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This patient presented with an ulcerated umbilical nodule, profuse vaginal bleeding and a hemoglobin level of 45 g/L. Tumour was visualized at the apex of the vagina; however, biopsy was contraindicated because of bleeding. Biopsy of the umbilical mass revealed metastatic endometrial adenocarcinoma that was strongly positive for both estrogen and progesterone receptors. A CT scan of the abdomen and pelvis supported the diagnosis of umbilical metastasis (Fig. 1) and showed massive tumour involvement of the uterus and cervix and a left adnexal metastasis (Fig. 2). Urgent radiotherapy successfully stopped the bleeding, and medroxyprogesterone therapy was started.
Sister Mary Joseph's nodule is an umbilical metastasis originating from intra-abdominal or intrapelvic malignant disease. First reported in 1864,1 it was named after an American nursing Sister who noted an association between the nodules and intra-abdominal cancer during operations when assisting Dr. William Mayo, founder of the Mayo clinic. The nodule is usually firm, irregular and ulcerated and can be associated with induration, bleeding, discharge and secondary infection. Primary lesions are most often of genitourinary, gastrointestinal or gynecologic origin. Spread to the umbilicus can be hematogenous or via lymphatics, contiguous extension, embryologic remnants, ventral hernia or iatrogenesis.1 The presence of an umbilical metastasis usually carries an ominous prognosis (average survival time 11 months2).
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Competing interests: None declared.