STRATIFIED MUCIN-PRODUCING INTRAEPITHELIAL LESION (SMILE)
CASE REPORT
Keywords:
cervical squamous intraepithelial lesions, glandular lesions, SMILE, mucinaAbstract
Stratified mucin-producing intraepithelial lesion (SMILE) is an unusual finding in the histopathology of the cervix, with controversial origin and few published studies regarding better management and follow-up. Case report: A 48-year-old patient, referred with a cervical cytology with atypical squamous cells which cannot exclude a high-grade squamous intraepitelial lesion (ASC-H). New tests were performed in our service, the result of which was cytology and histology compatible with high-grade squamous intraepithelial lesion (HSIL), in addition to immunohistochemistry (IHC) with a positive p16. A large loop excision of the transformation zone (LLETZ) was perform with anatomopathological result of a high-grade lesion with deep radial margin compromised by cervical intraepithelial neoplasia grade 3 (CIN 3) and SMILE-compatible morphological picture. The IHC concluded that these are immunomorphological findings suggestive of a lesion with mixed differentiation (adenosquamous). Cone biopsy was performed ninety days after LLETZ, without residual neoplasia in the surgical specimen and a semestral follow-up plan with cervical citology and colposcopy was made. Discussion: It was defined in 2014, by the World Health Organization, that SMILE is a variant of adenocarcinoma in situ (AIS), but some authors disagree and believe in the association of SMILE with HSIL and AIS, in addition to the invasive carcinoma. Morphologically it presents an overlap of CIN and AIS and a positive IHC for p16 and immunophenotypically it seems to be more similar to CIN than to AIS. Because there is no consensus whether it is more associated with CIN or AIS, the treatment of SMILE is controversial, in addition to the fact that studies are inconclusive regarding the risk of invasive carcinoma. Therefore, we believe that it should be treated with excisional treatment, with complete removal of the lesion and its follow-up in accordance with the recommended for AIS. There is no consensus on its management and monitoring, with we belive that more studies on the subject is needed.
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