{"paper_id":"7396796b-0c84-4f4c-9844-57f4bb012582","body_text":"Male patient, 76 years old, with a history of hypertension, smoking, former alcohol\nconsumption, gout, and stroke, admitted to Neurology two months previously with a\nnew stroke and recent weight loss. Physical examination showed a brownish\ncerebriform umbilical nodule 2cm in diameter surrounded by serous-hematic crust\n( Figure 1 ). Patient reported that the\nlesion was asymptomatic, present for one year, with no recent growth. On dermoscopy,\nthe cerebriform area showed comma-shaped and irregular vessels on a light pink\nbackground ( Figure 2 ). The location and\ndermoscopic clinical features raised the diagnostic hypothesis of Sister Mary\nJoseph's nodule, and an excisional biopsy was performed. Histopathology showed\nepidermal atrophy, nevus cells without atypia in the dermis, and preserved deep\nmaturation, interspersed with congested blood vessels ( Figures 3  and  4 ).\nFigure 1 Brownish cerebriform umbilical nodule 2cm in diameter with surrounding\nserous and hematic crust\nBrownish cerebriform umbilical nodule 2cm in diameter with surrounding\nserous and hematic crust\nFigure 2 Dermoscopy of the cerebriform area shows comma-shaped and irregular\nlinear vessels on light pink background\nDermoscopy of the cerebriform area shows comma-shaped and irregular\nlinear vessels on light pink background\nFigure 3 Atrophic epidermis, nevus cells without atypia in the dermis, and\npreserved deep maturation and interspersed congested blood vessels\n(Hematoxylin & eosin, x40)\nAtrophic epidermis, nevus cells without atypia in the dermis, and\npreserved deep maturation and interspersed congested blood vessels\n(Hematoxylin & eosin, x40)\nFigure 4 Detail: congested vessels in the deep dermis (Hematoxylin & eosin,\nx100)\nDetail: congested vessels in the deep dermis (Hematoxylin & eosin,\nx100)\n\nSister Mary Joseph's nodule is a metastasis located in the umbilicus, originating\nfrom advanced intraabdominal tumors and with a somber prognosis. Clinically, it\npresents as a firm, painful, irregular nodule 0.5-2cm in diameter. The surface may\nalso present ulceration, necrosis, and purulent or serous secretion. 1  In dermoscopic examination of this\nnodule, Mun JH  et al.  described vascular polymorphism with\nserpentine linear and curved linear vessels with whitish and milky-red unstructured\nareas. Differential diagnosis should include umbilical hernia, malignant or benign\nprimary tumors on the umbilical region, omphalitis, keloids, pyogenic granuloma,\nmelanocytic nevus, cutaneous endometriosis, and seborrheic keratosis. 1 , 2  Intradermal nevi present as raised lesions, either pigmented or\nnot, which may have a cerebriform appearance. Their most common location is on the\nface, but they may be found anywhere on the skin surface, although they are uncommon\non the palms and soles. On dermoscopy, they present with absence of pigment network\nand presence of dots and globules. They may also present fine or comma-shaped linear\nvessels, as in the case described here. 3 , 4  Thus, Sister Mary\nJoseph's nodule presents similar dermoscopic alterations to those of intradermal\nnevus. There are comma-shaped or curved linear vessels in both. In addition, there\nis no description of a specific lesion in Sister Mary Joseph's nodule, which\ncontributed to the difficulty in the differential diagnosis. In these cases, one\nshould suspect metastatic umbilical nodule, and histopathological examination is\nessential, considering the prognostic importance of this diagnosis, as performed in\nthe case reported here.","source_license":"CC-BY-4.0","license_restricted":false}