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[Clinical Picture] An ominous sign from Sister Mary Joseph

A 39-year-old man presented to our hospital with a 2-month history of painful nodules in his umbilicus. He had been diagnosed with gastric ring cell carcinoma of the stomach with extensive metastasis 9 months earlier. An ill-defined, firm, indurated plaque, with multiple nodules in and around the umbilicus (figure), was found on examination. A skin biopsy sample showed extensive infiltration of the dermis by signet ring cells (figure). A diagnosis of Sister Mary Joseph’s nodule was made: the lesion in the umbilicus was caused by metastases from the gastric carcinoma.