Sister Mary Joseph Nodule

A 61 year-old male presented to the emergency department due to chest discomfort, weakness of 3 days’ period. He had been alcohol dependence, which was quitted 2 years ago. He also noted unexplained body weight loss, yellowish skin, and lower legs edema. Physical examination revealed pale conjunctiva, icteric sclera, and an ulcerative tumor with necrotic appearance at the umbilicus (Figure A). Biochemical tests showed anemia and hyperbilirubinemia. Abdominal computed tomography revealed hepatic tumors, peritoneal carcinomatosis, and umbilical tumor (Figure B). Biopsy of the umbilical tumor was performed. Pathological result was metastatic adenocarcinoma (Figure C). The patient was seeking hospice and palliative care. Umbilical tumors, also known as Sister Mary Joseph nodule, may be the first sign of an underlying cancer or a recurrence of a previous cancer.