You are correct. A skin bx of the umbilical nodule revealed poorly differentiated adenocarcinoma, confirming the dx of a Sister Mary Joseph nodule. CT showed an extrahepatic biliary mass, a large secondary liver lesion, intra- and extra-hepatic biliary duct dilatation, and a left groin nodal mass, consistent w/ metastatic cholangiocarcinoma. Sister Mary Joseph nodules are cutaneous metastatic umbilical deposits from primary intra-abdominal or pelvic malignancies. When seen, they should prompt investigation for underlying malignancy. This pt developed obstructive jaundice, and repeat imaging showed dz progression. A palliative biliary stent was inserted, and the pt died 3mo after dx.

BMJ 2018;363:k4041