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Case of the Month

by Dr K C Choy AM (Mal), MBBS, M.Med, FRCR

Answer to Case Of the Month 
Sister Joseph’s Nodule due to ovarian carcinoma

Discussion of Findings
 The CT scan of the abdomen shows a solid nodule in the subcutaneous tissue (arrow) in the anterior abdominal wall. There is gross ascites. The section through the pelvis shows bilateral solid and cystic tumour in the ovaries.

  

Sister Joseph’s Nodule

Sister Joseph’s nodule is used to describe a firm, indurated umbilical nodule that is usually associated with advanced metastasizing intraabdominal cancer. Sister Mary Joseph (1856 –1939), a head nurse and surgical assistant to Dr. William Mayo (the forerunner of Mayo Clinic) first identified this clinical sign which now bears her name. 

Umbilical nodules may be benign or malignant, about 43% being malignant. The majority of malignant nodules are due to metastases (83%). Primary malignant  umbilical tumours are rare.

Histology of the umbilical metastatic nodule is usually adenocarcinoma. Common primary sites include stomach(25%),ovary(12%),colorectal (10%) and pancreas(7%).

The spread of metastatic cancer to the umbilicus has been postulated to occur by a variety of means:

a) direct spread of peritoneal cancer

b) hematogenous spread due to persistence of paraumblical veins

c)l ymphatic spread due to rich lymphatics in the paraumblical region

 
About the Author 
Dr K C Choy is currently attached to the Mahkota Medical Centre, Melaka as Radiologist.

 

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Last Updated:
Thursday, 21 August, 2003