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doi: 10.2169/internalmedicine.7414-21

Intern Med 60: 3339-3340, 2021

http://internmed.jp

【 PICTURES IN CLINICAL MEDICINE 】

Sister Mary Joseph’s Nodule from Pancreatic Cancer

Yuya Ando 1,2, Sachiko Ono 3, Yosuke Ono 1 and Jinghua Yin 4

Key words: Sister Mary Joseph’s nodule, pancreatic cancer, umbilical metastasis

(Intern Med 60: 3339-3340, 2021)(DOI: 10.2169/internalmedicine.7414-21)

An 89-year-old woman presented at an emergency outpa-

tient service owing to bleeding from the umbilicus induced

by abrasion. She had an umbilical hernia with a recent his-

tory of occasional bleeding. However, the bleeding stopped

spontaneously, and no specific treatment was administered.

The patient had an oval-shaped protruding umbilicus (major

axis=45 mm; minor axis=25 mm) with a purple lesion

caused by abrasion and palpable plate-like nodules in the

１Department of General Medicine, National Defense Medical College, Japan, ２Department of Family Medicine, Graduate School of Medical and

Dental Sciences, Tokyo Medical and Dental University, Japan, ３Department of Eat-loss Medicine, Graduate School of Medicine, The University

of Tokyo, Japan and ４Department of Gastroenterology, Mishuku Hospital, Japan

Received: February 23, 2021; Accepted: March 22, 2021; Advance Publication by J-STAGE: May 7, 2021

Correspondence to Dr. Yosuke Ono, onoyousuke1979@yahoo.co.jp

Intern Med 60: 3339-3340, 2021 DOI: 10.2169/internalmedicine.7414-21

3340

subcutaneous area (Picture 1). The bleeding stopped with

pressure, but computed tomography confirmed end-stage

pancreatic carcinoma with multiple hepatic metastases, peri-

toneal metastasis, and multiple seedings in the hernia (Pic-

tures 2-4). The diagnosis was Sister Mary Joseph’s nodule

(SMJN) associated with pancreatic cancer. SMJN is an um-

bilical metastasis of internal malignancies, such as cancer of

the stomach (23%), ovary (17%), colon and rectum (15%),

pancreas (9%), and uterus (6%) (1, 2). The patient chose to

remain at home and ultimately died within six months of the

cancer presentation.

The authors state that they have no Conflict of Interest (COI).

References

1. Otsuka I. Cutaneous metastasis after surgery, injury, lymphadeno-

pathy, and peritonitis: possible mechanisms. Int J Mol Sci 20:

3286, 2019.

2. Galvañ VG. Sister Mary Joseph’s nodule. Ann Intern Med 128:

410, 1998.

The Internal Medicine is an Open Access journal distributed under the Creative

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view the details of this license, please visit (https://creativecommons.org/licenses/

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Ⓒ 2021 The Japanese Society of Internal Medicine

Intern Med 60: 3339-3340, 2021