The Presence of Psammoma Bodies in Endometrial Tissue: A Case Study

1. Introduction

Endometrial cancer is the most common gynecologic malignancy in the Western world, with an annual incidence of approximately 6 per 100,000 women. The vast majority of endometrial cancers are adenocarcinomas, and most of these tumors are of the endometrioid type. Pathologic features that have been associated with an increased risk of malignancy include: tumor size ≥2 cm, uterine serosal invasion, cervical stromal involvement, myometrial invasion ≥50%, and lymphovascular space involvement. The presence of psammoma bodies is considered a benign finding in endometrial tissue and is thus not typically associated with an increased risk of malignancy.

2. Background

Psammoma bodies are traditionally defined as rounded, eosinophilic, basophilic, or shadow cells within a tumor mass that have a laminated appearance on hematoxylin and eosin (H&E) staining (Figure 1). They are often seen in papillary thyroid carcinomas, but can also be found in other malignant neoplasms such as ovarian tumors, meningiomas, mesotheliomas, breast carcinomas, and bladder carcinomas. While psammoma bodies are generally considered to be a marker of malignancy, their presence in endometrial tissue is generally considered to be benign. One study found that the prevalence of psammoma bodies in endometrial biopsies was 0.8%, and that their presence was not associated with an increased risk of endometrial cancer.

3. Clinical Presentation

The patient is a 38-year-old G2P1001 at 36 weeks gestation who presented to her obstetrician for a routine prenatal visit. She has no significant medical history and her pregnancy has been uncomplicated to date. She reported experiencing vaginal bleeding after intercourse 2 days prior to her visit; she did not report any other unusual vaginal bleeding or discharge. Her physical exam was unremarkable except for mild cervical tenderness upon palpation.

4. Pathologic Findings

A biopsy of the endocervix was performed and macroscopically revealed a tan-white mass with areas of necrosis (Figure 2). Microscopic examination revealed areas of atypical glandular cells with nuclear pleomorphism, enlarged nuclei, and frequent mitotic figures (Figure 3). There were also numerous psammoma bodies present within the tumor tissue (Figure 4).

5. Differential Diagnosis

The differential diagnosis for a patient presenting with postcoital bleeding and atypical glandular cells on biopsy includes: endometriosis, adenomyosis, cervical ectropion, cervical polyp, cervical infection, cervicalcancer. The presence of numerouspsammoma bodies favors a diagnosis of benign endometriosis over the other possibilities; however, the final diagnosis can only be made after a hysterectomy with pathologic evaluation of the endometrium is performed.

6. Treatment and Follow-up

The patient underwent a dilation and curettage procedure followed by a hysterectomy due to the suspicion for malignancy based on the biopsy findings. Pathologic examination revealed areas of atypical glandular cells with nuclear pleomorphism,
enlarged nuclei, and frequent mitotic figures (Figure 5). There were also numerous psammoma bodies present within the tumor tissue (Figure 6). The final diagnosis was benign endometriosis with atypical glandular cells and psammoma bodies. The patient was advised to follow-up with her obstetrician for routine prenatal care.

7. Conclusion

In this particular case, we believe that the presence of benign endometrial tissue and postcoital bleeding is explained by the emergence of atypical glandular cells. The atypical cells are likely a result of the endometriosis and are not indicative of malignancy. The patient’s prognosis is excellent and she will require no further treatment beyond routine obstetric care.


Psammoma bodies are small, calcified bodies that form in various types of tumors.

They are thought to form from the accumulation of calcium in areas of cell death.

Psammoma bodies are often found in ovarian and thyroid cancers, and their presence can indicate a more aggressive cancer.

There are no other known conditions associated with psammoma bodies.