Psammoma bodies on a cervical smear

• psammoma bodies are microscopic, laminated, calcified, extracellular bodies
  • psammoma bodies are found commonly in certain human neoplasms, most often in those of thyroid, ovarian, or meningeal origin; also psammoma bodies are observed in gastrointestinal tumors such as duodenal carcinoid and in the gastric adenocarcinoma
• psammoma bodies in cervical screening:
  • the presence of psamoma bodies in screening cervical cytologic smears is rare
    • there is a reported incidence of approximately 1 in 2,000 to 200,000 smears (1-3)
  • psammoma bodies have been considered a worrisome finding that are indicative of occult cervical, endometrial, tubal, or ovarian malignancy in up to 60% of historic case reports (2)
  • as a consequence it has been recommended that women whose smears contain psammoma bodies undergo extensive diagnostic evaluation that includes, at a minimum, biopsies of the cervix and endometrium and in some situations surgical exploration

Notes:

• psammoma bodies on a cervical smear:
  • the recommendations concerning extensive diagnostic evaluation were based on small series or single case reports, which totaled only 35 patients in publications through 2000 (2)
  • more recent studies (2,3,4) suggest that very few women with screening Papanicolaou test results that contain psammoma bodies have significant disease
    • women with a diagnosis of cancer typically had malignant cells that were detected on their cytologic smears
    • these women were also generally older and postmenopausal and had worrisome symptoms such as abnormal vaginal bleeding. Therefore these women would not be representative of asymptomatic women with otherwise normal cervical cytologic smears
    • Pakash et al found that the presence of psammoma on cervical screening was not as ominous a finding as previously indicated, as only 12.5% (1/8) of patients with psamoma bodies on their cervical smear harbor carcinoma.They conclude that:
      • psamomma bodies in a cervical smear in a young patient merits a thorough examination, but not surgical exploration in the absence of additional clinical findings or atypical cells on the cervical smear
      • older patients (>45 yr) have a higher incidence of malignancy, even in the absence of clinical findings or atypical cells on cervical smear, and may warrant a surgical exploration
  • a retrospective study of 25 cervical smears that showed psammoma bodies suggested that the presence of psammoma bodies in normal cytologic smears of asymptomatic women was an incidental finding (5)
• serous psammocarcinoma is a rare form of ovarian carcinoma and is characterized by massive psammoma body formation, invasiveness, and low-grade cytological features (6)

Reference:

1. Kern SB. Prevalence of psammoma bodies in Papanicolaoustained cervicovaginal smears. Acta Cytol 1991;35:81-8.
2. Nicklin JL et al. The significance of psammoma bodies on cervical cytology smears. Gynecol Oncol 2001;83:6-9.
3. Zreik TG, Rutherford TJ. Psammoma bodies in cervicovaginal smears. Obstet Gynecol 2001;97:693-5.
4. Parkash V, Chacho MS. Psammoma bodies in cervicovaginal smears: incidence and significance. Diagn Cytopathol 2002;26:81-6.
5. Howard G et al. The significance of psammoma bodies in screening cervical cytologic smears. Am J Obstet Gynecol 2003;188:1609-14.
6. Giordanoa G et al. Serous psammocarcinoma of the ovary: a case report and review of literature.Gynecologic Oncology 2005;96(1): 259-262.