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Sister Mary Joseph nodule
Corresponding author: Dr. Ananya Sharma, Department of Dermatology, Maulana Azad Medical College, New Delhi, India. ananyasharma0026@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Sharma A, Khurana N, Chirantan S, Barman KD. Sister Mary Joseph nodule. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_1852_2025
A 27-year-old woman presented with one month history of a single, well-defined, asymptomatic, gradually progressive, firm, erythematous umbilical nodule of size 3cm x 2cm with focal crusting, on the umbilicus [Figure 1a]. Histopathology revealed multiple atypical epithelial cells in deep dermis and subcutis, admixed with infiltrate of neutrophils, lymphocytes and plasma cells. At places, atypical cells showed signet ring morphology [Figure 1b]. On immunohistochemistry, they were immunoreactive for CK20 [Figure 1c], epithelial membrane antigen (EMA) and CDX2, suggesting gastrointestinal origin. PAX8 was negative.
A whole body positive emission tomography-computed tomography (PET-CT) scan revealed fluorodeoxyglucose (FDG) avid, circumferential thickening of proximal body of stomach [Figure 1d]. FDG uptake was also seen in the umbilical nodule, along with internal necrosis. Patient was diagnosed with carcinoma stomach and chemotherapy was initiated.
Sister Mary Joseph nodule (SMJN) is an uncommon, classical presentation of cutaneous metastasis to the umbilicus, generally from the gastrointestinal tract (stomach and colon), followed by gynaecological malignancies.1,2 It may be the first manifestation of malignancy.2 Umbilical, para-umbilical, within umbilical/para-umbilical hernia or iatrogenic metastases to port site or surgical scar are the four types of SMJN.3 It is a poor prognostic sign with a mean survival time of 7.9 months. Prognosis is better when it is the first clinical presentation rather than a subsequent development in a patient with known malignancy.4
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
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Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
References
- Radiation therapy for Sister Mary Joseph’s Nodule: A review. Adv Radiat Oncol. 2024;9:101321.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
- Umbilical metastases: Real-world data shows abysmal outcome. Int J Cancer. 2021;149:1266-73.
- [CrossRef] [PubMed] [PubMed Central] [Google Scholar]