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Exceptionally high levels of CA125 due to endometriosis

Discussion Psammoma bodies on cervical smears are rare and the prevalence varies between one in 1934 (Zriek et al., 2001) to one in 33 474 (Kern et al., 1991). A majority of these are in premenopausal women. In this group, psammoma bodies are generally associated with benign conditions such as IUDs, endosalpingiosis, PID, endometrial tuberculosis and pelvic endometriosis and a conservative approach is justified. In postmenopausal women, there is a very high association of statistical significance with a gynaecological malignancy, commonly ovarian and endometrial cancer (Nicklin et al., 2001). The background cytology was also found to be highly predictive in the same study. Although psammoma bodies by themselves are of no prognostic importance, the observational evidence is now robust to suggest an aggressive search for a female genital tract malignancy. We also feel that cytology laboratories should be able to code for PBCS and initiate an urgent gynaecological referral in postmenopausal women.