SHM Converge Scientific Abstract ePoster Gallery-Sister Mary Joseph Nodule: Clinical Sign of a Poor Prognosis

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The document describes Sister Mary Joseph nodule, a rare but important clinical sign of metastatic cancer. It is a firm, irregular umbilical nodule that may be painful or ulcerated and typically reflects spread from a deep-seated abdominopelvic malignancy, most commonly from gastrointestinal or genitourinary cancers. The term was first linked to metastatic disease by Dr. William Mayo’s surgical assistant, Sister Mary Joseph, in 1928.<br /><br />The main differential diagnoses include primary umbilical tumors, hernia, endometriosis, keloid, omphalith, pyoderma gangrenosum, and foreign body. Biopsy is used to confirm the diagnosis histologically. The prognosis is poor: average survival is about 11 months, and only 13.5% of patients survive two years.<br /><br />The case report describes a 47-year-old man with known esophageal adenocarcinoma and end-stage renal disease who presented with abdominal pain, distension, and melena. He had a prior endoscopy showing a friable bleeding esophageal mass and had poor follow-up with oncology. On readmission, physical examination revealed a tender reddish umbilical nodule that had enlarged over a month. Punch biopsy showed poorly differentiated adenocarcinoma consistent with metastasis from his known esophageal cancer.<br /><br />The key clinical message is that recognizing Sister Mary Joseph nodule is crucial because it signals widespread metastatic disease, poor prognosis, and may change treatment intensity and goals of care. Management focuses on treating the underlying malignancy.

Asset Subtitle

Nickolas Rockenback

Meta Tag

Author List Nickolas Rockenback, Rachel Darling

Category Clinical Vignettes

Concept Sister Mary Joseph Nodule

Concept Metastatic Disease

Concept Biopsy

Concept Umbilical Nodule

Concept Internal Malignancy

Distinguished Non-Finalist

Presenter Organization University of Minnesota

Presenting Author Nickolas Rockenback

Track Adult

Keywords

Sister Mary Joseph nodule

umbilical metastasis

metastatic cancer

abdominopelvic malignancy

esophageal adenocarcinoma

biopsy

poor prognosis

umbilical nodule

gastrointestinal cancer

genitourinary cancer

Sister Mary Joseph Nodule

Metastatic Disease

Biopsy

Umbilical Nodule

Internal Malignancy