Sister Mary Joseph Nodule as an Initial Presentation of Pancreatic Adenocarcinoma

Abstract

Sister Mary Joseph (SMJ) nodule is a metastatic umbilical nodule seen in primary tumors of the gastrointestinal or genitourinary tract. The stomach and colon are the common gastrointestinal cancers associated with SMJ nodule. The pancreas is a rare primary site for umbilical metastasis. Moreover, malignant umbilical nodules as the first presentation in pancreatic cancer is rare. Pancreatic adenocarcinoma that metastasizes to umbilicus usually arise from the body or tail of the pancreas. The presence of SMJ nodule usually indicates poor prognosis. Umbilical nodule is a simple physical finding to the presence of an advanced intra-abdominal malignancy. Although rare, pancreatic cancer should be considered as one of the primary sites in such a situation.

Figure 1.

Abdominal examination showing a pigmented umbilical nodule.

Figure 2.

Computed tomography of the abdomen showing (A) Sister Mary Joseph nodule (arrows) and (B) a mass involving the body and tail of the pancreas (arrows).

Figure 3.

Fine needle aspiration cytology–(A) pap stain, (B) Giemsa stain showing cohesive clusters of large tumor cells with moderate to abundant pale blue cytoplasm, irregular nuclear membrane, large vesicular nucleus with opened up chromatin and few conspicuous nucleoli, and (C) immunocytochemistry of umbilical nodule positive for cytokeratin 19.