Sister Mary Joseph nodule

Q: An umbilical nodule associated with ascites is a warning sign for which underlying pathology?

Answer: carcinoma

The underlying pathology in patients with ascites is quite wide, but it can be narrowed down significantly with physical examination. An umbilical nodule popularly known as Sister Mary Joseph nodule associated with ascites is usually due to underlying carcinoma of stomach, colon, hepatocellular, pelvis, or lymphoma, proving otherwise. One caution for clinicians to be aware of is sometimes the deceiving appearance of the umbilicus. Often underlying bowel or omentum may give an appearance of a nodule and should be properly ruled out.

Historical trivia: Sister Mary Joseph nodule is the term given in honor of Sister Mary Joseph in the early twentieth century, who was the first to notice this association. She was a superintendent nurse at St. Mary's Hospital in Rochester, Minnesota, USA. This honor was bestowed upon her by probably the most well-known English surgeon of all time Sir Hamilton Bailey in 1949.

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References:

1. Abu-Hilal M, Newman JS. Sister Mary Joseph and her nodule: historical and clinical perspective. Am J Med Sci. 2009 Apr;337(4):271-3. doi: 10.1097/MAJ.0b013e3181954187. PMID: 19365173.

2. Powell FC, Cooper AJ, Massa MC, Goellner JR, Su WP. Sister Mary Joseph's nodule: a clinical and histologic study. J Am Acad Dermatol. 1984 Apr;10(4):610-5. doi: 10.1016/s0190-9622(84)80265-0. PMID: 6715609.