Introduction/Background Sister Mary Joseph’s nodule is an exceptional metastatic site of cancer, often pelvic, with a poor prognosis due to its delayed diagnosis.

The aim of our work is to specify the diagnostic difficulties that practitioners face at the clinical, radiological, and pathological stages, particularly in determining the primary origin of this metastasis.

Methodology We report the case of a patient who presented to the Hassan II University Hospital in Fez with a bulging umbilical mass: Sister Mary Joseph’s nodule.

Results On clinical examination, the patient was conscious and stable in terms of hemodynamics and respiration, with the presence of an umbilical swelling: Sister Mary Joseph’s nodule, and on gynecological examination, a mass was found in the left-lateralized cul-de-sac of Douglas filling the left lateral cul-de-sac. The patient underwent a pelvic MRI and then a thoraco-abdomino-pelvic CT scan revealing multiple solid-cystic peritoneal masses, the largest of which involved the cul-de-sac of Douglas.

A biopsy of the Sister Mary Joseph’s nodule was performed with histopathological and immunohistochemical results in favor of a secondary cutaneous localization of a high-grade serous adenocarcinoma of very probable gynecologic origin.

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Abstract #1084 Figure 1

Conclusion Sister Mary Joseph’s nodule remains a rare tumor of metastatic origin, most often from a digestive cancer. The prognosis is still very poor, requiring early and systematic screening. This involves a biopsy of any umbilical nodule or mass to determine the nature of the pathological lesion.

Disclosures In this case study, we followed a patient whose umbilical metastases, showing aggressive disease and a poor prognosis. Their appearance is strongly linked to the progression of peritoneal carcinomatosis, suggesting a mixed mechanism of dissemination, most likely by lymphatic diffusion and promiscuity.