Sister Mary Joseph Nodule and peritoneal carcinomatosis from squamous cell cervical carcinoma
Sister Mary Joseph nodule is an eponym assigned to a nurse, first reported in 1949, denoting a rare form of cutaneous umbilical metastasis. The primary neoplasm is usually adenocarcinoma and the gastrointestinal tract is the most common primary site. The present case report describes a 79 year old woman with squamous cell cervical carcinoma. Her disease was managed with radiation and concurrent chemotherapy and no evidence of loco-regional recurrent disease was noted on follow-up examination. Eight months after treatment, gynecological examination suggested recurrent disease. Three weeks later, the patient presented with a painless umbilical nodule and the biopsy revealed a poorly differentiated carcinoma. Computed tomography showed ascites, diffuse peritoneal carcinomatosis including an umbilical nodule, multiple pulmonary nodules, bilateral pleural effusion, and retroperitoneal lymphadenopathy. She died 63 days after this manifestation. Review of the literature shows that a Sister Mary Joseph nodule is a sign of advanced neoplastic disease and is associated with poor prognosis. The treatment remains palliative either by radiation, chemotherapy or surgery.