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.

editor's note: This letter was sent to the author of “Lymphadenopathy: Differential Diagnosis and Evaluation,” who declined to reply.