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Histopathology. 2015 Apr;66(5):658-63. doi: 10.1111/his.12498. Epub 2015 Jan 15.

Stratified mucin-producing intraepithelial lesion (SMILE): report of a case series with associated pathological findings.

Author information

1
Department of Pathology, Belfast Health and Social Care Trust, Belfast, Northern Ireland.

Abstract

AIMS:

Stratified mucin-producing intraepithelial lesion (SMILE) is an uncommon premalignant cervical lesion showing morphological overlap with cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS)/cervical glandular intraepithelial neoplasia. Given the limited literature on SMILE, we aimed to document its frequency and assess the associated pathology in a large series of cases.

METHODS AND RESULTS:

Over a 6-year period, we documented all cases of SMILE and the associated findings. SMILE was diagnosed in 69 specimens from 60 patients (50 loop excisions and 19 punch biopsy specimens), constituting 0.6% of cervical specimens. Overall, SMILE coexisted with high-grade CIN in 93% of cases, AIS in 42%, and a carcinoma in 10%. When SMILE was diagnosed on a cervical punch biopsy, there was high-grade CIN in the follow-up loop in most cases. SMILE was consistently diffusely p16-positive and IMP3-negative.

CONCLUSIONS:

Given the morphological overlap and significant association with high-grade CIN and AIS, we believe that SMILE is best regarded as a form of high-grade reserve cell dysplasia, probably arising from reserve or stem cells with the capacity for multidirectional differentiation. We recommend that management of SMILE should be as for AIS.

KEYWORDS:

IMP3; adenocarcinoma in situ (AIS); cervical intraepithelial neoplasia (CIN); cervix; stratified mucin-producing intraepithelial lesion (SMILE)

PMID:
25039487
DOI:
10.1111/his.12498
[Indexed for MEDLINE]

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