title: Sister Joseph's nodule in hepatocellular carcinoma.
abstract: We describe three black South African patients in whom hepatocellular carcinoma metastasized to the umbilicus. Sister Joseph's nodule has previously been reported in only two patients with this tumour. A number of routes for this spread are possible: malignant hepatocytes in the portal venous system may reach the umbilicus via a patent umbilical vein; the tumour may propagate directly along the ligamentum teres hepatis to the umbilicus; contiguous spread of the tumour to the umbilicus from anterior peritoneal tissue, either directly infiltrated by hepatocellular carcinoma or the site of metastatic nodules, may occur; embolization of malignant hepatocytes to the umbilicus might take place by way of its arterial blood supply; or hepatocellular carcinoma might reach the umbilicus as a result of retrograde lymphatic spread from para-aortic lymph nodes or from the anterior abdominal wall, to which the tumour has metastasized.
authors.affiliation: Department of Medicine, Baragwanath and Johannesburg Hospitals and University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: H J
authors.initials: HJ
authors.lastname: Hodkinson
authors.forename: M C
authors.initials: MC
authors.lastname: Kew
mesh_terms: D000008:Abdominal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000556:secondary*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D014472:Umbilicus