Sister Mary Joseph’s nodule - A rare metastasis of hilar cholangiocarcinoma - A new case report and review of the literature

Sep 23, 2026

Uploaded by Oliver

Sister Mary Joseph’s nodule (SMJN) is a rare cutaneous sign of metastatic abdominal malignancy, particularly cholangiocarcinoma, with few cases reported and typically indicating advanced, widely metastatic disease and poor prognosis. A 46-year-old patient presented with right upper quadrant pain, obstructive jaundice, and fever, progressing to an ulcerated tender umbilical nodule. Imaging showed hilar cholangiocarcinoma with extensive local invasion and multiple distant metastases. Biopsy confirmed metastatic biliary adenocarcinoma, and palliative care was initiated. Recognition supports prompt diagnosis and tailored palliative interventions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Introduction

Case presentation

Discussion

Conclusion

Heliyon 11 (2025) e42449 Contents lists available at ScienceDirect Heliyon journal [homepage:](homepage: www.cell.com/heliyon)[ www.cell.com/heliyon](homepage: www.cell.com/heliyon) | Case report
Sister Mary Joseph’s nodule: A rare metastasis of hilarcholangiocarcinoma: A new case report and review of the literature
Imen Ben Ismail a,*, Mouna Mlikab, Ghazi Manaia, Saber Rebiia, Kamel Karma a, Ayoub Zoghlamia
a University of Tunis El Manar, Department of General Surgery, Trauma Center Ben Arous, Tunisia b University of Tunis El Manar, Department of Pathology, Trauma Center Ben Arous, Tunisia | | | --- | --- | | A R T I C L E I N F O
Keywords:
Cholangiocarcinoma. umbilical metastasis Sister Mary Joseph’s nodule
Palliative care
Case report | A B S T R A C T
Introduction: Sister Mary Joseph’s Nodule (SMJN) is a rare clinical sign of metastatic abdominal malignancies, particularly cholangiocarcinoma, with limited reported cases in the literature. SMJN is associated with poor prognosis, often indicating advanced disease with widespread metastasis.
Case presentation: we present a new case report of SMJN in a 46-year-old patient who presented with ten days of right upper quadrant pain, obstructive jaundice, and fever. Physical examination revealed obstructive jaundice with scratchy lesions in the trunk and tenderness in the right upper quadrant, along with a two-centimeter protuberant, tender ulcerated umbilical nodule. Despite previous management with antibiotics and local care, the nodule had been progressively growing over a month. Imaging studies revealed a hilar cholangiocarcinoma with extensive local invasion and multiple distant metastases, including cutaneous involvement at the umbilicus. Biopsies of the umbilical lesion confirmed metastatic adenocarcinoma of the biliary tree. Palliative measures, including biliary stent placement and chemotherapy, were initiated.
Discussion: SMJN is a rare but notable cutaneous manifestation associated with advanced intraabdominal malignancies. Although often linked to gastric, pancreatic, and ovarian cancers, it is uncommonly reported with cholangiocarcinoma. SMJN typically signifies a late-stage, metastatic progression, with prognosis largely determined by the underlying primary cancer’s aggressiveness and the extent of metastasis. In this case, SMJN presented alongside other symptoms of advanced disease, such as obstructive jaundice and extensive local invasion, underscoring its prognostic significance. Recognition of SMJN is essential for prompt diagnosis and initiation of palliative interventions in patients with suspected metastatic disease. This case adds to the limited literature on cholangiocarcinoma-associated SMJN and highlights the need for awareness among clinicians regarding atypical metastatic presentations, which may facilitate earlier diagnosis and tailored care strategies.
Conclusion: This case emphasizes the importance of recognizing SMJN as a rare but crucial indicator of advanced cholangiocarcinoma. It highlights the clinical challenges posed by metastatic cholangiocarcinoma and underscores the need for a comprehensive approach to palliative care inpatients with SMJN. | * Corresponding author. E-mail address: [imen_bi@yahoo.fr](imen_bi@yahoo.fr) (I. Ben Ismail). [https://doi.org/10.1016/j.heliyon.2025.e42449](https://doi.org/10.1016/j.heliyon.2025.e42449) Received 30 October 2024; Received in revised form 31 January 2025; Accepted 3 February 2025 Available online 3 February 2025 2405-8440/© 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). 1. Introduction Cholangiocarcinoma, a malignant tumor originating from the biliary epithelium, remains a significant challenge in hepatobiliary surgery due to its often insidious onset and poor prognosis. It accounts for ap

FAQs

What is Sister Mary Joseph’s nodule and why is it significant?

Sister Mary Joseph’s nodule is a rare clinical sign of metastatic abdominal malignancy, often indicating advanced disease with widespread metastasis and poor prognosis.

What symptoms and findings were present in the reported case?

The patient presented with right upper quadrant pain, obstructive jaundice, fever, and a progressively growing two-centimeter tender ulcerated umbilical nodule. Imaging showed hilar cholangiocarcinoma with extensive local invasion and distant metastases.

How was the diagnosis confirmed and what treatment was started?

Biopsies of the umbilical lesion confirmed metastatic adenocarcinoma of the biliary tree. Palliative measures, including biliary stent placement and chemotherapy, were initiated.

Sep 23, 2026

Uploaded by Oliver