Umbilical metastasis C79.2

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 31.08.2024

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Synonym(s)

Metastasis umbilical; Sister Joseph\'s Nodule; Sister Joseph's Nodules; umbilical metastasis

History
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Bailey 1949

Definition
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Rare form of a skin metastasis, usually originating from internal adenocarcinomas (stomach, ovaries, colon/rectum, pancreas). Metastasis per continuitatem is possible in peritoneal carcinomatosis, via umbilical vessels or via embryonic structures (urachus).

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Clinical features
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Rough, reddened, occasionally painful, on average 1-2 cm large lump with mostly intact, but possibly ulcerated surface. Occurs mostly in the late stage of the underlying tumor disease, but sometimes also as the first clinically detectable symptom.

Differential diagnosis
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Umbilical calculus formation; melanocytic nevus; lipoma; hemangioma; cutaneous endometriosis; carcinoma; omphalomesenteric duct cyst.

Therapy
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The aim of treatment is to maintain the best possible quality of life despite an unfavorable prognosis. Individual skin metastases can be excised; radiotherapy or cytostasis are possible for extensive metastases. The treatment regimen depends on the spread of the metastases. In the case of initial symptoms, the focus is on clarification and treatment of the primary tumor.

Progression/forecast
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Usually unfavorable, also depending on the primary tumor.

Note(s)
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The name refers to the surgical nurse Mary Joseph, who observed the occurrence of an umbilical node in an intra-abdominal malignancy in a hospital in Rochester, Minnesota. Hamilton Bailey named this rare metasis pathway in her honor.

Literature
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Bailey H (1949) Demonstrations of physical signs in clinical surgery. Williams and Wilkins, Baltimore
Bork K et al. (2002) Umbilical metastasis of a gallbladder carcinoma: "Sister Mary Joseph's nodule". Dtsch Med Wochenschr 127: 553-556
Boyde AM et al. (2003) Sister Mary Joseph's nodule in malignant peritoneal mesothelioma. Histopathology 43: 303-304
Clements AB (1952) Metastatic carcinoma of umbilicus. JAMA 150: 556-559
Holzki G et al. (1989) "Sister Joseph's module"--umbilical metastases of internal tumors. Dermatology 40: 312-315
Ishizawa T et al. (1997) Sister Joseph's nodule: a case report and review of the Japanese literature. J Dermatol 24: 662-665
Ständer S et al (2016) Spontaneously occurring livid nodule in the navel. Dermatologist 67: 500-502
Tam C et al. (2002) Diffuse large B-cell non-Hodgkin's lymphoma presenting as Sister Joseph's nodule. Leuk Lymphoma 43: 2055-2057
Hugen N et al. (2021) Umbilical metastases: Real-world data shows abysmal outcome. Int J Cancer ;149:1266-1273. doi: 10.1002/ijc.33684. Epub 2021 May 25. PMID: 33990961; PMCID: PMC8361932