. Clinical examination showed abdominal distention and a firm, non-tender, irregular 1 cm nodule within the umbilicus.

 

What is this finding called?

Sister Mary Joseph nodule (also called Sister Mary Joseph node or sign)

 

What does is represent?

This is a palpable nodule that is often protruding from the umbilicus which represents malignant and metastatic cancer.

 

What cancers are most likely to cause this?

  • Gastrointestinal malignancies (gastric cancer, colonic cancer and pancreatic cancer)
  • Gynecological cancers (ovarian cancer and uterine cancer)
  • Less common include:
    • Appendix cancer
    • Urinary or prostate cancer
    • Lung cancer

 

What is the pathogenesis of this finding?

While it is largely unknown, it is thought that the cancer cells spread to the umbilicus through many routes such as from direct spread to the peritoneum, via lymphatics, via the blood circulation or through remnant structures such as the falciform ligament, median umbilical ligament or a remnant of the vitelline duct.

 

How common is this?

These days, very rare as its usually a sign of pretty advanced disease and may carry a poor prognosis.

 

What are some other common regions to examine for malignancy?

A more common finding in metastatic disease is a mass in the left supraclavicular fossa (Virchow’s node). Another location is the left axilla (Irish node). Don’t forget to do a complete lymph node examination.

 

What is the history behind this name?

Julia Dempsey was an American nurse and hospital administrator born in Salamanca, NY in 1856. She entered  Third Order Regular of St. Francis of the Congregation of Our Lady of Lourdes, taking the name Sister Mary Joseph. In 1889, she came to Rochester to help staff the new St. Mary’s Hospital built by her order. The hospital staff would include the Mayo Family-surgeon, William W. Mayo and his two sons, Charles H. and William J. Mayo (whose family would later establish the flagship Mayo Clinic in Rochester). Working at St. Mary’s Hospital, Sister Mary Joseph studied nursing and in 1890 became William J. Mayo’s first surgical assistant, a post she held until 1915. She was known for extraordinary skills and judgement. She was the first to draw attention to this observation and in 1929, Dr. Mayo published the finding. In 1949, British surgeon, Henry Hamilton Bailey published this finding with the term: Sister Mary Joseph nodule.

Sister-Mary-Brigh-Cassidy

Sister Mary Joseph

 

 

Source/References:

  • This case was obtained from Clinical Case Reports article Sister Mary Joseph nodule published by Zhaowei Zhou and Da Zhang
  • H. Bailey: Demonstration of physical signs in clinical surgery. 11th edition, Baltimore, Williams & Wilkins, 1949, p 227.
  • Cohen, DC. A Man With an Umbilical Ulcer. Medscape J Med. 2008;10(1):11.
  • http://www.britannica.com/biography/Sister-Mary-Joseph-Dempsey
  • https://en.wikipedia.org/wiki/Sister_Mary_Joseph_nodule
  • https://en.wikipedia.org/wiki/Henry_Hamilton_Bailey