Sister Joseph's nodule in hepatocellular carcinoma

We describe three black South African patients in whom hepatocellular carci noma metastasized to the umbilicus. Sister Joseph's nodule has previously b een 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 propag ate directly along the ligamentum teres hepatis to the umbilicus; contiguou s spread of the tumour to the umbilicus from anterior peritoneal tissue, ei ther directly infiltrated by hepatocellular carcinoma or the site of metast atic nodules, may occur; embolization of malignant hepatocytes to the umbil icus might take place by way of its arterial blood supply; or hepatocellula r carcinoma might reach the umbilicus as a result of retrograde lymphatic s pread from para-aortic lymph nodes or from the anterior abdominal wall, to which the tumour has metastasized. (C) 2001 Lippincott Williams & Wilkins.