Original ArticlesInvasive 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 AdenocarcinomaLastra, Ricardo R. MD*,†; Park, Kay J. MD‡; Schoolmeester, J. Kenneth MD†,§ Author Information *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 Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Correspondence: John K. Schoolmeester, MD, Mayo Clinic, 200 First Street, Rochester, MN 55905 (e-mail: [email protected]). The American Journal of Surgical Pathology: February 2016 - Volume 40 - Issue 2 - p 262-269 doi: 10.1097/PAS.0000000000000543 Buy Metrics Abstract 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. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.