This weekly series highlights eponyms in oncology. This week, we explore the history and namesake of the Sister Mary Joseph nodule.

The Sister Mary Joseph Nodule (SMJN) is a palpable cutaneous nodule in the periumbilical area that represents umbilical metastasis.1 

SMJNs are described in 1% to 3% of patients with neoplasia of abdominopelvic origin.2 The most common cancers are gastric (30%), colorectal (25%), and pancreatic (18%) cancer in men, and ovarian (34%), endometrial (12%), and colorectal (12%) cancer in women. However, in 14% to 33% of cases, the origin of the primary tumor is unknown.

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SMJNs are usually indurated and firm.1 They may be white, red, or purple in color. They may be necrotic and ulcerated, with an associated discharge. Although SMJNs are usually painless, ulceration can be associated with pain. The nodules are usually 0.5 cm to 2 cm in size but can be much larger.3

SMJNs are generally associated with poor prognosis from widespread intra-abdominal or pelvic disease.1 

History of the Name

Sister Mary Joseph Dempsey is the namesake of the Sister Mary Joseph nodule. She was born Julia Dempsey in New York in 1856.1 In 1878, she entered the congregation of Our Lady of Lourdes in Rochester, Minnesota, and took the name Sister Mary Joseph. 

She began working at St. Mary’s Hospital in Rochester, Minnesota, in 1889.4 She studied nursing there, and, in 1890, she was appointed first surgical assistant to William James Mayo, MD. In 1892, she was appointed the nursing superintendent at the hospital, and she retained this role until her death in 1939. In 1906, she opened St. Mary’s Hospital School for Nurses.

While serving as a surgical assistant, Sister Mary Joseph noted that a group of patients with gastric cancer had umbilical nodules.1 She also observed that patients with these nodules had advanced cancer and worse prognosis. 

She presented her findings to Dr Mayo, who published the observations in the Mayo Clinic Proceedings in 1928. He described the umbilical nodule as “pants-button” umbilicus.

The term “Sister Mary Joseph nodule” was coined a decade after her death. In 1949, Hamilton Bailey, an English surgeon, used the term when describing the nodule in his textbook, Demonstrations of Physical Signs in Clinical Surgery.

References

  1. Kumar P, Brazel D, Benjamin DJ, Brem E. Eponyms in medical oncology. Cancer Treat Res Commun. 2022;31:100516. doi:10.1016/j.ctarc.2022.100516 
  2. Leyrat B, Bernadach M, Ginzac A, et al. Sister Mary Joseph Nodules: A case report about a rare location of skin metastasis. Case Rep Oncol. 2021 Apr 8;14(1):664-670. doi:10.1159/000515298.
  3. Vekariya P, Daneti DB, Selvan KS, et al. Sister Mary Joseph nodule as an initial presentation of pancreatic adenocarcinoma. ACG Case Rep J. 2020 Aug; 7(8): e00453. doi:10.14309/crj.0000000000000453 
  4. Britannica. Sister Mary Joseph Dempsey, American nurse. Updated March 25, 2022. Accessed March 25, 2022. https://www.britannica.com/biography/Sister-Mary-Joseph-Dempsey

This article originally appeared on Cancer Therapy Advisor

Topics:

Gastrointestinal Cancer General Oncology Gynecologic Cancers