Stratified mucin producing intraepithelial lesion (SMILE) and associated invasive carcinoma: a case report

Abstract

Case presentation A 34-year-old woman presented with two months history of intermittent vaginal bleeding. Her only past medical history was severe endometriosis and subsequent hemicolectomy. Pap smear showed high grade squamous intraepithelial lesion and cervical biopsy showed adenocarcinoma in situ (AIS) and SMILE with strong p16 positivity. She underwent a cone biopsy which demonstrated a 9 mm adenosquamous carcinoma and SMILE. The decision was made for a trachelectomy. Discussion and conclusion Given the morphological overlap and significant association with both CIN and AIS and diffuse p16 positivity, Boyle and McCluggage1 suggested that SMILE is likely to arise from high risk human papillomavirus infected reserve cells with the potential for multidirectional differentiation. SMILE is considered a variant of AIS.2 However, it has been suggested to be categorised as a distinct lesion separate from AIS, especially since classic AIS is only present in a minority of cases.1 SMILE is best regarded as a form of high grade reserve cell dysplasia and management should be as for AIS.1