Lastra Ricardo R, Park Kay J, Schoolmeester J Kenneth
*Department of Pathology, University of Chicago, Chicago, IL†Department of Pathology, Johns Hopkins Hospital, Baltimore, MD‡Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY§Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.
Am J Surg Pathol. 2016 Feb;40(2):262-9. doi: 10.1097/PAS.0000000000000543.
Stratified mucin-producing intraepithelial lesion (SMILE) is a cervical intraepithelial lesion, distinct from conventional squamous or glandular counterparts, believed to arise from embryonic cells at the transformation zone by transdifferentiation during high-risk HPV-associated carcinogenesis. It is characterized by stratified, immature epithelial cells displaying varying quantities of intracytoplasmic mucin throughout the majority of the lesional epithelium. We identified a distinct form of invasive cervical carcinoma with morphologic features identical to those in SMILE, which we have termed "invasive stratified mucin-producing carcinoma." Fifteen cases from 15 patients (mean 36 y; range, 22 to 64 y) were retrieved from the pathology archives of multiple institutions with a diagnosis of either SMILE or invasive cervical carcinoma with a description or comment about the invasive tumor's resemblance to SMILE. Seven cases had solely intraepithelial disease with a component of SMILE (mean 29 y; range, 22 to 40 y). The 8 other cases had invasive stratified mucin-producing carcinoma (mean 44; range, 34 to 64 y) in which SMILE was identified in 7. All cases of invasive stratified mucin-producing carcinoma demonstrated stratified, immature nuclei with intracytoplasmic mucin, which morphologically varied between cases from "mucin-rich" to "mucin-poor" in a similar manner to SMILE. All cases had mitotic figures and apoptotic debris, and an intralesional neutrophilic infiltrate was seen in the majority of cases. In cases of invasive carcinoma, the depth of invasion ranged from <1 to 19 mm. Follow-up information was available in 8 cases and ranged from 1 to 36 months (mean 11 mo). Three cases of invasive stratified mucin-producing carcinoma had biopsy or resection-proven metastatic carcinoma on follow-up. These 15 cases of cervical stratified mucin-producing lesions show a combination of intraepithelial and invasive growth patterns. Given that SMILE is well rooted as a distinct intraepithelial lesion, we propose "invasive stratified mucin-producing carcinoma" to describe its corresponding form of invasive carcinoma.
分层黏蛋白产生性上皮内病变（SMILE）是一种宫颈上皮内病变，与传统的鳞状或腺性病变不同，被认为是在高危人乳头瘤病毒相关致癌过程中，由转化区的胚胎细胞经转分化产生。其特征是分层的未成熟上皮细胞在大部分病变上皮中显示出不同数量的胞浆内黏蛋白。我们发现了一种具有与SMILE相同形态特征的独特形式的浸润性宫颈癌，我们将其称为“浸润性分层黏蛋白产生癌”。从多个机构的病理档案中检索出15例来自15名患者（平均年龄36岁；范围22至64岁）的病例，诊断为SMILE或浸润性宫颈癌，并对浸润性肿瘤与SMILE的相似性有描述或评论。7例仅为伴有SMILE成分的上皮内病变（平均年龄29岁；范围22至40岁）。另外8例为浸润性分层黏蛋白产生癌（平均年龄44岁；范围34至64岁），其中7例发现有SMILE。所有浸润性分层黏蛋白产生癌病例均显示分层的、带有胞浆内黏蛋白的未成熟细胞核，其形态在病例之间从“富含黏蛋白”到“黏蛋白缺乏”各不相同，与SMILE类似。所有病例均有有丝分裂象和凋亡碎片，大多数病例可见病变内嗜中性粒细胞浸润。在浸润癌病例中，浸润深度范围为<1至19毫米。8例有随访信息，范围为1至36个月（平均11个月）。3例浸润性分层黏蛋白产生癌在随访中有活检或切除证实的转移性癌。这15例宫颈分层黏蛋白产生性病变显示出上皮内和浸润性生长模式的组合。鉴于SMILE作为一种独特的上皮内病变已得到充分确立，我们提出“浸润性分层黏蛋白产生癌”来描述其相应的浸润癌形式。
