BMJ 2015;351:h5224 doi: 10.1136/bmj.h5224 (Published 15 October 2015)
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Endgames
ENDGAMES CASE SCENARIO
Sister Mary Joseph nodule Thabo Miller trust grade in general and emergency surgery, Jennifer Ashworth nurse practitioner in general and emergency surgery, Sarah Richards consultant in general and emergency surgery Department of Surgery, Royal United Hospital Bath, Bath BA1 3NG, UK
A 79 year old woman was referred by her GP because of a 2×2 cm irregular mass at her umbilicus with a discoloured and rough surface. She had associated ascites. A diagnosis of Sister Mary Joseph nodule was made. Investigations confirmed widespread metastases from a primary gynaecological tumour.
Learning points: • A Sister Mary Joseph nodule is a metastatic umbilical deposit
• The primary tumour is classically one of the stomach, large bowel, or tail of the pancreas, although about 25% are of gynaecological origin • The proposed route of metastasis is along the remnant structures at the umbilicus • A Sister Mary Joseph nodule implies the presence of peritoneal metastases and prognosis is poor.
Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: none. Patient consent obtained. Cite this as: BMJ 2015;351:h5224 © BMJ Publishing Group Ltd 2015
Correspondence to: T Miller
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