2022-RA-958-ESGO Invasive stratified mucin-producing intraepithelial lesion (iSMILE) a rare entity of cervical cancer

Introduction/Background

ISMILE adenocarcinoma is a rare entity, recently described as a distinct entity of invasive lesion associated with Human Papilloma Virus infection. Described in the few cases in the literature as a form with a poor prognosis. Clinical and prognostic data of this entity are very limited in the literature. In this case, we describe the clinical presentation, management and two-year follow-up of an invasive SMILE adenocarcinoma.

Methodology

A 47-year-old female patient, with no pathological history, mother of 3 children, not yet menopausal, who had no previous cervical cancer screening; the reason for consultation was vaginal bleeding and pelvic pain. Examination found a suspicious 4 cm budding and exophytic cervical mass.

Results

The appearance was in favour of a SMILE adenocarcinoma in situ with early cervical invasion. The tumour was classified as FIGO stage IIB. Treatment consisted of chemotherapy, external pelvic radiotherapy and neoadjuvant uterovaginal brachytherapy. Operated within one month she had a total hysterectomy associated with an inguinal lymphadenectomy. Final pathological examination concluded to a localized invasive cervical tumor type SMILE measuring 4 cm. Follow-up was without recurrence after 2 years.

Conclusion

SMILE adenocarcinoma is a rare entity of cervical tumour, recently described in the literature. Its treatment should not differ from other forms of invasive cervical carcinoma. However, knowledge of this entity and its capacity for invasion and distant metastasis is important to ensure proper management of patients.