Sister Joseph Nodules are present at: March 2005

Ans. A: Umbilicus Sister Mary Joseph nodule/node/ Sister Mary Joseph sign, refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen. Gastrointestinal malignancies account for about half of underlying sources (most commonly gastric cancer, colonic cancer or pancreatic cancer, mostly of the tail and body of the pancreas), and men are even more likely to have an underlying cancer of the gastrointestinal tract. Gynecological cancers account for about 1 in 4 cases (primarily ovarian cancer and also uterine cancer). Unknown primary tumors and rarely, urinary or respiratory tract malignancies cause umbilical metastases. Proposed mechanisms for the spread of cancer cells to the umbilicus include direct transperitoneal spread, the lymphatics which run alongside the obliterated umbilical vein, hematogenous spread, or remnant structures such as the falciform ligament, median umbilical ligament, or a remnant of the vitelline duct. Sister Joseph nodule is associated with multiple peritoneal metastases and a poor prognosis. Virchow's node (or signal node) is an enlarged, hard, left supraclavicular lymph node which can contain metastasis of visceral (abdominal) malignancy.