Article thumbnail

Sister Mary Joseph's Nodule at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 34 cases.

By Phillipo L Chalya, Joseph B Mabula, Peter F Rambau and Mabula D McHembe


Sister Mary Joseph's nodule is a metastatic tumor deposit in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. There is a paucity of published data on this subject in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients, and to proffer solutions for improved outcome. This was a retrospective study of histologically confirmed cases of Sister Mary Joseph's nodule seen at Bugando Medical Centre between March 2003 and February 2013. Data collected were analyzed using descriptive statistics. A total of 34 patients were enrolled in the study. Males outnumbered females by a ratio of 1.4:1. The vast majority of patients (70.6%) presented with large umbilical nodule > 2 cm in size. The stomach (41.1%) was the most common location of the primary tumor. Adenocarcinoma (88.2%) was the most frequent histopathological type. Most of the primary tumors (52.9%) were poorly differentiated. As the disease was advanced and metastatic in all patients, only palliative therapy was offered. Out of 34 patients, 11 patients died in the hospital giving a mortality rate of 32.4%. Patients were followed up for 24 months. At the end of the follow-up period, 14(60.9%) patients were lost to follow-up and the remaining 9 (39.1%) patients died. Patients survived for a median period of 28 weeks (range, 2 to 64 weeks). The nodule recurred in 6 (26.1%) patients after complete excision. Sister Mary Joseph's nodule of the umbilicus is not rare in our environment and often represents manifestation of a variety of advanced intra-abdominal malignancies. The majority of the patients present at a late stage and many with distant metastases. The patient's survival is very short leading to a poor outcome. Early detection of primary cancer at an early stage may improve the prognosis

Topics: Cancer
Publisher: Biomed Central
Year: 2013
DOI identifier: 10.1186/1477-7819-11-151
OAI identifier:

Suggested articles


  1. (1991). AG: The Sister Mary Joseph nodule: its significance in gynecology. Gynecol Oncol doi
  2. AJ: Tumors of the umbilicus. Mt Sinai J Med 1977, 44:257–262. doi:10.1186/1477-7819-11-151 Cite this article as: Chalya et al.: Sister Mary Joseph's nodule at a University teaching hospital in northwestern Tanzania: a retrospective review of 34 cases.
  3. (2004). Azhar R: Umbilical metastasis from oesophageal squamous cell carcinoma: a case report. The Internet Journal of Gastroenterology. doi
  4. (1999). CM: Pseudo Sister Mary Joseph’s nodule.
  5. (1997). Cook B: Metastatic carcinoma of umbilicus: “Sister Mary Joseph’s”. Cutis
  6. (1949). Demonstrations of Physical Signs in Clinical Surgery. 11th edition. doi
  7. (2002). Diffuse large B-cell Non-Hodgkin’s lymphoma presenting as Sister Joseph's nodule. Leuk Lymphoma doi
  8. (2004). Göring HD: The umbilical metastasis. Sister Mary Joseph and her time [in German]. Hautarzt
  9. (1965). Helwig EB: Tumors of the umbilicus. Cancer doi
  10. (1980). HM: Umbilical metastasis from carcinoma of the pancreas. Arch Dermatol doi
  11. (1964). Hudgins PT: Umbilical metastases. Arch Intern Med
  12. (1986). LR: Sister Mary Joseph's nodule.
  13. (1998). Metastatic cancer of the skin.I nSkin Cancer Recognition and Management.
  14. (1952). Metastatic carcinoma of the umbilicus. doi
  15. (1990). Metastatic tumors of the umbilicus: a review 1830–1989. J Surg Oncol doi
  16. (1966). Metastatic tumors of the umbilicus. doi
  17. (1964). O'Leary JA: Carcinoma of the umbilicus.
  18. (2010). Sibiany AM: Sister Mary Joseph’s nodule of the umbilicus: is it always of gastric origin? A review of eight cases at different sites of origin. doi
  19. (1971). Sister Joseph's nodule and malignant ascites in multiple myeloma. doi
  20. (2005). Sister Joseph's nodule in a liver transplant recipient: case report and mini-review of literature. World J Surg Oncol
  21. (2004). Sister Mary Joseph's nodule as a first surgery of cancer of the caecum: report of a case. Dis Colon Rectum doi
  22. (1966). Sister Mary Joseph's nodule. doi
  23. (1990). Smyczek B: Sister Mary Joseph's nodule. Diagnosis of umbilical metastases by fine needle aspiration. Acta Cytol doi
  24. (2007). Stage IV epithelial ovarian carcinoma in an 18 year old patient presenting with a Sister Mary Joseph’s nodule and metastasis in both breasts: a case report and review of the literature. Gynecol Oncol doi
  25. (2000). Umbilical cutaneous metastasis (or Sister Mary Joseph nodule disclosing an ovarian adenocarcinoma. GynecolObstetFertil
  26. (2005). Umbilical metastases: current viewpoint. World J Surg Oncol doi
  27. (1999). Umbilical metastasis as first sign of cecal carcinoma in a cirrhotic patient (Sister Mary Joseph nodule). Report of a case. Radiol Med
  28. (2002). Umbilical metastasis from ovarian carcinoma: Sister Mary Joseph’s Nodule. JEADV doi
  29. (1998). Umbilical metastasis or Sister Mary Joseph's nodule. doi
  30. (2006). Umbilical metastasis: Sister Mary Joseph's nodule. Harefuah doi
  31. (1984). WP: Sister Joseph's nodule: a clinical and histologic study. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.