Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear

Our plain-English summary of Diffuse Malignant Peritoneal Mesothelioma Presenting with Psammomatous Calcification on a Cervical Smear, by A. Tan, P. Cohen, M. Raoofi, et al (Acta Cytologica, 2015).

The study

• Authors: A. Tan, P. Cohen, M. Raoofi, J. Tan, N. Mesbah Ardakani, G. Sterrett
• Journal: Acta Cytologica
• Published: 2015;59(6):498-504
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Psammoma bodies in cervical smears are rare but may be associated with benign and malignant diseases of the female genital tract.

Case: A 52-year-old nulliparous woman presented with a 2-month history of intermittent vaginal spotting and post-coital bleeding. A cervical smear showed an inconclusive high-grade glandular lesion with psammomatous calcification. Previous cervical smears had been normal. This smear contained papillary tissue fragments, occasional spheres of gland-like cells and frequent psammoma bodies. The patient underwent a laparoscopic hysterectomy, bilateral salpingo-oophorectomy and omentectomy. The surface of the omentum and both ovaries contained psammoma bodies with groups of cells identical to those in the cervical smear. Within the omentum, there were invasive malignant epithelioid cells positive for CK7, CK5/6, calretinin, D2-40, WT-1, CK5/6, p16 and EMA. Desmin and PAX-8 immunostains were negative. There was also evidence of BRCA1-associated protein 1 (BAP1) dysfunction compatible with diffuse malignant peritoneal mesothelioma (DMPM).

Conclusion: We describe the first reported case of DMPM presenting with an abnormal cervical smear, a rare but important differential diagnosis to consider in abnormal cervical smears showing psammomatous calcification.

© 2016 S. Karger AG, Basel.

In plain English

This case report, by authors in Perth, Australia, described one patient. A 52-year-old woman who had never given birth had two months of intermittent vaginal spotting and bleeding after intercourse. Her cervical smear, unlike her earlier normal ones, showed abnormal glandular cells that raised the possibility of a high-grade lesion. It also showed psammoma bodies (small layered calcium deposits). An endometrial biopsy first suggested a low-grade serous papillary lesion. Her uterus, ovaries, fallopian tubes and omentum were then removed, and invasive malignant cells were found in the omentum. Their staining pattern and evidence of BAP1 gene dysfunction were compatible with diffuse malignant mesothelioma of primary peritoneal origin. She was a non-smoker with no previous occupational dust exposure. She had, however, been directly exposed to a large volume of asbestos dust in the late 1990s while cleaning the roof of a holiday home. The fiber type was not stated. She received 4 cycles of pemetrexed and cisplatin chemotherapy. The authors described this as the first reported case of peritoneal mesothelioma presenting on a cervical smear. They concluded it is a rare possibility to consider when abnormal smears show psammoma bodies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 52-year-old nulliparous (never having given birth), perimenopausal woman with a 2-month history of intermittent vaginal spotting and post-coital bleeding; the authors are based in Perth, Australia
• Exposure: Direct exposure to a large volume of asbestos dust in the late 1990s while cleaning the roof of a holiday home. Fiber type not stated. She was a non-smoker with no previous exposure to occupational dusts, molds, pollen or dyes.
• Main results:
  • The cervical smear showed glandular cell changes raising the possibility of a high-grade lesion, with psammoma bodies; squamous cells were normal
  • On the endometrial pipelle biopsy, a low-grade serous papillary lesion was initially favoured as the working diagnosis
  • The omentum contained sheets of invasive epithelioid cells with high mitotic activity and overtly malignant features
  • Tumour cells were strongly positive for CK7, CK5/6 and the mesothelial markers calretinin and D2-40; desmin and PAX-8 were negative
  • There was loss of nuclear BAP1 staining and a heterozygous deletion at the BAP1 locus (3p21) by FISH; no CDKN2A gene abnormality was found
  • The findings were compatible with diffuse malignant mesothelioma of primary peritoneal origin
  • The patient underwent 4 cycles of pemetrexed and cisplatin chemotherapy; no further outcome was reported
• The authors' conclusion: The authors concluded that this was, to their knowledge, the first reported case of diffuse malignant peritoneal mesothelioma presenting on an abnormal cervical smear. They concluded it is a rare diagnosis to consider in abnormal cervical smears showing psammomatous calcification.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Bilateral, Omentum, Epithelioid, Calretinin, Podoplanin (D2-40), Wilms Tumor 1 (WT-1), Desmin.

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