Sister Mary Joseph's Nodule as Initial Presentation of Pancreatic Adenocarcinoma

A 60-year-old man came to the emergency department due to persistent omphalitis, treated with antibiotic therapy, that had been progressing for 4 months. He reported lower back pain with no evident toxic symptoms. On examination, a hard umbilical mass was observed with seropurulent discharge (Fig. 1).

Figure 1

Computed tomography revealed a pancreatic tumor with extensive local invasion (Fig. 2), as well as peritoneal carcinomatosis with multiple implants, one in the umbilical region. The pathology results of the umbilical nodule identified adenocarcinoma of pancreatic–biliary origin, which confirmed the diagnosis of Sister Mary Joseph's nodule. After evaluation by the multidisciplinary committee, treatment with palliative chemotherapy was started.

Figure 2