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