Sister Mary Joseph Nodule as a Presenting Sign of Pancreatobiliary Adenocarcinoma

Sister Mary Joseph nodules represent metastatic cancer of the umbilicus. These malignancies are usually associated with the ovary and gastrointestinal tract. The authors report the case of a Sister Mary Joseph nodule originating from the bifurcation of the common hepatic duct. Umbilical nodules should prompt clinical evaluations, as these tumors are usually associated with poor prognosis.A 79-year-old man presented to the emergency room with a two-month history of mild periumbilical pain and an enlarging umbilical mass. For the past two weeks, he had experienced worsening right upper quadrant pain and abnormally dark urine, light-colored stool, and yellowing of his skin. Over this same period of time, he experienced anorexia and had lost nearly 15 to 20 pounds. He denied having similar complaints in the past and reported a normal colonoscopy nearly two years earlier.On physical exam, the patient had a 3x3cm hard, firm, ulcerated umbilical nodule with a diffuse infiltration of the entire periumbilical area (Figure 1). He also had right upper quadrant tenderness with a firm liver edge palpated 2cm below the costal margin.Open in a separate windowFigure 1Enlarged ulcerating umbilical tumor with marked deep tissue component