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Age and Ageing Advance Access originally published online on February 8, 2008
Age and Ageing 2008 37(3):349; doi:10.1093/ageing/afn020
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Copyright © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.

Clinical Reminder

Sister Joseph's nodule

Abhay Kumar Das*, Andrew Higgins and Jennifer Fildes

Pontefract General Infirmary, Medicine for the Elderly, UK

* To whom correspondence should be addressed E-mail: abhaylopa{at}yahoo.co.uk

A 69-year-old male patient developed a firm, indurated, painless, bluish nodule around the umbilicus (Figure 1) while awaiting gastroscopy for iron deficiency anaemia. His general health deteriorated, and endoscopy and histology confirmed adenocarcinoma of the stomach. CT scan showed the Sister Joseph's nodule and linitis plastica.


Figure 1
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  		Figure 1. Sister Joseph's nodule.

 
Sister Joseph's nodule is associated with advanced metastasising intra-abdominal cancer, and generally indicates poor prognosis. Gastric adenocarcinoma is the commonest of primary tumours [1]. Abdomino-pelvic tumours metastasise to the umbilicus in 1–3% cases; although in 11% the primary cause remains unknown [2]. In such cases, histological findings from the nodule will assist further management [3]. Sister Mary Joseph noted the connection between the umbilical nodule and intra-abdominal cancer while working as a surgical assistant over a century ago. This time-honoured clinical sign provides easy and safe access for tissue diagnosis, which enables more common benign conditions to be differentiated from advanced cancers.


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   References
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  1. Clague JE. Sister Joseph's nodule. Postgrad Med J (2002) 78:174.[Free Full Text]
  2. Dubreuli A, Dompmartin A, Barjot P, et al. Umbilical metastasis or sister Mary Joseph's nodule. Int J Dermatol (1998) 37:70–3.
  3. Panaro F, Andorno E, Domenico SD, et al. Sister Joseph's nodule in a liver transplant recipient: Case report and mini-review of literature. World J Surg Oncol (2005) 3:4.[CrossRef][Medline]

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This Article
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