{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:41:01Z","timestamp":1776919261428,"version":"3.51.2"},"reference-count":5,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 47-year-old woman with metastatic pancreatic adenocarcinoma, diagnosed five months earlier and treated with palliative chemotherapy, was admitted with fever, jaundice, and right upper quadrant pain consistent with ascending cholangitis. Treatment with antibiotics was initiated and an endoscopic retrograde cholangiography was performed, whereby a biliary stent was placed to relieve malignant biliary obstruction. Physical examination revealed moderate ascites. Careful inspection of the umbilicus revealed a small nodular lesion located within the umbilical fold that became visible only after eversion of the umbilicus. The lesion had developed gradually over several weeks. Computed tomography confirmed the known pancreatic malignancy with metastatic disease and ascites. On re-review of the images, a small soft tissue nodule replacing the umbilicus was also visible. The lesion was clinically consistent with a Sister Mary Joseph nodule, an umbilical metastasis most commonly associated with advanced gastrointestinal or gynecologic malignancies. These lesions may arise through lymphatic or hematogenous spread or through direct extension into the umbilicus. This case highlights that umbilical metastases may be subtle and located within the umbilical fold, requiring careful physical examination to be detected.<\/jats:p>","DOI":"10.3390\/diagnostics16081190","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:05:36Z","timestamp":1776348336000},"page":"1190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Subtle Sister Mary Joseph Nodule in Metastatic Pancreatic Cancer"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6057-9858","authenticated-orcid":false,"given":"Mohammed","family":"Abdulrasak","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences, Lund University, 203 13 Malmo, Sweden"},{"name":"Department of Gastroenterology and Nutrition, Sk\u00e5ne University Hospital, 205 02 Malmo, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/MAJ.0b013e3181954187","article-title":"Sister Mary Joseph and Her Nodule: Historical and Clinical Perspective","volume":"337","author":"Newman","year":"2009","journal-title":"Am. J. Med. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1503\/cmaj.060847","article-title":"Sister Mary Joseph\u2019s Nodule","volume":"176","author":"Fairchild","year":"2007","journal-title":"Can. Med. Assoc. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1179554921995022","DOI":"10.1177\/1179554921995022","article-title":"Benign Umbilical Tumors Resembling Sister Mary Joseph Nodule","volume":"15","author":"Ha","year":"2021","journal-title":"Clin. Med. Insights Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1177\/1066896918758916","article-title":"Umbilical Lesions: Clinicopathologic Features of 99 Tumors","volume":"26","author":"Yan","year":"2018","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_5","first-page":"1087513","article-title":"Sister Mary Joseph Nodule as a First Manifestation of a Metastatic Ovarian Cancer","volume":"2016","author":"Calongos","year":"2016","journal-title":"Case Rep. Obstet. Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1190\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:10:28Z","timestamp":1776917428000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/8\/1190"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":5,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diagnostics16081190"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16081190","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}