Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, 508126, Hyderabad, Telangana, India.
Department of Pathology, All India Institute of Medical Sciences, Bibinagar, 508126, Hyderabad, Telangana, India.
Infect Disord Drug Targets. 2024;24(6):e290124226396. doi: 10.2174/0118715265284722240110114107.
Cervical cancer is the fourth most common cancer among women globally and has a strong association with Human Papillomavirus (HPV) infection. Stratified mucinproducing intraepithelial lesion (SMILE), a variant of Adenocarcinoma in situ (AIS), is a rare cervical precancer lesion that is often missed or detected incidentally.
The present case report briefs the finding of a 39-year-old woman who presented to the gynecological outpatient department with complaints of vaginal discharge for 6-8 months. She had no history of irregular menstrual cycles or postcoital bleeding. Her routine Pap smear revealed atypical squamous cells of undetermined significance (ASCUS) and was positive for HPV-16 type. Her cervical biopsy report revealed AIS and her histopathological report of hysterectomy revealed SMILE, a variant of AIS.
The SMILE variant of AIS is a rare cervical precancerous lesion characterized by the morphological overlap of both squamous intraepithelial lesions and AIS. It is often difficult to diagnose on Pap smear and is commonly associated with high-risk HPV infections. The management of SMILE is the same as that for AIS, which is the excisional procedure followed by a hysterectomy if the margins are negative and depending on the fertility desires of the patient, followed by regular follow-up with HPV testing.
SMILE is a rare variant of AIS, which is often missed on cytological screening of the cervix. It is commonly associated with high-risk types of HPV. Hence, incorporating HPV testing in the screening of cervical cancer is important and recommended to increase the overall sensitivity of screening for adenocarcinoma lesions.
宫颈癌是全球女性中第四常见的癌症，与人类乳头瘤病毒（HPV）感染密切相关。分层黏液产生上皮内病变（SMILE）是原位腺癌（AIS）的一种变体，是一种罕见的宫颈癌前病变，常被忽视或偶然发现。
本病例报告简要介绍了一名 39 岁女性的就诊情况，她因阴道分泌物 6-8 个月而到妇科门诊就诊。她没有月经不规律或性交后出血的病史。她的常规巴氏涂片显示非典型鳞状细胞意义不明（ASCUS），HPV-16 型阳性。她的宫颈活检报告显示为 AIS，子宫切除术后的组织病理学报告显示为 SMILE，是 AIS 的一种变体。
AIS 的 SMILE 变体是一种罕见的宫颈癌前病变，其特征是鳞状上皮内病变和 AIS 的形态重叠。在巴氏涂片上很难诊断，通常与高危 HPV 感染有关。SMILE 的处理与 AIS 相同，即切除后如果边缘阴性，根据患者的生育意愿进行子宫切除术，然后定期进行 HPV 检测随访。
SMILE 是 AIS 的一种罕见变体，在宫颈细胞学筛查中常被忽视。它通常与高危型 HPV 有关。因此，在宫颈癌筛查中纳入 HPV 检测对于提高腺癌病变筛查的整体敏感性非常重要。
