Lars-Christian Horn1, Romy Handzel2, Gudrun Borte3, Udo Siebolts4, Anja Haak4, Christine E Brambs5. 1. Division of Gynecologic, Breast and Perinatal Pathology, Institute of Pathology, University Hospital Leipzig, Liebigstrasse 26, 04103, Leipzig, Germany. hornl@medizin.uni-leipzig.de. 2. Division of Gynecologic Oncologic Surgery, Department of Obstetrics and Gynecology (Institute of Trier), University Hospital Leipzig, Leipzig, Germany. 3. Department of Diagnostic Radiology, University Hospital Leipzig, Leipzig, Germany. 4. Division of Molecular Pathology, Institute of Pathology, University Hospital Halle/Saale, Halle/saale, Germany. 5. Department of Obstetrics and Gynecology, Technical University Munich, Munich, Germany.
Abstract
PURPOSE: Invasive stratified mucin-producing carcinoma (i-SMILE) represents a recently recognized subtype of cervical adenocarcinoma (AC) developing in a background of a stratified mucin-producing intraepithelial lesion (SMILE). Clinical and prognostic data on i-SMILE are limited. METHODS: We report a series of five cases with histopathological, immunohistochemical (p16) and PCR analyses. The cases as well as the patients previously published in the literature were reviewed for follow-up information. RESULTS: Thirteen cases were identified. The mean age of 47.1 years (range 34-66) was not different from the usual type of cervical AC. 10/13 cases presented with tumors > 2 cm and a polypoid-exophytic appearance. Regardless of tumor size and stage of the disease, 7 out of 11 patients developed recurrent disease after a mean of 7.8 months (range 6 weeks-36 months). Five patients developed distant metastases (three of them in the lungs). Five out of the 11 informative cases died of the disease. All reported cases were positive for high-risk HPV (mainly HPV type 18) and associated with p16-overexpression. CONCLUSION: i-SMILE represent a distinct subtype of invasive endocervical AC, associated high-risk HPV infection and strong p16-overexpression. Clinically, i-SMILE may represent an aggressive tumor with early recurrent disease and substantial risk of distant metastatic disease, especially to the lungs.
PURPOSE: Invasive stratified mucin-producing carcinoma (i-SMILE) represents a recently recognized subtype of cervical adenocarcinoma (AC) developing in a background of a stratified mucin-producing intraepithelial lesion (SMILE). Clinical and prognostic data on i-SMILE are limited. METHODS: We report a series of five cases with histopathological, immunohistochemical (p16) and PCR analyses. The cases as well as the patients previously published in the literature were reviewed for follow-up information. RESULTS: Thirteen cases were identified. The mean age of 47.1 years (range 34-66) was not different from the usual type of cervical AC. 10/13 cases presented with tumors > 2 cm and a polypoid-exophytic appearance. Regardless of tumor size and stage of the disease, 7 out of 11 patients developed recurrent disease after a mean of 7.8 months (range 6 weeks-36 months). Five patients developed distant metastases (three of them in the lungs). Five out of the 11 informative cases died of the disease. All reported cases were positive for high-risk HPV (mainly HPV type 18) and associated with p16-overexpression. CONCLUSION: i-SMILE represent a distinct subtype of invasive endocervical AC, associated high-risk HPV infection and strong p16-overexpression. Clinically, i-SMILE may represent an aggressive tumor with early recurrent disease and substantial risk of distant metastatic disease, especially to the lungs.
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Authors: Lars-Christian Horn; Matthias W Beckmann; Markus Follmann; Martin C Koch; Monika Nothacker; Birgit Pöschel; Frederik Stübs; Dietmar Schmidt; Anne Kathrin Höhn Journal: Pathologie (Heidelb) Date: 2022-02-21