Indian Journal of Cancer Medknow Publications on behalf of Indian Cancer Society ISSN: 0019-509X EISSN: 1998-4774 Vol. 48, Num. 2, 2011, pp. 258-260

Indian Journal of Cancer, Vol. 48, No. 2, April-June, 2011, pp. 258-260

Letter to Editor

Primary peritoneal psammocarcinoma - as nodular mass lesions on the serosa of large bowel

Kumari P Ramana, Nuthaki S Rao

Ramani Histopathology Laboratory, Janardhani Hospital, Guntur, Andhra Pradesh, India

Correspondence Address: Kumari P Ramana Ramani Histopathology Laboratory, Janardhani Hospital, Guntur, Andhra Pradesh India ramanihistopathologylab@gmail.com

Code Number: cn11063

DOI: 10.4103/0019-509X.82883

Sir,

Primary peritoneal psammocarcinoma (PPP) is a relatively newly identified entity, a subtype of primary peritoneal serous carcinoma, and is characterized by abnormal carcinomatosis of the peritoneal cavity, with minimal or no involvement of the ovaries. ^[1] PPP should be differentiated from papillary adenocarcinoma of the ovary and peritoneal mesothelioma, which has an aggressive course.

The clinical behavior of PPP is variable; majority of them show a relative favorable prognosis and some PPP may show recurrences and metastasis.

In this paper, we report a case of PPP.

The case details are as follows. A 55-year-old post-menopausal woman presented with pain in abdomen. Imaging revealed an ileocaecal mass. At laparotomy, multiple nodular mass lesions on the serosal surface of the large intestine were identified, which is an unusual presentation. A right hemicolectomy was done.

Gross examination: A right hemicolectomy specimen comprising 12 cm long ascending colon, caecum with appendix and 15 cm long ileum was submitted for histopathological examination.

The serosal surface of the caecum and ascending colon were studded with multiple gray white nodular lesions of size ranging from 1 to 3 cm in diameter. C/S of the bowel segment showed intact mucosa [Figure - 1]. Microscopic examination: Multiple sections from the serosal nodules showed tumor cells arranged predominantly in papillary patterns, gland patterns, and cystic spaces, with almost 75% of papillae associated with psammoma bodies.

Individual cells are uniform looking, round to oval with pale scooped out nuclear chromatin and scanty cytoplasm [Figure - 2].

Initially, primary peritoneal tumors were classified as mesotheliomas, because the two malignancies were thought to have a common ancestry. However, epidemiologic studies revealed significant differences between the two diseases;

PPC is histologically identical to epithelial ovarian carcinoma. The main differentiating feature is advanced peritoneal involvement of tumor without gross involvement of the ovaries. ^[2]

Pathological characterizations of psammocarcinoma of peritoneum have been reported previously, by Gilks et al., who described 11 cases of psammocarcinoma, eight of the ovary and three of the peritoneum.

The diagnostic criteria defined for PPP are as follows.

1. No more than moderate nuclear atypia.
2. No areas of solid epithelial proliferation except for occasional nests.
3. At least 75% of the papillary or nests associated with or completely replaced by psammoma bodies ^[3],[4] .

In the present case, a 55-year-old post-menopausal woman showed extraovarian peritoneal seedling, involving serosal surface of the caecum and ascending colon. Ovaries appeared normal in size and morphology. Histology of the present case showed many psammoma bodies associated with papillae and nests of tumor cells and the individual cells showed low-grade cytological features.

Ovarian and peritoneal psammocarcinomas are quite rare and because of this, knowledge of their behavior is limited. However, most seem to follow an indolent course, similar to that of borderline lesions of the ovary. ^[4] But on the other end of spectrum, a few cases with recurrence and distant metastases are also reported. ^[5]

In the present case, the patient, despite not receiving adjuvant treatment, is still alive 24 months after initial diagnosis, without the signs of metastasis or disease recurrence.

Decisions regarding management should be individualized, with a close periodic follow up for possible recurrence.

References

Copyright 2011 - Indian Journal of Cancer

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