SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases
Adenocarcinoma is a type of cervical tumor originating in the lining epithelium of the endocervical mucosa, constituting between 10-20% of malignant epithelial tumors of said location. Mucin-producing stratified intraepithelial lesion (SMILE) is a variant of adenocarcinoma in situ (AIS) that wa...
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/42657 |
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I10-R327-article-42657 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
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R-327 |
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Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
Cervical neoplasms Adenocarcinoma in situ Human Papilloma Virus HPV neoplasias del cuello uterino, Adenocarcinoma in situ Virus del Papiloma Humano HPV |
| spellingShingle |
Cervical neoplasms Adenocarcinoma in situ Human Papilloma Virus HPV neoplasias del cuello uterino, Adenocarcinoma in situ Virus del Papiloma Humano HPV Faure, EE Barbero, CJ Bengió, V SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| topic_facet |
Cervical neoplasms Adenocarcinoma in situ Human Papilloma Virus HPV neoplasias del cuello uterino, Adenocarcinoma in situ Virus del Papiloma Humano HPV |
| author |
Faure, EE Barbero, CJ Bengió, V |
| author_facet |
Faure, EE Barbero, CJ Bengió, V |
| author_sort |
Faure, EE |
| title |
SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| title_short |
SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| title_full |
SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| title_fullStr |
SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| title_full_unstemmed |
SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| title_sort |
smile-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases |
| description |
Adenocarcinoma is a type of cervical tumor originating in the lining epithelium of the endocervical mucosa, constituting between 10-20% of malignant epithelial tumors of said location. Mucin-producing stratified intraepithelial lesion (SMILE) is a variant of adenocarcinoma in situ (AIS) that was first reported in 2000 as a lesion with some overlap between squamous intraepithelial lesion (SIL) architecture and AIS, due to its presumably origin in the reserve cells of the transformation zone, considering it a rare cervical precancerous lesion. Like squamous cell carcinoma, it is etiologically related to persistent high-risk HPV infection due to strong nuclear and cytoplasmic positivity for p16 by immunohistochemistry. Cytological diagnosis requires a high index of suspicion, since it is more difficult to detect in early stages and its location in the upper part of the endocervical canal may limit obtaining a representative biopsy for histopathological diagnosis.
Case presentation: 43-year-old patient who consulted for postmenstrual spotting. Colposcopy with a dense acetowhite lesion and dilated vessels at hour 12 within the transformation zone. Cervicovaginal cytology reports squamous cells compatible with Low-Grade Squamous Intraepithelial Lesion (L-SIL) and atypical glandular cells (AGUS). A biopsy of the lesion was performed, which revealed adenocarcinoma in situ, SMILE type. Immunohistochemistry: diffuse p16 positive, Ki-67 70%, ER positive and CDX-2 negative.
Cervical adenocarcinoma constitutes a fraction of malignant neoplasms with limitations for cytological diagnosis. SMILEs are a relatively recently recognized rare variant of AIS, it express p16 and have a high Ki-67 proliferation rate. It is important to recognize the morphological spectrum of this lesion in order to promptly suspect from cytology and be able to confirm with biopsy, since they are potentially aggressive tumors compared to the usual type and are usually diagnosed in more advanced stages. Finally, it is essential that gynecologists are familiar with the diagnosis in order to guarantee proper management of these patients.
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| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/42657 |
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AT faureee smiletypeendocervicaladenocarcinomainsitutheimportanceofthecorrelationbetweencytologyandbiopsyfortheearlydiagnosisofrarediseases AT barberocj smiletypeendocervicaladenocarcinomainsitutheimportanceofthecorrelationbetweencytologyandbiopsyfortheearlydiagnosisofrarediseases AT bengiov smiletypeendocervicaladenocarcinomainsitutheimportanceofthecorrelationbetweencytologyandbiopsyfortheearlydiagnosisofrarediseases AT faureee adenocarcinomaendocervicalinsitutiposmilelaimportanciadelacorrelacionentrecitologiaybiopsiaparaeldiagnosticoprecozdepatologiaspocofrecuentes AT barberocj adenocarcinomaendocervicalinsitutiposmilelaimportanciadelacorrelacionentrecitologiaybiopsiaparaeldiagnosticoprecozdepatologiaspocofrecuentes AT bengiov adenocarcinomaendocervicalinsitutiposmilelaimportanciadelacorrelacionentrecitologiaybiopsiaparaeldiagnosticoprecozdepatologiaspocofrecuentes |
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I10-R327-article-426572023-10-19T21:20:17Z SMILE-type endocervical adenocarcinoma in situ: the importance of the correlation between cytology and biopsy for the early diagnosis of rare diseases Adenocarcinoma endocervical in situ tipo SMILE: la importancia de la correlación entre citología y biopsia para el diagnóstico precoz de patologías poco frecuentes Faure, EE Barbero, CJ Bengió, V Cervical neoplasms Adenocarcinoma in situ Human Papilloma Virus HPV neoplasias del cuello uterino, Adenocarcinoma in situ Virus del Papiloma Humano HPV Adenocarcinoma is a type of cervical tumor originating in the lining epithelium of the endocervical mucosa, constituting between 10-20% of malignant epithelial tumors of said location. Mucin-producing stratified intraepithelial lesion (SMILE) is a variant of adenocarcinoma in situ (AIS) that was first reported in 2000 as a lesion with some overlap between squamous intraepithelial lesion (SIL) architecture and AIS, due to its presumably origin in the reserve cells of the transformation zone, considering it a rare cervical precancerous lesion. Like squamous cell carcinoma, it is etiologically related to persistent high-risk HPV infection due to strong nuclear and cytoplasmic positivity for p16 by immunohistochemistry. Cytological diagnosis requires a high index of suspicion, since it is more difficult to detect in early stages and its location in the upper part of the endocervical canal may limit obtaining a representative biopsy for histopathological diagnosis. Case presentation: 43-year-old patient who consulted for postmenstrual spotting. Colposcopy with a dense acetowhite lesion and dilated vessels at hour 12 within the transformation zone. Cervicovaginal cytology reports squamous cells compatible with Low-Grade Squamous Intraepithelial Lesion (L-SIL) and atypical glandular cells (AGUS). A biopsy of the lesion was performed, which revealed adenocarcinoma in situ, SMILE type. Immunohistochemistry: diffuse p16 positive, Ki-67 70%, ER positive and CDX-2 negative. Cervical adenocarcinoma constitutes a fraction of malignant neoplasms with limitations for cytological diagnosis. SMILEs are a relatively recently recognized rare variant of AIS, it express p16 and have a high Ki-67 proliferation rate. It is important to recognize the morphological spectrum of this lesion in order to promptly suspect from cytology and be able to confirm with biopsy, since they are potentially aggressive tumors compared to the usual type and are usually diagnosed in more advanced stages. Finally, it is essential that gynecologists are familiar with the diagnosis in order to guarantee proper management of these patients. El adenocarcinoma es un tipo de tumor de cuello uterino originado en el epitelio de revestimiento de la mucosa endocervical, constituyendo entre el 10-20% de los tumores epiteliales malignos de dicha localización. La lesión intraepitelial estratificada productora de mucina (SMILE) es una variante de adenocarcinoma in situ (AIS) que se informó por primera vez en el 2000 como una lesión con cierta superposición entre la arquitectura de lesiones intraepiteliales escamosas (SIL) y el AIS, debido a su presumible origen en las células de reserva de la zona de transformación, considerándose una lesión precancerosa cervical poco frecuente. Al igual que el carcinoma escamoso, está etiológicamente relacionada con la infección persistente por HPV de alto riesgo debido a la fuerte positividad nuclear y citoplasmática para p16 por inmunohistoquímica. El diagnóstico citológico requiere de un alto índice de sospecha, ya que cuesta más detectarlo en etapas tempranas y su localización en la parte alta del canal endocervical puede limitar la obtención de una biopsia representativa para el diagnóstico histopatológico. Presentación del caso: Paciente de 43 años que consulta por spotting postmenstrual. Colposcopía con lesión aceto-blanca densa y vasos dilatados en hora 12 dentro de la zona de transformación. La citología cervicovaginal informa células escamosas compatibles con Lesión Escamosa Intraepitelial de Bajo Grado (L-SIL) y células glandulares atípicas (AGUS). Se realiza biopsia de la lesión, la que informa adenocarcinoma in situ, tipo SMILE. Inmunohistoquímica: p16 positivo difuso, Ki-67 70%, RE positivo y CDX-2 negativo. El adenocarcinoma de cuello uterino constituye una fracción de las neoplasias malignas con limitaciones para el diagnóstico citológico. Los SMILE constituyen una variante rara de AIS reconocida de forma relativamente reciente, son p16 positivos y tienen un alto índice de proliferación de Ki-67. Resulta importante reconocer el espectro morfológico de esta lesión para así sospecharlo oportunamente desde la citología y poder confirmarlo con la biopsia, ya que son tumores potencialmente agresivos en comparación con el tipo habitual y suelen diagnosticarse en estadios más avanzados. Finalmente, resulta fundamental que los ginecólogos estén familiarizados con el diagnóstico para así garantizar un manejo adecuado de estas pacientes. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-10-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/42657 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 (2023): Suplemento JIC XXIV Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 (2023): Suplemento JIC XXIV Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 (2023): Suplemento JIC XXIV 1853-0605 0014-6722 spa https://revistas.unc.edu.ar/index.php/med/article/view/42657/42903 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |