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Gideonsson I, Israelsson P, Strandberg SN, Ottander U. Long-Term Follow-Up of Tamoxifen Treatment and the Use of Imaging in Psammocarcinoma: A Case Report, Review of the Literature and Discussion of Diagnostic and Therapeutic Challenges. Curr Oncol 2023; 30:10260-10271. [PMID: 38132381 PMCID: PMC10742443 DOI: 10.3390/curroncol30120747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Psammocarcinoma (PsC) represents a rare form of low-grade serous tumor of the ovary or peritoneum. Although ovarian cancer generally has a poor prognosis in its late stages, PsC seems to have a more indolent course. We present a patient with a history of unspecific abdominal pain for more than a year, with sudden acute onset of severe inguinal pain. On admission to the hospital, a computed tomography (CT) revealed a pelvic mass of suspected ovarian origin. Radical surgery was attempted but not achieved due to widespread tumor growth. Histopathological evaluation revealed estrogen receptor-positive stage III PsC. Tamoxifen treatment was thus initiated, still maintaining stable disease 10 years later. The patient has undergone extensive radiological work-up, including CT, chest X-ray, 18F-fluoro-deoxy-glucose positron emission tomography (PET)/CT, 99mTc- hydroxymethylene diphosphonate (HDP) bone scintigraphy, 18F-fluoro-thymidine (FLT) PET/CT, Tc-99m depreotide scintigraphy and magnetic resonance imaging. In conclusion, we demonstrate that PsC has characteristic radiological features and different imaging modalities can be suitable in different clinical situations. In contrast to most other ovarian cancers, PsC does not always warrant adjuvant chemotherapy, even in advanced stages. This emphasizes the need for a deeper knowledge of the biological behavior of this rare tumor, to select the optimal treatment strategy.
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Affiliation(s)
- Ida Gideonsson
- Center of Obstetrics and Gynecology, Umeå University Hospital, 901 85 Umeå, Sweden;
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 85 Umeå, Sweden;
| | - Pernilla Israelsson
- Department of Radiation Sciences, Oncology, Umeå University, 901 85 Umeå, Sweden
| | - Sara N. Strandberg
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, 901 85 Umeå, Sweden;
| | - Ulrika Ottander
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 85 Umeå, Sweden;
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Sapna F, Cajigas A, Perkash RS, Qi X, Gera S. Recurrent Primary Peritoneal Psammocarcinoma: A Case Report on a Diagnostic Challenge in Cytology. Cureus 2023; 15:e41964. [PMID: 37588315 PMCID: PMC10427141 DOI: 10.7759/cureus.41964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2023] [Indexed: 08/18/2023] Open
Abstract
Psammocarcinoma (PCa) is a rare variant of low-grade papillary serous carcinoma that can arise from the peritoneal as well as ovarian surfaces. When this tumor involves the extra-ovarian peritoneum significantly and the ovarian surface minimally or not at all, it is considered of peritoneal origin. PCa has a recurrent indolent clinical course. It is challenging to diagnose peritoneal PCa, particularly on cytological smears because of the bland cellular features of neoplastic cells. We report a case of recurrent metastatic primary peritoneal PCa in a 71-year-old female of Ashkenazi Jewish ancestry diagnosed on cytology of ascitic and cystic fluid.
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Affiliation(s)
- Fnu Sapna
- Pathology, Albert Einstein College of Medicine, Bronx, USA
| | | | | | - Xiaohua Qi
- Pathology, Albert Einstein College of Medicine, Bronx, USA
| | - Shweta Gera
- Pathology, Albert Einstein College of Medicine, Bronx, USA
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3
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Kancharla S, Alaniz A, Kothari P, Norton S. Primary peritoneal serous psammocarcinoma, rare variant: A case report. Gynecol Oncol Rep 2023; 47:101176. [PMID: 37122436 PMCID: PMC10130463 DOI: 10.1016/j.gore.2023.101176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Psammocarcinoma is a rare form of serous carcinoma of the ovary or peritoneum characterized by extensive psammoma body formation seen on histology. A 49-year-old obese woman, gravida 1 para 1 with poorly controlled type 2 diabetes, presented with a history of menorrhagia. She was diagnosed with both leiomyomata and simple endometrial hyperplasia without atypia in the office. Consultation with gynecological oncology and primary gynecologist resulted in a planned hysterectomy with bilateral salpingo-oophorectomy. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed by primary gynecologist. Intraoperative survey of pelvis found concerning nodular lesions seen in posterior cul-de-sac. Lesions were excised and sent for frozen section. Pathology showed invasive peritoneal epithelial implant with psammomatous calcifications. Gynecological oncologist stand-by was called in and proceeded with surgical debulking and staging procedure. Post operatively, the patient has been diagnosed with primary peritoneal low grade serous psammomacarcinoma stage III A2. Her case has been presented to tumor board for multidisciplinary management and is now undergoing adjuvant hormonal therapy utilizing letrozole with chest, abdomen, and pelvic CT scans every 6 months. Standardized protocols are hindered by the rarity of this tumor. Benefits for this oncologic diagnosis are not clearly understood due to the rarity of this tumor. The significance of this case presentation is to highlight the multidisciplinary approach to the workup, diagnosis, treatment (both surgical and medical) and follow up of a rare gynecologic oncologic case. While the surgical team was expecting to find at most significant pathology, an endometrial carcinoma, a rarer primary peritoneal carcinoma was found. Due to the pre surgical planning, and intraoperative teamwork of the pathology, gynecology and oncology teams, this patient received the individualized and disease specific needed surgical and medical care warranted by her unique diagnosis.
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Affiliation(s)
- Srujan Kancharla
- 3rd Year Medical Student at Texas A&M Intercollegiate School of Engineering Medicine, United States
- Corresponding author.
| | - Anne Alaniz
- Oncologic Gynecologic Surgeon at Houston Methodist Willowbrook, United States
| | - Pulin Kothari
- Pathologist at Houston Methodist Willowbrook, United States
| | - Stacy Norton
- Gynecologic Surgeon at Houston Methodist Willowbrook, United States
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4
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Arole VC, Deshpande KA, Jadhav DB, Jogi A. Primary peritoneal psammocarcinoma. J Obstet Gynaecol Res 2017; 43:1366-1372. [DOI: 10.1111/jog.13355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/13/2017] [Accepted: 03/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Akash Jogi
- Department of Pathology; Grant Government Medical College; Mumbai India
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5
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Takahashi R, Ueda Y, Shioji M, Adachi S, Ohashi H, Morii E, Aozasa K, Yoshino K, Fujita M, Enomoto T, Kimura T, Tokuhira A. Enormous Cystic Tumor of Peritoneal Psammocarcinoma Exhibiting Complete Response to Cisplatin and Cyclophosphamide after Suboptimal Cytoreduction: Case Report and Review of the Literature. Gynecol Obstet Invest 2012; 74:165-70. [DOI: 10.1159/000336793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 01/24/2012] [Indexed: 11/19/2022]
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Poujade O, Uzan C, Gouy S, Pautier P, Duvillard P, Morice P. Primary Psammocarcinoma of the Ovary or Peritoneum. Int J Gynecol Cancer 2009; 19:844-6. [DOI: 10.1111/igc.0b013e3181a69a26] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zhen-Zhong D, Zheng N, Liu H, Liao DY, Ye XQ, Zhou QM, Jie, Li HH, Liu Q, Lu KM. Elevated CA125 in primary peritoneal serous psammocarcinoma: a case report and review of the literature. BMJ Case Rep 2009; 2009:bcr10.2008.1063. [PMID: 21686474 DOI: 10.1136/bcr.10.2008.1063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Psammocarcinoma is a rare form of serous carcinoma of the ovary or peritoneum, and it is characterised by extensive psammoma body formation and invasion of surrounding structures. This report describes the case of a 42-year-old woman who presented with large ascites and raised CA125 level. Following a full staging laparotomy, she was made stable in stage IIIC. Despite the limited number of cases reported, the clinical prognosis of carcinomas resembling the serous borderline lesions seems much more favourable than the common serous carcinomas. A summary of all the reported cases is provided to highlight the clinical and prognostic features of this scarce tumour.
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Affiliation(s)
- Deng Zhen-Zhong
- Nanjing University, Medical School, Room 902, Taoyuan 2 Building, Nanjing, 210093, China
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8
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A unique case of ovarian psammocarcinoma with mediastinal, pulmonary, subcutaneous, and omental metastases. Arch Gynecol Obstet 2008; 280:283-6. [DOI: 10.1007/s00404-008-0883-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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Alanbay I, Dede M, Ustün Y, Karaşahin E, Deveci S, Günhan O, Yenen MC. Serous psammocarcinoma of the ovary and peritoneum: two case reports and review of the literature. Arch Gynecol Obstet 2008; 279:931-6. [PMID: 18982336 DOI: 10.1007/s00404-008-0826-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 10/14/2008] [Indexed: 11/26/2022]
Affiliation(s)
- Ibrahim Alanbay
- Gülhane Military Medical Academy, Obstetrics and Gynecology, Ankara, Turkey
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10
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Koumoundourou D, Michail G, Kourounis G, Ravazoula P. Primary peritoneal psammocarcinoma: a case presenting synchronously with bowel carcinoma. Gynecol Oncol 2006; 102:576-9. [PMID: 16624390 DOI: 10.1016/j.ygyno.2006.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 02/26/2006] [Accepted: 02/27/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psammocarcinomas are rare epithelial tumors usually originating from the ovarian surface epithelium or the peritoneum. In our case, a peritoneal psammocarcinoma was incidental surgical finding during laparotomy. CASE An 83-year-old woman underwent surgery for bowel obstruction. Intraoperativelly, a bowel carcinoma was documented. Notable were numerous small disseminated peritoneal nodules that studded the omentum and bowel serosa. At reintervention, similar nodules were observed in the serosal surface of the two ovaries, uterus, left salpinx, and omentum. The nodules corresponded histologically to psammocarcinoma of peritoneal origin. Despite not receiving adjuvant treatment, the patient is still alive 53 months following the second operation, without signs of metastases or disease recurrence. CONCLUSION Though unpredictable, psammocarcinomas might run an indolent course, and decisions regarding management should be individualized.
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Affiliation(s)
- D Koumoundourou
- Department of Pathology, Patras University Medical School, Greece
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Abstract
Psammocarcinoma is a rare type of serous carcinoma arising from the ovaries or the peritoneum. Histopathologically, it has large deposits of psammoma bodies, invasion to surrounding tissues, and low-grade cytologic atypia. Biologic behavior is similar to borderline serous tumors with a favorable survival time. Primary surgical debulking with complete resection of the tumor should be the main surgical approach, while the benefit of postoperative chemotherapy remains unknown. A new case of primary peritoneal psammocarcinoma with survival after an initial diagnosis of 5.5 years is presented with a literature review.
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Affiliation(s)
- T Bilgin
- Department of Obstetrics, Faculty of Medicine, Uludağ University, Bursa, Turkey.
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Abstract
Psammomacarcinoma is a rare histologic subtype of serous carcinoma originating in the ovary or peritoneum, characterized by massive psammoma body formation, invasiveness, and low-grade differentiation. Its clinical behavior appears similar to that of serous borderline tumors rather than that of typical invasive serous carcinomas. Peritoneal psammomacarcinoma is even rarer than its ovarian counterpart with only 10 cases have previously been documented in the literature. A case of F.I.G.O. stage IIIC peritoneal psammomacarcinoma is described. Optimal debulking surgery, including omentectomy, total abdominal hysterectomy, bilateral adnexectomy, and resection of segment of jejunum, was performed. The patient received adjuvant chemotherapy with taxol and cisplatin, and to date, 15 months after surgery, she is alive and with no evidence of disease. It is concluded that peritoneal psammomacarcinoma is a very rare tumor that behaves less aggressively than typical serous carcinoma. The mainstay of treatment is surgical debulking. The role of adjuvant chemotherapy has as yet not been established.
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Affiliation(s)
- B Piura
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 151, 84101, Beer-Sheva, Israel.
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Whitcomb BP, Kost ER, Hines JF, Zahn CM, Hall KL. Primary peritoneal psammocarcinoma: A case presenting with an upper abdominal mass and elevated CA-125. Gynecol Oncol 1999; 73:331-4. [PMID: 10329057 DOI: 10.1006/gyno.1998.5309] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Primary peritoneal serous adenocarcinoma with predominating psammoma bodies, psammocarcinoma, is a very rare tumor with only seven cases documented in the English literature. Pathological classification of this entity was established in 1990 and clinical behavior of this tumor is uncertain. Based on limited data these tumors appear to behave similarly to low malignant potential tumors of the ovary. This case describes a 59-year-old woman who underwent exploratory laparotomy for a large upper abdominal cystic mass. Findings included a large tumor mass involving the gastrocolic omentum and dense small bowel adhesions. The patient had normal ovaries and was debulked to no macroscopic disease. Final pathologic diagnosis confirmed a stage IIIC primary peritoneal psammocarcinoma. The patient has received no adjunctive therapy and is without evidence of disease 2 years after surgery. Primary peritoneal psammocarcinoma is a neoplasm which can mimic serous adenocarcinoma of the ovary. In contrast, primary peritoneal psammocarcinoma appears to behave in an indolent fashion. Primary surgical debulking should be attempted, while the utility of postoperative chemotherapy remains unknown.
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Affiliation(s)
- B P Whitcomb
- Department of Obstetrics and Gynecology, Brooke Army Medical Center/Wilford Hall Air Force Medical Center, San Antonio, Texas, USA
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Molpus KL, Wu H, Fuller AF. Recurrent psammocarcinoma of the peritoneum with complete response to tamoxifen therapy. Gynecol Oncol 1998; 68:206-9. [PMID: 9514798 DOI: 10.1006/gyno.1997.4908] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psammocarcinoma is a rare type of serous carcinoma arising from the ovary or peritoneum, characterized by massive psammoma body formation, invasiveness, and low-grade cytological features. A case of primary peritoneal psammocarcinoma is presented. Aspects of clinical presentation, diagnosis, and management are described. Emphasis is placed on successful management of recurrent disease using tamoxifen therapy.
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Affiliation(s)
- K L Molpus
- Vincent Gynecologic Oncology Service, Massachusetts General Hospital, Boston 02114, USA.
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