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1 March 1998 | Volume 128 Issue 5 | Page 410
Sister Mary Joseph's nodule has traditionally been considered a sign of ominous prognosis (survival of 10 months on average) and suggests therapeutic abstention [1]. We conducted a MEDLINE search of papers published from 1966 to January 1997 to evaluate the evidence for this belief.
It seems necessary to obtain a histopathologic diagnosis because most umbilical tumors are primary [2]. Fine-needle aspiration biopsy has been established as an adequate method for early and easy diagnosis [3]. A total of 407 reports of Sister Mary Joseph's nodules have been published. The most common origins are gastrointestinal (52%), gynecologic (28%), stomach (23%), and ovarian (16%) cancer. Fifteen percent of cases have unknown origins, and 3% originate from the thoracic cavity (Table 1). Most such metastases develop from adenocarcinomas [4]. In 14% to 33% of cases, umbilical metastasis leads to the diagnosis of previously occult neoplasms [4]. In 40% of patients with a known neoplasm, the nodule was an early sign of relapse [5]. LETTER
Sister Mary Joseph's Nodule
TO THE EDITOR:
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Authors have reported cases of survival longer than 1 year and have shown that, depending on the neoplasm and the patient's general state, medical and surgical treatment combined significantly improved survival (from 2.3 to 17.6 months) [3]. Given that most umbilical tumors are benign, that radical exeresis in primary malignant processes is often curative, and that umbilical metastasis can be the only metastasis at the moment of the diagnosis, the finding of an umbilical nodule cannot always be considered a sign of poor prognosis or a contraindication to an active and curative treatment regimen. Sister Mary Joseph's nodule must be considered an easy method for diagnosis of unknown neoplasm or relapse of a previously known neoplasm.
Author and Article Information
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References
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TopAuthor & Article InfoReferences |
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1. Clements AB. Metastatic carcinoma of umbilicus. JAMA. 1952; 150:556-9.
2. Barrow MV. Metastatic tumors of the umbilicus. J Chronic Dis. 1966; 19:1113-7.
3. Schneider V, Smyczek B. Sister Mary Joseph's nodule. Diagnosis of umbilical metastases by fine needle aspiration. Acta Cytol. 1990; 34:555-8.
4. Majmudar B, Wiskind AK, Croft BN, Dudley AG. The Sister (Mary) Joseph nodule: its significance in gynecology. Gynecol Oncol. 1991; 40:152-9.
5. Srinivasan R. Metastatic cutaneous and subcutaneous deposits from internal carcinoma. An analysis of cases diagnosed by fine needle aspiration. Acta Cytol. 1993; 37:894-8.
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