Free
Clinical Images  |   July 2012
Sister Mary Joseph Nodule From Prostate Cancer
Author Notes
  • From the departments of internal medicine (Dr Kruczek) and hematology and oncology (Dr Nabhan) at Advocate Lutheran General Hospital in Park Ridge, Illinois 
  • Address correspondence to Kimberly Kruczek, DO, Department of Internal Medicine, Advocate Lutheran General Hospital, 1775 Dempster St, Park Ridge, IL 60068-1143. E-mail: kimberly.kruczek@advocatehealth.com  
Article Information
Imaging / Urological Disorders / Clinical Images
Clinical Images   |   July 2012
Sister Mary Joseph Nodule From Prostate Cancer
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 462. doi:10.7556/jaoa.2012.112.7.462
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 462. doi:10.7556/jaoa.2012.112.7.462
An 81-year-old man presented with a nonbleeding umbilical nodule that developed 2 weeks before presentation (panel A). The patient had a history of prostate cancer that was diagnosed in 1995 (Gleason score, 8; prostate-specific antigen [PSA] level, 29 ng/mL) and managed with external beam radiotherapy and brachytherapy. Antiandrogen therapy was initiated 6 years later because of elevated PSA levels (12.2 ng/mL). The patient developed metastatic cancer with bladder invasion in 2010. He completed 4.5 cycles of lenalidomide (28-day cycle; 25 mg on days 1-21) but discontinued therapy because of fatigue. The patient underwent 3 infusions of sipuleucel-T immunotherapy, at which time the umbilical nodule developed. Topical antimicrobial treatment provided no resolution. Biopsy of the nodule revealed the presence of PSA, confirming metastasis from prostate cancer (panel B). The patient died approximately 10 months later. Sister Mary Joseph nodules are rare physical findings usually seen in patients with gastric or ovarian malignancies.1 Cases of Sister Mary Joseph nodules are seen infrequently in patients with prostate cancers and foretell poor outcomes.2 
   Financial Disclosures: None reported.
 
   Authors interested in contributing to “Clinical Images” should refer to the JAOA's “Information for Contributors” at http://www.jaoa.org/misc/ifora.shtml. Submissions should be sent to jaoa@osteopathic.org
 
References
Sina B, Deng A. Umbilical metastasis from prostate carcinoma (Sister Mary Joseph's nodule): a case report and review of the literature. J Cutan Pathol. 2007;34(7):581-583. [CrossRef] [PubMed]
Deb P, Rai RS, Rai R, Gupta E, Chander Y. Sister Mary Joseph nodule as the presenting sign of disseminated prostate carcinoma. J Cancer Res Ther. 2009;5(2):127-129. [CrossRef] [PubMed]