Sister Mary Joseph’s Nodule in a Patient with Adenocarcinoma of Lung

Abstract

Sister Mary Joseph's nodule (SMJN) is a metastatic umbilical deposit secondary to any primary visceral malignancy. It is a relatively rare phenomenon which signifies poor prognosis and shorter survival time as it is usually associated with advanced malignancy. The most common origins of SMJN are gastrointestinal and gynaecological malignancies. We present a case of a 69-year-old male who presented with progressive breathlessness, cachexia and a coexisting umbilical lesion suggestive of SMJN. He was found to have a right side malignant pleural effusion with multiple pleural deposits and the histopathological studies of both pleural and umbilical deposits confirmed metastatic deposits from an adenocarcinoma of primary pulmonary origin, which is a rare occurrence with only a few cases reported so far.Cutaneous metastases at the umbilicus manifesting as a palpable nodule is referred to as Sister Mary Joseph nodule. This sign was first identified by Sister Mary Joseph in 1928 and the term SMJN was used by Sir Hamilton Bailey in his textbook 'Demonstration of Physical Signs in Clinical Surgery" in 1949 [1]. It is a relatively rare clinical finding in modern medical practice, however when present it signifies advanced malignancy, hence limited treatment options. More than half of SMJN occurs secondary to gastrointestinal malignancies [2] (gastric, colonic, pancreatic) while the rest is accounted for by gynaecological malignancies mainly (ovarian, endometrial) and unknown primary tumors [3,4]. Primary lung malignancy has rarely been associated with SMJN with only a few reported cases so far [5]. Previous case analysis of patients with SMJN conducted by Charoenkul V, et al. [6] and Chalya PL, et al. [7] using 262 and 34 patients respectively did not reveal lung malignancy as the primary site. Hence here we report a patient who presented with umbilical deposits and was subsequently diagnosed to have disseminated lung malignancy.A 69-year-old previously healthy male presented to the respiratory unit in National Hospital, Kandy with a five month history of progressive breathlessness and non-productive cough. There was associated pleuritic type of chest pain on the right side, which gradually worsened in severity