The morphological and immunohistochemical characteristics of stratified mucin-producing intraepithelial lesion

Shamarakova M.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Asaturova A.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Ezhova L.S.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Dumanovskaya M.R.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Faĭzullina N.M.

FGBU "NTsAGiP im. akad. V.I Kulakova" Minzdrava Rossii, Moskva

Kozachenko A.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

The morphological and immunohistochemical characteristics of stratified mucin-producing intraepithelial lesion

Authors:

Shamarakova M.V., Asaturova A.V., Ezhova L.S., Dumanovskaya M.R., Faĭzullina N.M., Kozachenko A.V.

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Journal: Russian Journal of Archive of Pathology. 2017;79(5): 16‑20

DOI: 10.17116/patol201779516-20

Downloaded: 60

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To cite this article:

Shamarakova MV, Asaturova AV, Ezhova LS, Dumanovskaya MR, Faĭzullina NM, Kozachenko AV. The morphological and immunohistochemical characteristics of stratified mucin-producing intraepithelial lesion. Russian Journal of Archive of Pathology. 2017;79(5):16‑20. (In Russ.)
https://doi.org/10.17116/patol201779516-20

Подписка 2025 (Russian Journal of Archive of Pathology)

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Stratified mucin-producing intraepithelial lesion (SMILE) is a rare premalignant cervical lesion that combines the structural features of cervical intraepithelial neoplasia (CIN) and endocervical adenocarcinoma in situ (AIS). Objective: to analyze archival materials for the detection of SMILE and its subsequent morphological and immunohistochemical characterization. Material and methods. Cervical cone specimens from 53 women with histologically verified CIN3 were examined. The diagnosis of SMILE was based on the positive mucicarmine staining and weak focal expression of p63. The samples containing SMILE were further immunohistochemically examined using the biomarkers P16, Ki-67, Oct4, CD117, CD34, p53, EMA, and CK15. SMILE was detected in 2 of the 53 patients and concurrent with CIN3 in both cases. SMILE was characterized by the stratified arrangement of atypical cells containing mucin, the positive mucicarmine staining of the entire layer of the atypical epithelium, weak focal p63 expression, high Ki-67 expression, and diffuse р16Іnk4а staining. Both SMILE samples showed weak diffuse p53 expression in the presence of single cells with the pronounced nuclear staining pattern for p53 in one female patient. Weak focal CK15 expression was visualized in SMILE. The expression of the stem cell markers Oct4 and CD117 and the angiogenic marker CD34 was absent in the examined cervical epithelial preparations. The diffuse and intense expression of the marker EMA, which was not different from that in the endocervical and stratified squamous epithelium, and CIN3 was established in SMILE. Results. The findings suggest that SMILE is morphologically and immunohistochemically similar to CIN3. In this investigation, these abnormalities differed only in the mucicarmine staining and expression of p63. This may be indicative of the underdiagnosis of SMILE, attendant СIN3 in the routine practice of a clinical pathologist, as the diagnosis of CIN3 is primarily based on the results of assessment of only the preparations stained with hematoxylin and eosin; the expression of p16 and Ki-67 is evaluated in some cases, which fails to differentiate SMILE and CIN3 in a number of preparations. Conclusion. The diagnosis of SMILE can be made only by immunohistochemical examination.

Keywords:

stratified mucin-producing intraepithelial lesion (SMILE)

cervical intraepithelial neoplasia (CIN)

adenocarcinoma in situ (AIS)

Authors:

Shamarakova M.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Asaturova A.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Ezhova L.S.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Dumanovskaya M.R.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

Faĭzullina N.M.

FGBU "NTsAGiP im. akad. V.I Kulakova" Minzdrava Rossii, Moskva

Kozachenko A.V.

V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow, Russia

List of references:

Kurman RJ, Carcangiu ML, Herrington CS, Young RH eds. World Health Organization classification of tumours of female reproductive organs. Lyon: IARC Press; 2014.
Park JJ, Sun D, Quade BJ, Flynn C, Sheets EE, Yang A, McKeon F, Crum CP. Stratified mucin-producing intraepithelial lesions of the cervix: adenosquamous or columnar cell neoplasia. Am J Surg Pathol. 2000;24(10):1414-1419.
McCluggage WG. New developments in endocervical glandular lesions. Histopathology. 2013;62(1):138-160. https://doi.org/10.1111/his.12012
Boyle DP, McCluggage WG. Stratified mucin-producing intraepithelial lesion (SMILE): report of a case series with associated pathological findings. Histopathology. 2015;66(5):658-663. https://doi.org/10.1111/his.12498
Backhouse A, Stewart CJ, Koay MH, Hunter A, Tran H, Farrell L, Ruba S. Cytologic findings in stratified mucin-producing intraepithelial lesion of the cervix: a report of 34 cases. Diagn Cytopathol. 2016;44(1):20-25. https://doi.org/10.1002/dc.23381
Onishi J, Sato Y, Sawaguchi A, Yamashita A, Maekawa K, Sameshima H, Asada Y. Stratified mucin-producing intraepithelial lesion with invasive carcinoma: 12 cases with immunohistochemical and ultrastructural findings. Hum Pathol. 2016;55:174-181. https://doi.org/10.1016/j.humpath.2016.05.007
Lastra RR, Park KJ, Schoolmeester JK. Invasive stratified mucin-producing carcinoma and stratified mucin-producing intraepithelial lesion (SMILE): 15 cases presenting a spectrum of cervical neoplasia with description of a distinctive variant of invasive adenocarcinoma. Am J Surg Pathol. 2016;40(2):262-269. https://doi.org/10.1097/PAS.0000000000000543
Wright TC, Ferenczy A, Kurman RJ. Carcinoma and other tumors of the cervix. In: Kurman RJ, ed. Blaustein’s pathology of the female genital tract. New York, NY: Springer-Verlag; 1994:279-326.
Colgan TJ, Auger M, McLaughlin JR. Histopathologic classification of cervical carcinomas and recognition of mucin-secreting squamous carcinomas. Int J Gynecol Pathol. 1993;12:64-69.
Thelmo WL, Nicastri AD, Fruchter R, Spring H, DiMaio T, Boyce J. Mucoepidermoid carcinoma of the uterine cervix stage IB. Long-term follow-up, histochemical and immunohistochemical study. Int J Gynecol Pathol. 1990;9(4):316-324.
Forder MD, Tiltman AJ. Mucin production in cervical intraepithelial neoplasia. S Afr Med J. 1992;81(3):155-156.
Nikolaou M, Koumoundourou D, Ravazoula P, Papadopoulou M, Michail G, Decavalas G. An immunohistochemical analysis of sex-steroid receptors, tumor suppressor gene p53 and Ki-67 in the normal and neoplastic uterine cervix squamous epithelium. Med Pregl. 2014;67(7-8):202-207.
Smedts F, Ramaekers F, Leube RE, Keijser K, Link M, Vooijs P. Expression of keratins 1, 6, 15, 16, and 20 in normal cervical epithelium, squamous metaplasia, cervical intraepithelial neoplasia, and cervical carcinoma. Am J Pathol. 1993;142(2):403-412.
Park JJ, Sun D, Crum CP. Squamomucinous intraepithelial (SMIL) and invasive lesions of the cervix: a distinct pathologic entity. Mod Pathol. 1999;12:121A.
Crum CP. Contemporary theories of cervical carcinogenesis: the virus, the host, and the stem cell. Mod Pathol. 2000;13(3):243-251.
Herfs M, Vargas SO, Yamamoto Y, Howitt BE, Nucci MR, Hornick JL, McKeon FD, Xian W, Crum CP. A novel blueprint for ‘top down’ differentiation defines the cervical squamocolumnar junction during development, reproductive life, and neoplasia. J Pathol. 2013;229(3):460-468. https://doi.org/10.1002/path.4110

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