Psammoma bodies in cervicovaginal smears: significance and practical implications for diagnostic cytopathology

ArticleinAdvances in Anatomic Pathology 11(5):250-61 · October 2004with11 Reads
Source: PubMed
The traditional association of psammoma bodies with some malignancies of the gynecologic tract raises potentially significant management difficulties when such bodies are identified on routine cervicovaginal smears. This review summarizes the reported cases of psammoma bodies identified on cervicovaginal smears in the world literature (a total of 140 cases, 113 (81%) of which had sufficient clinicopathologic information). Our conclusions are as follows: (1) The finding of psammoma bodies in this setting is distinctly unusual with an incidence of less than 0.001% on consecutively screened smears. (2) On consecutively screened smears, patients with psammoma bodies have an associated malignancy or ovarian borderline tumor 0-22.7% of the time, depending on the series; this figure climbs to 38% when all the case reports and small series in the literature are included. (3) The most reliable predictor of a malignancy in these patients is the finding of cells on the smear that by themselves are diagnostic of malignancy on cytologic grounds. (4) Other factors that, on a purely statistical basis, appear to increase the likelihood of a synchronous or metachronous malignancy or borderline tumor include an older age at diagnosis and/or clinical presentations such as postmenopausal bleeding. (5) When 1 or more psammoma bodies are identified on a cervicovaginal smear, this finding should not be ignored and should generate some clinical investigation to identify its source.
    • "Calcifications and PBs are present in almost the 30% of ovarian cystoadenofibromas [23] and this can justify the presence of PBs in CVS, like in the fourth benign case of ours; the same mechanism above described may be evoked. When PBs in the CVS are associated with malignant or borderline tumors, the ovary is the most common primary site (51%), serous cystoadenocarcinoma being the most common neoplasm, followed by the uterine corpus (30%) [24]. In our two cases, the presence of malignant cells with PBs in the lumen of the fallopian tubes may be the mechanism responsible for the cytological findings. "
    [Show abstract] [Hide abstract] ABSTRACT: The purpose of our study was to determine the prevalence and significance of psammoma bodies (PBs) in the cervicovaginal smears of the screening population of Trento district (Italy), with the description of the cytological presentation of an asymptomatic bilateral ovarian psammocarcinoma. From 1993 to 2006, women with PBs detected on consecutively screened cervical smears were identified from the computerized pathology database of Rovereto Hospital. The follow-up period was set from the time of cytological diagnosis to May 31st, 2007. Clinical information was obtained from retrospective review of women's medical records. The source of PBs was identified with adequate diagnostic procedures. PBs were found in six of the 201,231 Papanicolaou screening smears (0.0029%). Benign conditions (intrauterine device, inclusion ovarian cysts and ovarian cystoadenofibroma with PBs) were found in four patients. In two cases, PBs were associated with malignant cells; a bilateral ovarian malignancy was diagnosed in both cases, a serous adenocarcinoma and a psammocarcinoma. PBs in the cervicovaginal smears are a rare finding, associated more often with benign conditions than with malignancies. Moreover, to our knowledge, our case of primary ovarian psammocarcinoma is the first report in which the presence of malignant cells and PBs in the cervicovaginal and endometrial smears represents the first manifestation of disease.
    Full-text · Article · Feb 2008
  • [Show abstract] [Hide abstract] ABSTRACT: Psammoma bodies in cervicovaginal cytology specimens are associated with malignant and benign conditions. Few studies have evaluated which features distinguish patients with underlying malignancy from those with benign conditions. Pathology files were searched for cervicovaginal specimens having psammoma bodies. The cytology specimen was assessed for the background, glandular atypia, squamous atypia, and presence of non-psammomatous calcifications. Clinical data was obtained from chart review. Nineteen women (mean age 42.7 years) had benign outcomes. None had signs or symptoms suggesting malignancy. None had highly atypical or malignant appearing glandular cells. Twelve women had malignant neoplasms (mean age 56 years), including 6 with recurrent disease. Four women without prior malignancy had worrisome signs including bleeding or mass. All six women with prior malignancy had signs of recurrent disease. All specimens contained highly atypical or malignant glandular cells. The only cytologic feature predictive of outcome was the presence of highly atypical glandular cells in the specimen (P = 0.001), but these cells may be few. Women with underlying malignancy were older than those with benign outcome (P = 0.014) and more likely to be postmenopausal (P = 0.05). Women with malignancy had signs that warranted additional investigation whereas those with benign outcome were usually asymptomatic (P = 0.001).
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