The Sister Mary Joseph Nodule (SMJN) is a well-known manifestation of intraabdominal malignancy. The majority of published case reports demonstrate that SMJNs typically arise from a gastrointestinal or gynecologic source. Furthermore, these patients have a dismal prognosis, with many patients dying within a few months of diagnosis. We aimed to conduct a comprehensive review of patients with SMJNs in order to better illustrate the underlying malignancy and to better elucidate survival outcomes.
We retrospectively reviewed charts from 1992 to March 2017 that included descriptions of the “Sister Mary Joseph Nodule”, such as umbilical nodule, umbilical node, and umbilical metastasis. After ensuring that an appropriate physical examination indicative of an SMJN was documented, pathology reports were reviewed to confirm that patients had a biopsy proven umbilical metastasis. Abstracted data included basic demographics at diagnosis, primary cancer site, treatment modalities, and survival. Microsoft Excel and JMP pro were used for computation of descriptive statistics, hypothesis testing with analysis of variance, Χ2, and student’s t-test as indicated, and survival characteristics.
A total of 113 biopsy proven SMJN patients were included in the final analysis. Overall mortality was 79.6%, with follow up ranging from 0.4 to 231.5 months. Of those followed for at least 2 years and 5 years, two year mortality was 61.6%, and 5 year mortality was 87.4%. 47.8% of patients had a primary GI malignancy (of these, 31.5% colorectal), 35.4% had a primary gynecologic malignancy (of these, 52.5% ovarian), and 4.4% had a primary hematologic malignancy. The remainder had a mix of various primary tumor types, each less than 2.6% of the total. Of those that died, median survival was 14.6 months (IQR 5.2-30.0 months). In deceased patients and those with at least 14.6 months of follow-up, improved average survival was associated with gynecologic cancer compared to primary GI neoplasia (38.8 months vs 19.0 months; p
The finding of a biopsy proven SMJN confirms a poor prognosis, with a median survival of 14.6 months. The most commonly implicated malignancies arise from a gastrointestinal (colorectal) and gynecologic (ovarian) source. Gynecologic malignancies presenting with an SMJN have improved survival compared to patients with gastrointestinal primaries. Treatment with chemotherapy and surgery, regardless of primary tumor type, shows improved survival compared to chemotherapy alone or no treatment.
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All authors have declared no conflicts of interest.