RSS Feeds
Sister Mary Joseph's Nodule
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
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].
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.
Vicente Giner Galvan, MD
Hospital Clinic i Provincial; Barcelona, Spain
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
