Gastric carcinoma of the umbilicus: case report of Sister Mary Joseph nodule.

Sister Mary Joseph nodule is a metastatic lesion of the umbilicus, which is an uncommon phenomenon that carries an ominous prognosis. We describe a patient with gastric cancer who presented with asymptomatic papules on the umbilicus proven to be metastatic foci by biopsy. The lesion represented spread of the malignancy despite chemotherapy; thus, treatment was initiated with second-line agents. Sister Mary Joseph nodule can be the first presenting sign of an occult malignancy, or as demonstrated in this case, a sign of disease progression. Given the variable appearance of the lesions, a high index of suspicion is necessary to make an accurate diagnosis.