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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 280-281
Primary psammocarcinoma of peritoneum


Department of Pathology, IGMC, Shimla, India

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How to cite this article:
Asotra S, Gupta S, Gupta N. Primary psammocarcinoma of peritoneum. Indian J Pathol Microbiol 2009;52:280-1

How to cite this URL:
Asotra S, Gupta S, Gupta N. Primary psammocarcinoma of peritoneum. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Apr 8];52:280-1. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/280/48949


Sir,

We report a case of primary psammocarcinoma of the peritoneum, which is a rare variant of serous neoplasm characterized by massive psammoma body formation and low-grade cytological features.

Primary peritoneal serous borderline tumors are usually associated with widespread extra-ovarian peritoneal involvement and normal-sized ovaries that are free of disease. [1] Many cases are discovered incidentally at laparotomy for other conditions. Peritoneal psammomacarcinoma is a subtype of low-grade peritoneal serous carcinoma, with psammoma bodies in most of the tumor nests and absent or rare solid epithelial proliferation. [2]

A 50-year-old post-menopausal woman presented with a 6-month history of lower abdominal pain. On examination, there was a large abdominal mass. She underwent exploratory laparotomy with bilateral salpingoopherectomy and omental biopsy.

Gross examination of the uterus revealed a normal endometrium, myometrium, cervix and both-sided  Fallopian tube More Detailss. Both the ovaries were normal in size and their surface revealed small miliary nodules. Omental tissue also revealed small miliary granules.

Microscopic examination of the omentum showed psammoma bodies in fibrocollagenous tissue, at places lying in cystic spaces lined by attenuated epithelium. They were surrounded by nests of epithelial cells in some focal areas revealing mild nuclear atypia [Figure 1]. Histopathology of both ovaries also showed the presence of psammmoma bodies and at places showed solid nests of epithelial cells. No nuclear atypia was found in cells of the ovary.

The endometrium, myometrium, cervix and both side tubes were microscopically unremarkable.

The extra-ovarian peritoneal serous papillary carcinoma is a rare primary multicentric tumor that is histological identical to ovarian serous carcinoma of an equivalent grade, which can spare or minimally involve the ovaries. [3] The age group involvement and clinical presentation is similar to that of advanced-stage epithelial ovarian cancer. [4] Patients commonly present with non-specific pain, abdomen lump and ascitis. At laparotomy, almost all cases show diffuse peritoneal implantation. The ovaries are almost always of a normal size and shape and may show surface tumor implants that may be focally invasive. They may rarely be grossly and histologically normal. [5]

The correct diagnosis of extra-ovarian peritoneal serous papillary carcinoma is made by exclusion after both operative and pathological study. The gynecologic and oncology group has given criteria to differentiate extra ovarian primary peritoneal carcinoma (EOPPC) from papillary adenocarcinoma of the ovary. [1] Histology must be predominantly serous or identical to any grade of ovarian papillary serous tumor. [2] Ovaries are of a normal size or enlarged by a benign process. [3] Involvement in the extra-ovarian site must be greater than the involvement on the surface of either ovary. [4] The ovarian component must be non-existent or must be confined to the surface of the epithelium or less than 5 5mm within the stroma.

The primary peritoneal psammocarcinoma is a subtype of low-grade peritoneal serous carcinoma, which shows at least 75% psammoma bodies, no more than moderate cytological atypia, tissue or lymph vascular space invasion or both and rare epithelial proliferation of less than 15 cell areas.

The clinical behavior of psammocarcinoma closely resembles that of borderline serous tumor and usually has a relatively favorable prognosis. [6] Primary peritoneal psammocarcinoma is a rare neoplasm. The number of cases of primary peritoneal psammocarcinoma reported in the literature is too small.

 
   References Top

1.Bell DA, Scully RE. Serous borderline tumors of the peritoneum. Am J Surg Pathol 1990;14:230-9.  Back to cited text no. 1  [PUBMED]  
2.Eltabbabh GH, Piver MS. Extra ovarian primary peritoneal carcinoma. Oncology 1998;12:813-25.  Back to cited text no. 2    
3.Kouststelini HA, Lazaris AC, Thromopoulou G, Papayannopoulou A, Kairi-vasilatou E. Papillary serous carcinoma of peritoneum: Case study and review of literature on differential diagnosis of malignant peritoneal tumors. Adv Clinc Path 2001;5:99-104.  Back to cited text no. 3    
4.Weir MM, Bell DA, Young RH. Grade-I peritoneal serous carcinomas a report of 14 cases and comparison with peritoneal serous psammocarcinoma and 19 peritoneal serous borderline tumors. Am J Surg Pathol 1998;22:849-62.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Akbulent M, Kelten C, Bir F, Soysal ME, Duzcan SE. Primary peritoneal serous psammocarcinoma with recurrent disease and metastasis: A case report and review of literature. Gynecol Oncol 2007;105:248-51.  Back to cited text no. 5    
6.Bilgin T, Ozuysal S, Cankilic H. Primary psammocarcinoma of the peritoneum. Int J Gynecol Cancer 2006;16:129-31.  Back to cited text no. 6    

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Correspondence Address:
Sarita Asotra
Flat No-5 Block No-5, Phase-III New-Shimla-171 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48949

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