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The diagnosis was Sister Mary nodule/metastatic umbilical deposit. The half body positron emission tomography (PET) examination (fig 1) demonstrated a circumferential area of increased 18F-fluorodeoxyglucose (FDG) uptake (black arrow) in the region of the cardia of the stomach. This corresponded to the site of endoscopic biopsy that revealed adenocarcinoma of the gastro-oesophageal junction. Another focus of hypermetabolic activity was seen in the periumbilical region (white arrow), representing a metastatic unbiblical deposit. In the 16 detector multislice computed tomography (CT) examination (fig 2), this umbilical lesion was shown as a high density nodule (white arrow).

Sister Mary Joseph, the First Assistant in the early days of the Mayo Clinic, noticed umbilical lesions in those with advanced abdominal malignancy. Sir Hamilton Bailey termed these lesions “Sister Mary nodules,” in recognition of the initial observer. They represent metastatic umbilical deposits. It is thought that a combination of generous blood supply, proximity to the peritoneum, and abundant embryological ligaments contribute to the high incidence of these deposits. Histological examination of these lesions usually reveals adenocarcinoma, most commonly originating from the stomach, pancreas, ovary, or colon. As we have demonstrated, various modern day cross sectional imaging techniques such as multidetector CT have successfully demonstrated umbilical malignant nodules. These deposits are now also being increasingly imaged using recent nuclear medicine techniques such as FDG PET.

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