Background: Umbilical metastasis, also known as Sister Mary Joseph nodule, is a rare pathognomonic clinical sign suggesting the presence of an internal cancer. Case Presentation: We describe two female patients with Sister Mary Joseph nodule. In one case, there was a relapse of cancer. In the other patient, the Sister Mary Joseph nodule was the first and only clinical sign of an abdominal malignancy. We will briefly discuss the association with various internal malignancies as well as the pathogenesis and differential diagnosis. Conclusion: We conclude that Sister Mary Joseph nodule is a sign of intra-abdominal malignancy most frequently associated with gastro-intestinal or gynecological cancer. It can be the first and only clinical sign of abdominal malignancy in an otherwise healthy appearing patient or it can be an indication of oncological progressive disease, tumor relapse. Umbilical lesions should raise suspicion of a Sister Mary Joseph nodule, but a differential diagnosis must be made with other primary umbilical malignancies as well as with benign conditions involving the umbilicus.

Background Sudden unexpected cardiac arrest is one of the life threatening interventions of the pre hospital emergency medicine teams. Globally sudden cardiac death (SCD) accounts for 4-5 million deaths per year and is in most cases linked to coronary artery disease. Other causes include cardiomyopathies and channelopathies. Case presentation We present two unconscious patients with life threatening cardiac arrest who were unsuccessfully resuscitated by the emergency team. As the cause of the sudden cardiac death was unclear an autopsy was performed. Conclusion Sudden cardiac death can be the final stage of several pathologies. In acute myocardial infarction due to coronary artery disease the underlying cause is clear. The situation is however more complex in drug abuse and the physician should be aware that underlying pathologies can be masked. If the cause of sudden cardiac arrest is unclear, an autopsy is recommended especially the so called "molecular" autopsy. Genetic screening can be beneficial to detect genetic susceptibility to dysrhythmias (long QT syndrome, Brugada syndrome, ..), cardiomyopathies, thoracic aortic aneurysm and dissection. Genetic analysis closely correlated with the post mortem findings and significant clinical information can be used to detect underlying pathologies and to decide whether genetic screening and clinical follow up of relatives should be carried out.