[Sister Mary Joseph's nodule].

44 SA JOURNAL OF RADIOLOGY • September 2006 Cutaneous metastases localised to the umbilicus are named ‘Sister Mary Joseph’s nodules’. Sister Mary Joseph, who was the superintendent nurse and surgical assistant of Dr William Mayo at St. Mayo Hospital from 1856 to 1939, was the first to note the link between umbilical nodules and intra-abdominal malignancies. Metastases to the umbilicus are uncommon and represent only 10% of all secondary tumours which have spread to the skin. This umbilical nodule usually represents a poor prognosis. Umbilical neoplastic nodules may be due to a primary tumour in 38% of cases, to endometriosis in 32% of individuals and in 30% may actually be secondary tumour deposits from a primary tumour elsewhere. In the case of metastases the source of the primary tumour is usually the gastro-intestinal (35-65%) or genito-urinary (12-35%) tract. This case demonstrates the presence of a large Sister Mary Joseph’s nodule in a 16-year-old female patient who presented with a recurrence of a yolk sac tumour locally, and peritoneal, subserosal and liver metastases. Clinically an umbilical node was palpable.