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Sister Mary Joseph's nodule: the tip of an iceberg.

Sister Mary Joseph's nodule is a rare palpable umbilical cutaneous lesion as a result of an advanced intra-abdominal and/or pelvic malignancy. It may be the initial clinical manifestation of an underlying malignancy, originating mainly from the gastro-digestive or genito-urinary tract. We present here a rare case of a 67-year-old woman with a Sister Mary Joseph's nodule. On surgical exploration, a left ovarian mass with anterior abdominal wall metastasis, ascites and extensive intra-abdominal metastatic lesions were observed. Our case report shows the importance of a careful physical examination as an invaluable diagnostic tool in modern medicine. High index of suspicion and awareness of this clinical sign may lead to the detection of the primary source, to its diagnosis and more appropriate treatment options in order to achieve the best survival possibility. KEY WORDS: Ovarian cancer, Sister Mary Joseph's nodule, Umbilical metastasis.