Sister Mary Joseph’s nodule: an unusual but important physical finding characteristic of widespread internal malignancy

IntroduCtIonSister Mary Joseph's nodule is an eponymous term referring to a malignant metastatic umbilical nodule.It is a rare but important physical finding as it is a sign of advanced stage of malignancy.This case report describes an 82-year-old female diagnosed with metastatic pancreatic adenocarcinoma presenting with a Sister Mary Joseph's nodule.This is an unusual presentation of pancreatic malignancy. CaSe reportAn 82-year-old woman presented to the GP with a 4-week history of an umbilical nodule (Figure 1).This was suspected to be a neoplastic lesion and she was referred to the dermatology department for further assessment.She was otherwise asymptomatic.She had a past medical history of type 2 diabetes mellitus, essential hypertension, and anaemia due to chronic kidney disease.On examination, she looked well with no abdominal discomfort.There was a 3 cm umbilical nodule and bilateral inguinal lymphadenopathy.The working diagnosis was a Sister Mary Joseph's nodule with underlying internal malignancy.Urgent outpatient investigations were arranged.Blood tests demonstrated normocytic anaemia, raised tumour markers, renal impairment, and a normal liver function test.Imaging with a staging computerised tomography scan of her chest, abdomen, and pelvis, and biopsy of the umbilical nodule confirmed the diagnosis of metastatic pancreatic adenocarcinoma.She was referred to the hepatobiliary multidisciplinary team; the malignancy was judged to be inoperable due to the extent of the disease, and she was referred to the Macmillan Team for continuing palliative care in the community.Six weeks after initial presentation to secondary care, she developed gastric outlet obstruction symptoms and died 5 weeks later.