Image Challenge of the Week!

What is the following palpable, non-reducible, and non-painful physical exam finding and what disease does it suggest?

SMJ nodule
Cureus. 2018 Feb; 10(2): e2244.

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Answer:

Sister Mary Joseph nodule; advanced malignancy usually of gastrointestinal or gynecologic origin

Discussion:

The Sister Mary Joseph nodule is a rare finding representing a periumbilical or umbilical metastasis from a malignancy usually of the gastrointestinal tract or ovary.

More examples are shown here:

SMJ nodule 2
SMJ nodule 3
Med Arch. 2017 Apr; 71(2): 154–157.

Fun fact: Sister Mary Joseph was a nurse and first surgical assistant to Dr. William Mayo of the Mayo Clinic. She was a key player in the success of the Mayo Clinic. During her time preparing patients for surgery, she sometimes noted periumbilical nodules in patients with advanced visceral malignancies and brought this to the attention of Dr. Mayo. This finding was eventually given its eponym in her honor.