The Sister Mary Joseph Nodule

Abstract

A 63-year-old Puerto Rican male presented with penile swelling, discomfort, and difficulty urinating. On physical examination, the patient was noted to have a firm, nodular umbilical mass, initially thought to be an irreducible umbilical hernia (Fig. 1, Panels a and b). Abdominal computed tomography (CT) confirmed a 4-cm umbilical nodule (Fig. 2, Panel a), a 10-cm mass posterior to the bladder (Fig. 2, Panel b), and multiple additional masses in the inguinal canal, liver, and retroperitoneum. Biopsy of the umbilical nodule was consistent with malignant peritoneal mesothelioma.This umbilical lesion is a so-called Sister Mary Joseph (SMJ) nodule, indicative of underlying abdominal malignancy and poor prognosis. Named for Sister Mary Joseph , the first assistant for Dr. William Mayo at the Mayo Clinic, these lesions were often associated with advanced abdominal malignancies at the time of surgery. 1 SMJ nodules are seen in 1-3 % of all intra-abdominal and pelvic malignancies 2 and are metastases most commonly from primary tumors of the gastrointestinal and genitourinary tracts. 3 SMJ nodules may be the first and only sign of an underlying neoplasm in approximately 30 % of cases. 4 This patient ultimately elected to pursue treatment near family in Puerto Rico, and was discharged from our care.

Benign Umbilical Tumors Resembling Sister Mary Joseph Nodule

“…The “benign umbilical tumor” group comprised 19 patients. The “Sister Mary Joseph nodule” group consisted of 30 patients: 2 from our department and 28 from a PubMed search using the keyword “Sister Mary Joseph nodule [title].” 4 - 25 …”

Nódulo da Irmã Maria José – um sinal semiológico de alerta: relato de caso

“…Os pacientes podem apresentar simultaneamente ao nódulo sintomas sugestivos de neoplasia, porém, em até 15%-45% dos casos o nódulo é primário e o único sinal da doença, sendo o local primário do tumor desconhecido. Pode ainda significar recidiva (FOGAÇA et al, 2003;GIBSON et al, 2018;MURINELLO et al, 2010;PANARO et al, 2005;PEDRO et al, 2017;RENDÓN;RIVEROS;HOYOS, 2013;VEKARIYA et al, 2020;ZHANG;SANKEY, 2015).…”

“…O epônimo "nódulo da Irmã Maria José -NIMJ" ("Sister Mary-Joseph Nodule") foi descrito em publicação por Hamilton Bailey em 1949, em homenagem à assistente cirúrgica do Dr. William Mayo (Mary Joseph Dempsey) no St. Mary's Hospital (atual Mayo Clinic), que observou pela primeira vez a relação dos nódulos metastáticos umbilicais com malignidade intra-abdominal inoperável avançada (ESPERTO; CANHA, 2012;FOGAÇA et al, 2003;GATTU et al, 2020;GIBSON et al, 2018;MURINELLO et al, 2010;O'CONNOR-BYRNE et al, 2020;PANARO et al, 2005;PEDRO et al, 2017;PEREIRA et al, 2011;POPARIC et al, 2017;RENDÓN;RIVEROS;HOYOS, 2013;ZHANG;SANKEY, 2015). Alguns autores afirmam que o NIMJ é mais comum no sexo feminino (GIBSON et al, 2018;NIKOLAOU et al, 2013).…”

“…O achado é frequentemente um nódulo endurecido e de crescimento rápido, ulcerado e de coloração variada (FOGAÇA et al, 2003;GIBSON et al, 2018;HUSEIN-ELAHMED et al, 2010;MURINELLO et al, 2010;NIKOLAOU et al, 2013;O'CONNOR-BYRNE et al, 2020;PEDRO et al, 2017;PEREIRA et al, 2011;POPARIC et al, 2017;RENDÓN;RIVEROS;HOYOS, 2013;VEKARIYA et al, 2020;ZHANG;SANKEY, 2015). Sua confirmação é feita por biópsia incisional ou excisional ou por punção aspirativa (FOGAÇA et al, 2003;GIBSON et al, 2018;HUSEIN-ELAHMED et al, 2010;NIKOLAOU et al, 2013;PANARO et al, 2005;PEDRO et al, 2017;PEREIRA et al, 2011;POPARIC et al, 2017;RENDÓN;RIVEROS;HOYOS, 2013;VEKARIYA et al, 2020;ZHANG;SANKEY, 2015), sendo o tipo histológico mais encontrado o adenocarcinoma (GIBSON et al, 2018;PANARO et al, 2005;PEDRO et al, 2017;PEREIRA et al, 2011;POPARIC et al, 2017).…”

“…As neoplasias gastrointestinais e as neoplasias ginecológicas são os locais primários mais comuns (ESPERTO;CANHA, 2012;FOGAÇA et al, 2003;GIBSON et al, 2018;NIKOLAOU et al, 2013;O'CONNOR-BYRNE et al, 2020;MURINELLO et al, 2010;PANARO et al, 2005;PEDRO et al, 2017;PEREIRA et al, 2011;POPARIC et al, 2017;RENDÓN;RIVEROS;HOYOS, 2013;VEKARIYA et al, 2020;ZHANG;SANKEY, 2015).…”