Stratified Mucin-producing Intraepithelial Lesions of the Cervix: Clinical Diversity of Cases and Literature Review

• Published in: Anticancer research Vol. 42; no. 2; pp. 1175 - 1180
• Main Authors: Delrue, Charlotte, Vanwalleghem, Lieve, Paepe, Pascale DE, Van Trappen, Philippe
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01.02.2022
• Subjects: Adenocarcinoma; Adult; Aorta; Cancer; Case reports; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - metabolism; Cervical Intraepithelial Neoplasia - pathology; Cervix; Cervix Uteri - metabolism; Cervix Uteri - pathology; Female; Humans; Hysterectomy; Lesions; Literature reviews; Lymph nodes; Lymph Nodes - metabolism; Lymph Nodes - pathology; Lymphatic Metastasis; Metastases; Middle Aged; Mucin; Mucins - metabolism; Neoplasm Invasiveness; Neoplasm Staging; Radiation therapy; Robotic surgery; Robotics; Tumors; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - metabolism; Uterine Cervical Neoplasms - pathology; cervical tumor; pathology; SMILE; robotic; stratified mucin-producing intraepithelial tumor
• ISSN: 0250-7005; 1791-7530
• DOI: 10.21873/anticanres.15583

This report discusses the current literature on both non-invasive and invasive SMILE ((i)SMILE) lesions of the cervix with focus on the pathology and its related clinical diversity in several cases. Currently, the knowledge on (i)SMILE is limited to single case reports and series. As a consequence, consensus guidelines regarding the management are lacking. Although there is overlap with both high grade squamous intra-epithelial lesion (HSIL) and adenocarcinoma in situ (AIS) on immunohistochemical analyses, it is recommended to treat SMILE like AIS and further excision is needed when surgical margins are positive for SMILE on conization. (i)SMILE, should be considered as a rare subtype of adenocarcinoma of the cervix, and should be treated as such. We describe a case with a SMILE lesion undergoing a subsequent robotic hysterectomy after conization and two cases with iSMILE: one case with an early FIGO-stage 1B1 iSMILE tumor, undergoing a robotic radical hysterectomy with sentinel procedure, and one case undergoing a robotic-assisted pelvic/para-aortic lymph node staging dissection, confirming a metastatic FIGO-stage 3C2 (for primary chemo-radiotherapy treatment). Here, we report for the first time a few cases of (i)SMILE with different clinical presentations, their management and follow-up. Immunohistochemical characteristics are given for both primary lesions as well as the metastases.