Psammoma bodies in routine pap smears may not herald malignancy. (Asymptomatic Women).

RANCHO MRAGE, CALIF. -- The presence of psammoma bodies in a cervical cytology smear has long been thought to be associated with gynecologic malignancies, but a retrospective review of 400,000 smears collected during routine screening suggests they may be an incidental finding in an asymptomatic population.

Dr. Howard G. Muntz, a gynecologic oncologist at Virginia Mason Medical Center in Seattle, reviewed 9 years' worth of Pap smears in a computerized cytology registry finding 25 evaluable samples that contained psammomatous calcifications, for an incidence of 1 in 16,000. "As gynecologists, we worry about psammoma bodies, because they are frequently associated with ovarian serous papillary carcinomas as well as other ... malignancies," he said at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

However, the studies that linked 60% of smears containing psammoma bodies to cancer generally included samples from women with malignant background cytology or abnormal symptoms, he noted.

In asymptomatic women undergoing routine screening in Seattle, psammoma bodies were seen in conjunction with a variety of benign conditions and sometimes seemed to indicate nothing at all, Dr. Muntz said at the meeting, cosponsored by the American College of Obstetricians and Gynecologists.

The average age of a woman with psammoma bodies in the Seattle series was 36, with a range of 22-72. Nine of the 25 were postmenopausal, and 4 in fact had abnormal uterine bleeding, including 2 with menorrhagia, although their Pap smears were performed as part of routine screening examinations. Several had remote histories of abnormal Pap smears unrelated to the index smear that contained psammoma bodies.

Completely normal epithelial components were present in 20 of 25 of the smears in question, while 5 had "a few minor epithelial abnormalities." Ten of 25 smears contained normal endometrial ...