The name, was originally coined by Sir Hamilton Bailey, an English surgeon and the first to mention it in its book “Demonstrations of Physical Signs in Clinical Surgery”, published in 1949, honoring the Sister Mary Joseph (1856-1939) (Figure 1), who was superintendent nurse and Dr. William Mayo most frequent first assistant, at the St. Mary’s Hospital (now Mayo Clinic) of Rochester, Minnesota.

The Sister Mary Joseph, was the first person who observed that the patients with advanced abdominal-pelvic malignancies, frequently presented a periumbilical palpable nodule. ^{3, 4} Until now, over 400 cases has being published. ⁵

Figure 1. Figure 1. Julia Dempsey (Sister Mary Joseph) (1856-1939). Born in Salamanca, New York, child of Irish immigrants, Julia Dempsey joins in 1878 the “Our Lady of Lourdes” congregation in Rochester, Minnesota, becomes a nun and adopts the name of Sister Mary Joseph. In 1889 ends the construction of the Saint Mary’s hospital, in Rochester, that latter would become the Mayo Clinic. The close relation between its congregation and the St. Mary’s hospital allows the Sister Mary Joseph to start working as a nurse in 1889 and just 6 weeks later is entitled as chief of the nursing department. A year later she becomes first surgical assistant of the Dr. William J. Mayo. Due its exceptional management capacities, 3 years later, she became superintendent of the whole hospital. At the hospital, the Mayo’s brothers soon adopted the last advances in the fields of anesthesia, asepsis/antisepsis and hemostasis; this allowed them to improve the abdominal surgical technic. In acknowledgment of the Sister Mary Joseph achievements and qualities, the Mayo brothers involved her in their surgical practice; she was in charge of the patient preparation and even started the surgery and closed the incision. In a short time, she noticed the relation between the presence of the periumbilical nodule and the advanced intraabdominal malignancy, even allowing her to “select” the patients that could be good surgery candidates with full support of the Mayo brothers. Recently, the original Saint Mary’s hospital building has been renamed as Joseph’s Hospital in her honor. http://www.historiadelamedicina.org/mariajose.html https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101420097-img A) Portrait of the Sister Mary Joseph; B) Drawing of the Sister Mary Joseph, noticing the nodule; C) Picture of the original dependencies of the Saint Mary’s Hospital, now Mayo Clinic. Source: Pictures from the History of Medicine (NLM). Bethesda, MD: U.S. National Library of Medicine.

The SMJN represents a cutaneous metastatic nodule located in the periumbilical cutaneous area. This nodule almost every time is a secondary location of an advanced intraabdominal malignancy and is considered as a very poor prognosis sign with an average life expectancy no greater than 6 months. Careful examination of all umbilical lesions is recommended. Most of the clinical diagnosed SMJNs are metastases of intraabdominal carcinomas that are observables in MDCT studies; 52% of these cases are secondary locations of gastrointestinal neoplasms and a 28% are gynecologic metastases. Although the diagnose of the SMJN originally translated essentially an advanced cancer of unknown origin, today, its presence may represent up to 40%, recurrence of a previously treated malignancy.

The etiology of the primary malignancy determines the prognosis, and MDCT images and Fine Needle Aspiration Cytology of the tumor are invaluable in the diagnosis and recognition of the primary lesion.

The Sister Joseph`s nodule remains an interesting and valid useful radiologic and clinical sign in our days. Its correct diagnose is invaluable and the prognosis depends on it, radiologists must be aware.

Conflict of interest statement and founding. We declare that we did not have any conflict of interest at the submission time, and this paper did not receive any kind of external founding or sponsorship.