I read the Clinical Imaging in Gastroenterology article by Renau et al.1 with great interest. I would like to point out that this presentation has been referred to as Sister Mary Joseph’s nodule (SMJN) and comment on its brief history and clinical implications. Umbilical metastasis, known as SMJN, is a manifestation of advanced malignancy. The head surgical nurse, Sister Mary Joseph (1856-1939), pointed out this clinical sign and its negative prognostic value to Dr. William Mayo (1861-1939). In 1949, Sir Hamilton Bailey, a British surgeon, coined the term “SMJN”.2 SMJNs mainly originate from intra-abdominal cancers. The most frequent primary cancer site was the ovary (25.4%), followed by the colon (17.9%), the pancreas (6.5%), and the stomach (5.9%). The median survival rate was 7 months.2 Since the umbilicus is a special anatomical location with a complex network of vessels and developmental anomalies, various lesions, including infectious, inflammatory, benign, and malignant ones, can be encountered.3,4 Renau’s excellent images underscore the importance of recognizing SMJN as a rare but crucial indicator of advanced intra-abdominal cancer.