The umbilical clue: recognizing Sister Mary Joseph Nodule

The umbilical clue: recognizing Sister Mary Joseph Nodule | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report The umbilical clue: recognizing Sister Mary Joseph Nodule João Lança Pereira, Elisa Veigas, Andreia Lopes, Catarina Silva, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6622952/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Sister Mary Joseph’s nodule (SMJN) is a rare manifestation of intra-abdominal malignancy presenting as a metastatic umbilical lesion. We report the case of an 82-year-old woman with no prior medical history who presented with asthenia, weight loss, and a violaceous, ulcerated umbilical lesion. Imaging revealed peritoneal carcinomatosis, pelvic lymphadenopathy, and a suspicious endometrial mass. Pelvic MRI identified a heterogeneous lesion within the endometrial cavity suggestive of neoplasia. Transvaginal ultrasound and hysteroscopy confirmed a friable, polypoid endometrial mass. Biopsies of both the cutaneous and endometrial lesions identified a serous endometrial adenocarcinoma with umbilical metastasis, confirmed by immunohistochemical markers (CK7+, PAX8+, CK20−, CDX2−). Given the extent of lymphatic and peritoneal spread, the patient was referred to palliative care. SMJN accounts for approximately 10% of cutaneous metastases and often signifies advanced disease with a poor prognosis. Although rare, it may be the first visible sign of a hidden malignancy. This case highlights the importance of considering SMJN in differential diagnoses of umbilical lesions and underscores the need for prompt investigation to determine the underlying pathology. Early recognition can aid in appropriate management, although treatment is typically palliative due to the advanced stage at diagnosis. Figures Figure 1 Figure 2 Figure 3 Full Text An 82-year-old woman with no known medical history was referred to the emergency department due to asthenia, weight loss, and an abdominal cutaneous lesion that had been growing over the last two months. Physical examination revealed a violaceous umbilical lesion with irregular borders, ulceration, and tenderness on palpation with serohematic discharge (Fig. 1 ) . All vital signs were within normal values. The possibility of a Sister Mary Joseph nodule was considered. To identify the primary tumor, a contrast-enhanced computed tomography (CT) scan of the thorax, abdomen and pelvis was ordered. The scan showed continuity between the umbilical lesion and multiple hypercaptating formations distributed along the omental and mesenteric planes consistent with peritoneal carcinomatosis. At the pelvic level, lymphadenopathy proliferation was visible as well as the presence of hydrocolpos and hyperenhancement along the inner perimeter of the endometrial region. No other significant findings were found. To further evaluate these findings, a pelvic magnetic resonance imaging (MRI) was performed. It revealed that the endometrial cavity was distended by a heterogeneous lesion with an intermediate T2 signal, measuring 15x25 mm, with an intralesional pedicle, suggesting a polypoid origin and raising suspicion of endometrial neoplasia (Fig. 2 ). Additionally, the previously described peritoneal implants were also identified, thus raising the hypothesis of endometrial neoplasia with lymphatic and peritoneal dissemination. The transvaginal ultrasound showed an enlarged uterus with a thickened and heterogeneous endometrium. The hysteroscopy revealed a hyperplasic and friable endometrium with multiple polypoid structures. Both the cutaneous and endometrial lesions were biopsied. The histological analysis of the umbilical lesion was suggestive of metastatic adenocarcinoma (Fig. 3 a) with immunohistochemical positivity for cytokeratin 7 (CK7) and paired box 8 (PAX8) (Fig. 3 b and 3 c), with CK20 and negative caudal type homeobox (CDX2), supporting the hypothesis of cutaneous metastasis from a genitourinary origin. Meanwhile, the endometrial biopsy confirmed the primary tumor, ultimately identified as a serous endometrial adenocarcinoma. Given the advanced stage of the disease with no possibility of cure, the patient was referred to palliative care. Cutaneous metastases are relatively rare, occurring in approximately 5–9% of cancer cases. Sister Mary Joseph’s nodule is a metastatic growth that manifests in the umbilicus, typically resulting from the spread of tumors from within the abdomen or pelvic cavity. This condition is uncommon, representing only about 10% of all cutaneous metastases [ 1 ]. In men, the gastrointestinal tract is the most frequent site of origin, with the stomach being the most commonly affected organ. In women, gynecological cancers, particularly epithelial ovarian tumors, are the most common primary sources [ 2 ]. From an anatomic-pathological perspective, the adenocarcinoma is the most common histological subtype [ 1 – 2 ]. Differential diagnoses may occasionally involve benign conditions like umbilical endometriosis, hernias, or benign umbilical tumors such as epidermal cysts or nevi. Additionally, some manifestations of Crohn's disease, granulomas, and hemangiomas may also be considered [ 3 ]. Since this lesion can sometimes be the first and only sign of an underlying malignancy, early detection is crucial for confirming the diagnosis and initiating timely intervention. The discovery of a Sister Mary Joseph nodule typically suggests advanced metastatic carcinoma with a dismal prognosis associated, with an average survival time of about 10 months. Treatment is often palliative, as methods such as wide excision, surgery, and radiotherapy have proven futile [ 4 ]. Sister Mary Joseph’s nodule is a rare but conspicuous symptom that always requires further investigation to clarify its etiology. While it is often associated with a poor prognosis, early diagnosis is crucial. In cases where a cure is not possible, timely palliative care can help ensure the best possible quality of life for patients. Declarations Conflict of Interest : The authors declare that they have no conflict of interest. Funding : No funding was received. Experimental Protocols: This publication is a clinical case report; therefore, no experimental protocols were implemented. Ethics approval and consent to participate: This article is a case report; therefore, approval was waived by the Comissão de Ética para a Saúde da ULSVDL ethics committee. This clinical case was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Informed consent was obtained from the patient. Consent to Publish: Informed consent was obtained to publish both the information and images presented in this work. Consent to Participate declaration : Not applicable. Clinical Trial Number : Not appliable. Data availability : The data used during the current study is available from the corresponding author upon reasonable request. References Al-Mashat F, Sibiany AM. Sister Mary Joseph’s nodule of the umbilicus: Is it always of gastric origin A review of eight cases at different sites of origin. Indian J Cancer. 2010;47(1):65–9. 10.4103/0019-509X.58862 . Gabriele R, Borghese M, Conte M, Basso L. Sister Mary Joseph’s nodule as a first sign of cancer of the cecum: report of a case. Dis Colon Rectum. 2004;47(1):115–7. 10.1007/S10350-003-0018-5 . Boufettal H, Hermas S, Mahdaoui S, Noun M, Samouh N. Nodule de Sœur-Marie-Joseph: à propos d’un cas. Imagerie de la Femme. 2011;21(2):83–5. 10.1016/J.FEMME.2011.03.002 . Dar IH, Kamili MA, Dar SH, Kuchaai FA. (2009): Sister Mary Joseph nodule-A case report with review of literature. J Res Med Sci , vol. 14, no. 6, p. 385. Accessed: Mar. 24, 2025. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC3129082/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6622952","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":487655051,"identity":"4042833c-66b1-444e-a316-a22cd7941cbd","order_by":0,"name":"João Lança 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18:23:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6622952/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6622952/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87550664,"identity":"116c09ee-a7b8-4d27-b9ca-da915736b7a0","added_by":"auto","created_at":"2025-07-25 06:14:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":388693,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea) \u003c/strong\u003eUmbilical lesion with serohematic discharge \u003cstrong\u003eb)\u003c/strong\u003e The same lesion magnified, showing its irregular borders and ulcerated areas\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6622952/v1/98a0fdf7b97fe4c9e22a82c3.png"},{"id":87551253,"identity":"76ae32b0-04f0-4273-928e-9e0f96e8f99a","added_by":"auto","created_at":"2025-07-25 06:22:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":239816,"visible":true,"origin":"","legend":"\u003cp\u003eParacoronal plane section of the pelvic MRI showing an heterogenous lesion with a pedicle suggestive of a polypoid lesion (arrow) with suspicious characteristics\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6622952/v1/da0c9eb1a4543d9221550a0d.png"},{"id":87550662,"identity":"6e19231e-b83b-4e7d-9f68-408e8d3d77cf","added_by":"auto","created_at":"2025-07-25 06:14:06","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":451167,"visible":true,"origin":"","legend":"\u003cp\u003eHistological analysis of the umbilical lesion \u003cstrong\u003ea) \u003c/strong\u003eHematoxylin and eosin stain, revealing atypical cell proliferation and irregular glandular structure in the dermis, suggestive of metastatic adenocarcinoma \u003cstrong\u003eb)\u003c/strong\u003ePositive CK7 stain highlighting abnormal glands in the dermis \u003cstrong\u003ec)\u003c/strong\u003e Strong PAX8 expression\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6622952/v1/2f9f16daae3aef83d9950112.png"},{"id":91619548,"identity":"efb115d1-a47e-4e29-bc8e-5ba3f7df2932","added_by":"auto","created_at":"2025-09-18 11:09:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1607381,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6622952/v1/bdcbcd79-6277-4b28-b23c-5d21e738d91f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The umbilical clue: recognizing Sister Mary Joseph Nodule","fulltext":[{"header":"Full Text","content":"\u003cp\u003eAn 82-year-old woman with no known medical history was referred to the emergency department due to asthenia, weight loss, and an abdominal cutaneous lesion that had been growing over the last two months.\u003c/p\u003e\u003cp\u003ePhysical examination revealed a violaceous umbilical lesion with irregular borders, ulceration, and tenderness on palpation with serohematic discharge (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. All vital signs were within normal values.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe possibility of a Sister Mary Joseph nodule was considered. To identify the primary tumor, a contrast-enhanced computed tomography (CT) scan of the thorax, abdomen and pelvis was ordered. The scan showed continuity between the umbilical lesion and multiple hypercaptating formations distributed along the omental and mesenteric planes consistent with peritoneal carcinomatosis. At the pelvic level, lymphadenopathy proliferation was visible as well as the presence of hydrocolpos and hyperenhancement along the inner perimeter of the endometrial region. No other significant findings were found.\u003c/p\u003e\u003cp\u003eTo further evaluate these findings, a pelvic magnetic resonance imaging (MRI) was performed. It revealed that the endometrial cavity was distended by a heterogeneous lesion with an intermediate T2 signal, measuring 15x25 mm, with an intralesional pedicle, suggesting a polypoid origin and raising suspicion of endometrial neoplasia (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Additionally, the previously described peritoneal implants were also identified, thus raising the hypothesis of endometrial neoplasia with lymphatic and peritoneal dissemination.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe transvaginal ultrasound showed an enlarged uterus with a thickened and heterogeneous endometrium. The hysteroscopy revealed a hyperplasic and friable endometrium with multiple polypoid structures.\u003c/p\u003e\u003cp\u003eBoth the cutaneous and endometrial lesions were biopsied. The histological analysis of the umbilical lesion was suggestive of metastatic adenocarcinoma (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea) with immunohistochemical positivity for cytokeratin 7 (CK7) and paired box 8 (PAX8) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ec), with CK20 and negative caudal type homeobox (CDX2), supporting the hypothesis of cutaneous metastasis from a genitourinary origin. Meanwhile, the endometrial biopsy confirmed the primary tumor, ultimately identified as a serous endometrial adenocarcinoma.\u003c/p\u003e\u003cp\u003eGiven the advanced stage of the disease with no possibility of cure, the patient was referred to palliative care.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCutaneous metastases are relatively rare, occurring in approximately 5\u0026ndash;9% of cancer cases. Sister Mary Joseph\u0026rsquo;s nodule is a metastatic growth that manifests in the umbilicus, typically resulting from the spread of tumors from within the abdomen or pelvic cavity. This condition is uncommon, representing only about 10% of all cutaneous metastases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn men, the gastrointestinal tract is the most frequent site of origin, with the stomach being the most commonly affected organ. In women, gynecological cancers, particularly epithelial ovarian tumors, are the most common primary sources [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. From an anatomic-pathological perspective, the adenocarcinoma is the most common histological subtype [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDifferential diagnoses may occasionally involve benign conditions like umbilical endometriosis, hernias, or benign umbilical tumors such as epidermal cysts or nevi. Additionally, some manifestations of Crohn's disease, granulomas, and hemangiomas may also be considered [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSince this lesion can sometimes be the first and only sign of an underlying malignancy, early detection is crucial for confirming the diagnosis and initiating timely intervention. The discovery of a Sister Mary Joseph nodule typically suggests advanced metastatic carcinoma with a dismal prognosis associated, with an average survival time of about 10 months. Treatment is often palliative, as methods such as wide excision, surgery, and radiotherapy have proven futile [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSister Mary Joseph\u0026rsquo;s nodule is a rare but conspicuous symptom that always requires further investigation to clarify its etiology. While it is often associated with a poor prognosis, early diagnosis is crucial. In cases where a cure is not possible, timely palliative care can help ensure the best possible quality of life for patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funding was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Protocols:\u003c/strong\u003e This publication is a clinical case report; therefore, no experimental protocols were implemented.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate: \u003c/strong\u003eThis article is a case report; therefore, approval was waived by the Comiss\u0026atilde;o de \u0026Eacute;tica para a Sa\u0026uacute;de da ULSVDL ethics committee. This clinical case was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Informed consent was obtained from the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish: \u003c/strong\u003eInformed consent was obtained to publish both the information and images presented in this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e: Not appliable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e: The data used during the current study is available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAl-Mashat F, Sibiany AM. Sister Mary Joseph\u0026rsquo;s nodule of the umbilicus: Is it always of gastric origin A review of eight cases at different sites of origin. Indian J Cancer. 2010;47(1):65\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0019-509X.58862\u003c/span\u003e\u003cspan address=\"10.4103/0019-509X.58862\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGabriele R, Borghese M, Conte M, Basso L. Sister Mary Joseph\u0026rsquo;s nodule as a first sign of cancer of the cecum: report of a case. Dis Colon Rectum. 2004;47(1):115\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/S10350-003-0018-5\u003c/span\u003e\u003cspan address=\"10.1007/S10350-003-0018-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoufettal H, Hermas S, Mahdaoui S, Noun M, Samouh N. Nodule de Sœur-Marie-Joseph: \u0026agrave; propos d\u0026rsquo;un cas. Imagerie de la Femme. 2011;21(2):83\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/J.FEMME.2011.03.002\u003c/span\u003e\u003cspan address=\"10.1016/J.FEMME.2011.03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDar IH, Kamili MA, Dar SH, Kuchaai FA. (2009): Sister Mary Joseph nodule-A case report with review of literature. \u003cem\u003eJ Res Med Sci\u003c/em\u003e, vol. 14, no. 6, p. 385. Accessed: Mar. 24, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC3129082/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC3129082/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6622952/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6622952/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSister Mary Joseph\u0026rsquo;s nodule (SMJN) is a rare manifestation of intra-abdominal malignancy presenting as a metastatic umbilical lesion. We report the case of an 82-year-old woman with no prior medical history who presented with asthenia, weight loss, and a violaceous, ulcerated umbilical lesion. Imaging revealed peritoneal carcinomatosis, pelvic lymphadenopathy, and a suspicious endometrial mass. Pelvic MRI identified a heterogeneous lesion within the endometrial cavity suggestive of neoplasia. Transvaginal ultrasound and hysteroscopy confirmed a friable, polypoid endometrial mass. Biopsies of both the cutaneous and endometrial lesions identified a serous endometrial adenocarcinoma with umbilical metastasis, confirmed by immunohistochemical markers (CK7+, PAX8+, CK20\u0026minus;, CDX2\u0026minus;). Given the extent of lymphatic and peritoneal spread, the patient was referred to palliative care. SMJN accounts for approximately 10% of cutaneous metastases and often signifies advanced disease with a poor prognosis. Although rare, it may be the first visible sign of a hidden malignancy. This case highlights the importance of considering SMJN in differential diagnoses of umbilical lesions and underscores the need for prompt investigation to determine the underlying pathology. Early recognition can aid in appropriate management, although treatment is typically palliative due to the advanced stage at diagnosis.\u003c/p\u003e","manuscriptTitle":"The umbilical clue: recognizing Sister Mary Joseph Nodule","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-25 06:14:02","doi":"10.21203/rs.3.rs-6622952/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5d69c03-62ad-41fe-a037-4b5e603287de","owner":[],"postedDate":"July 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T11:09:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-25 06:14:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6622952","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6622952","identity":"rs-6622952","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}