Sister Mary Joseph's nodule as a rare sign of lymphoma.

Sister Mary Joseph's periumbilical metastatic nodule is an ominous harbinger of an internal malignancy usually originating from gastrointestinal or genital system primary cancers. At the time of diagnosis, they are inoperable and therefore deemed incurable, suggesting an invariably dismal prognosis. Periumbilical neoplastic deposits from primary non-Hodgkin's lymphoma are extremely rare. A 72-year-old white male with a history of gastric cancer was referred with a painful lesion in the umbilicus. A delayed biopsy of the nodule showed diffuse large B-cell lymphoma. After a work up, he was successfully treated with standard combination chemotherapy and achieved complete remission. However, the patient developed central nervous system relapse and died a few months later. Our patient illustrates the importance of obtaining a tissue diagnosis before diagnosing an internal carcinoma as the underlying cause in patients with Sister Mary Joseph's nodule. We should keep in mind that not all periumbilical tumoral deposits are the same.