hello kids,

I have serious one for you today, my lovelies.  can you tell me the
definition of this nodule (aka Sister Joseph nodule)?  I'd also like
to know the following:

symptoms?
endoscopic photo of SMJN v. hiatal hernia? (if you can find one)
how is it diagnosed?  exam?  x-ray?  other?
has it ever been misdiagnosed as a hiatal hernia?

I know this is a very specialized question and should be addressed by
a physician (yada-yada) but I'd like the information anyway.  please
no one get their shorts in an uproar that you're dispensing medical
advice.  you're not.  you're dispensing information.  just after some
facts here and I would be most grateful to anyone willing to tackle
this assignment.  thanks again for all your diligent effort.

ever curious (and in no hurry, as usual)
GB

Hi badabing:

Yes, this is indeed a "serious one". This "Sister Joseph's Nodule" or
"Sister Mary Joseph's Nodule" certainly seems like something that
shouldn't be trifled with...

[I hereby dispense with all the yada-yada about getting professional
medical advice - as you've so obviously heard it before - and move
straight onto dispensing with the information.]


Definition:
***********

"Sister Mary Joseph's nodule is a collective term for any metastatic
deposit at the umbilicus originating from a primary malignancy which
is frequently intra-abdominal."
From: http://www.uhrad.com/ctarc/ct193.htm

"The term Sister Joseph's Nodule is used to describe a malignant
umbilical tumor. The tumor is usually associated with advanced,
metastasizing intra-abdominal cancer."
From: http://www.turner-white.com/pdf/hp_may01_sister.pdf

All the other definitions I found were variations on the above theme.


Symptoms:
*********

"In most patients who have such a metastatic lesion, it is the lesion
and not the development of other symptoms of a malignancy that prompts
them to seek medical attention."
From: http://www.corecontent.com/prod11.htm

"Patients with Sister Joseph’s nodule may present with a number of
other clinical symptoms consistent with intra-abdominal cancer,
including epigastric pain, abdominal distension, weight loss, nausea,
and ascites."
From: http://www.turner-white.com/pdf/hp_may01_sister.pdf


Photos:
*******

While I was unable to find any *endoscopic* photos of this condition,
I was able to find many other types of images, including:

CAT Scans:
http://www.uhrad.com/ctarc/ct193.htm
http://www.turner-white.com/pdf/hp_may01_sister.pdf
http://www.rbrs.org/journal/volume80/page317.html

External Pictures:
http://www.corecontent.com/prod11.htm
http://www.turner-white.com/pdf/hp_may01_sister.pdf
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cjs/vol-40/issue-3/0167fig1.htm
http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cjs/vol-40/issue-3/0167fig1.htm

Ultrasound:
http://www.rbrs.org/journal/volume80/page317.html

As for hiatal hernias, there are plenty of endoscopic pictures around
of these:

Endoscopic:
http://www.luz.ve/ICA/Atlas_med/html/english/i_Esofago/i_hernia.html
http://www.mindspring.com/~dmmmd2/es_ge_03.html
http://www.endo-world.com/images/Peptic/peptic15.jpg
http://www.gastrolab.net/ng023.htm
http://www.gastrolab.net/ng002.htm


Diagnosis:
**********

"Initial investigation should be to obtain a histologic diagnosis.
Previously, an excisional biopsy would be performed. Currently, a
fine-needle aspiration biopsy provides the diagnosis with minimal
patient discomfort. Selection of other invasive tests (such as upper
and lower endoscopy) and imaging studies (such as CT of the abdomen)
will depend on the findings of the biopsy."
From: http://www.corecontent.com/prod11.htm

"Some patients, however, may present with an umbilical nodule, which
could be Sister Joseph’s nodule, but they may have no other signs or
symptoms of an internal malignancy. Thus, a histologic examination of
a biopsy specimen from the nodule becomes important in determining a
diagnosis."
From: http://www.turner-white.com/pdf/hp_may01_sister.pdf


Misdiagnosis as Hiatal Hernia:
******************************

I found the following information about Sister Joseph's Nodule being
mistaken for a hernia:

One page (http://www.surgical-tutor.org.uk/default-home.htm?system/abdomen/hernias2.htm~right)
listed  it as a "Differential Diagnosis" for "Umbilical Hernia".
Differential diagnosis means something commonly mistaken for another
ailment.

Another page agreed with the above and added a couple of other
possibly mistaken diagnoses:

"The differential diagnosis of an umbilical nodule includes, but is
not limited to, granuloma (pyogenic, foreign body), urachal duct cyst,
endometrioma, keloid, hernia and epithelial inclusion cyst."
From: http://www.aafp.org/afp/20000801/photo.html


Other Pages of Interest:
************************

Of course, reading the relevant sections of all of the URLs I've
provided would be a great place to start. Some other pages not quoted
above are:

A Case Study Approach to Abdominal Assessment
http://www.npace.org/journal/Vol_6_No_1/003-010.Solomon_new.pdf

Sister Mary Joseph's nodule. A case report.
http://www.crcpr-online.com/pub/vol_3/no_5/576.pdf


I hope this information is of help! If you need clarification of
anything I've provided, please ask using the Clarification feature.

Thanks. 

websearcher-ga


Search Strategy:

"Sister Joseph's nodule"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22Sister+Joseph%27s+nodule%22

"Sister Joseph's nodule" OR "Sister Mary Joseph's Nodule"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22Sister+Joseph%27s+nodule%22+OR+%22Sister+Mary+Joseph%27s+Nodule%22

"Sister Joseph's nodule" OR "Sister Mary Joseph's Nodule" symptoms
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=%22Sister+Joseph%27s+nodule%22+OR+%22Sister+Mary+Joseph%27s+Nodule%22+symptoms

hernia "Sister Joseph's nodule" OR "Sister Mary Joseph's Nodule"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=hernia+%22Sister+Joseph%27s+nodule%22+OR+%22Sister+Mary+Joseph%27s+Nodule%22

endoscopic "Sister Joseph's nodule" OR "Sister Mary Joseph's Nodule"
://www.google.com/search?hl=en&lr=&ie=ISO-8859-1&safe=off&q=endoscopic+%22Sister+Joseph%27s+nodule%22+OR+%22Sister+Mary+Joseph%27s+Nodule%22

perfect, just what I wanted!  well-organized and well-documented and
lots of links.  thanks so much for being my hunter-gatherer on this
not-very-sexy topic.

It's probably clear from the above links, but I thought I'd stop by to
say that there is no relation whatever between hiatal hernia and
Sister Mary Joseph's sign: the latter refers to the umbilicus (belly
button), and the former is herniation of the esophagus through the
diaprhagm. And since the belly button is not connected to the
esophagus or other parts of the intestine (well, there are a couple of
rare situations...) there is no way to get endoscopic pictures of it.
Umbilical hernia, an entirely different animal from hiatal hernia, can
indeed be confused with the SMJN; the latter being rare enough that
absent symptoms of the originating cancer, a lump in the belly button
that has not eroded the surface skin could be mistaken for an
incarcerated (stuck) umbilical hernia

hey doc,

gee, thanks for that backdoor consult!  sure hope you can stick around
for a bit.  wasn't that savvy on the location of this nodule but
"websearcher" set me straight that it is in the umbilical region
rather than esophageal area, so I can cross that off my "things to
worry about" list.

would sure like your opinion on this Google Answers thing as it
pertains to medical questions (if you'd like to venture forth). 
thanks again!

graduate of Wood E. Allen School of Hypochondria,
grannybing