Fungating sister mary joseph’s nodule as an initial manifestation of transverse colon adenocarcinoma

Abstract

Sister Mary Joseph’s nodule refers to a palpable umbilical metastasis secondary to underlying abdominopelvic malignancies (gastric, colonic, pancreatic, ovarian and uterine cancer). The clinical appearance varies from small nodule to a large fungating or ulcerated lesion. Proposed hypothesis for spread is through  direct trans-peritoneal extension via lymphatic running along the obliterated umbilical vein, hematogenous spread or via median umbilical ligament or a remnant of the umbilical duct. Sister Mary Joseph nodule is associated with dismal prognosis. Here-in we present a case of 76 year old Saudi woman who presented with initial manifestation of Sister Marry Joseph’s nodule which subsequently diagnosed as case of underlying metastatic adenocarcinoma of transverse colon and was treated with systemic chemotherapy and radiotherapy to Sister Marry Joseph’s nodule.