Am Fam Physician. 1999 Jun 1;59(11):2984.
to the editor: We appreciated the thorough review of lymphadenopathy in Dr. Ferrer's recent article.1 We would like to point out that the paraumbilical nodule (“Sister Joseph's node”), cited by Dr. Ferrer as a sign of an abdominal or pelvic neoplasm, is not a lymph node but rather a direct metastatic lesion to the umbilicus.2,3 The nodule is most commonly associated with metastatic gastric or ovarian cancer.3 Less commonly, the nodule may be a metastatic lesion from colon or pancreatic cancer.3 The most important route for the spread of cancer to the umbilicus is considered to be direct extension from the anterior peritoneum.2
Whether the proper eponym for the nodule is Sister Mary Joseph's node or Sister Joseph's node has been debated. Sister (Mary?) Joseph was the daughter of Irish immigrants who settled in Minnesota.2 In the 1890s, she became the superintendent of Saint Mary's Hospital (part of the early Mayo Clinic) in Rochester.2 Her responsibilities included preparing abdomens of patients for surgery, and during this task she pointed out a paraumbilical nodule that was associated with advanced intra-abdominal cancer.2 The nodule was first named Sister Joseph's nodule by Sir Hamilton Bailey in 1949.2,3
In any event, the rare finding of a paraumbilical nodule suggests an intra-abdominal malignancy and warrants further evaluation. Fortunately, the accessibility of the nodule makes histologic diagnosis relatively simple.
REFERENCESshow all references
1. Ferrer R. Lymphadenopathy: differential diagnosis and evaluation. Am Fam Physician. 1998;58:1313–20....
2. Hill M, O'Leary JP. Vignettes in medical history. Sister Mary Joseph and her node. Am Surgeon. 1996;62:328–9.
3. Skellchock LE, Goltz RW. Umbilical nodule: metastatic adenocarcinoma (Sister Mary Joseph nodule). Arch Derm. 1992;128:551–2.
4. Schwartz IS. Sister (Mary?) Joseph's nodule. N Engl J Med. 1987;316:1348–9.
editor's note: This letter was sent to the author of “Lymphadenopathy: Differential Diagnosis and Evaluation,” who declined to reply.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 1999 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions