Sister Mary Joseph nodule in umbilical hernia
Known metastatic pancreatic cancer. Now has a palpable lump in umbilicus.
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Subtle but definite thickening of the greater omentum (arrow) indicative of peritoneal metastases extending via an umbilical hernia into the umbilicus where there is a more focal (solid) mass indicative of a Sister Mary Joseph tumour nodule.
These Mary Joseph nodules reflect peritoneal tumour infiltration (ovarian, gastro-intestinal including pancreas primary) to enter the umbilicus via transcoelomic spread . They can also arrive in the umbilicus via the para-umbilical vein. In this case a small umbilical hernia has allowed tumour in the greater omentum to exit the abdominal cavity.