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What Is Stratified Mucin Producing Intraepithelial Lesion?

Posted on Fri, 31 Jan 2014

Question: I was diagnosed with high risk hpv and had a normal pap smear. I had a colposcopy and biopsy which showed i had grandular changes and SMILE (Stratified mucin-producing intraepithelial lesion). I had the lletz procedure and the results came back today and said no evidence of pre-cancerous changes had been found. Another smear going to be in 6 months. My questions are... 1)What is SMILE? 2) is is likely it would have been removed? 3) Is it likely to return? 4) Can I have another baby? I am 32 years old and had a baby 5 months ago. I had a lletz procedure also in 2009. Thank you for your help

Answered by Dr. Monika Choudhary (13 hours later)

Brief Answer: please provide history of immunization Detailed Answer: Hi XXXXXXX Welcome to healthcare Magic! Before I answer, would just like to know if you have any comorbidities like diabetes, drug abuse etc. History of sexual exposures, whether any STD in past, whether any history of abortion. Whether you have got immunization for papilloma. I hope the advise after this detail would be more informative and useful for you. Take Care!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Monika Choudhary (25 minutes later)

Hi there. I am otherwise healthy, no diabetes etc. I have had no abortions in the past but I have had chlamydia in 2005 which was cleared with antibiotics. I am generally not a smoker but did smoke cannabis for about 2 years before I got pregnant, then stopped. I have not had a HPV vaccination. I have had about 10 sexual partners in my lifetime and have been wth my current partner for 3 years. Had a baby boy 5 months ago and i am 33 next month. Thank yo

Answered by Dr. Monika Choudhary (3 hours later)

Brief Answer: SMILE is cervical intra-epithelial neoplasia Detailed Answer: Hello, Welcome back. SMILE is high grade cervical intra-epithelial neoplasia & you are lucky that your biopsy report came negative for carcinoma. However be careful as SMILE can return back & get pap smear done at regular interval as advised by your gynaecologist. If your 3 consecutive pap smears come negative, then you can plan for second pregnancy. If one is having multiple sexual partners then there is more risk for this disease so adopt safe life style.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Monika Choudhary (5 minutes later)

If the high risk hpv goes dormant, will the smile come back then or is it just when i have an active infection? Would the SMILE have been removed now? I find it confusing it was found on the punch biopsy at the colposcopy but then there was no pre-cancer changes were found on the Lletz. Do you know why this could be? Could the biopsy be wrong and I did not have SMILE?

Answered by Dr. Monika Choudhary (10 hours later)

Brief Answer: Regular follow up is the answer. Detailed Answer: Hi XXXXXXX Welcome back to healthcare magic. Hpv whether dormant or active it can lead to recurrence of such lesions in future. Regular follow up and screening is needed to be on safer side. Take care. Brief Answer: You should undergo repeated pap smear Detailed Answer: Hello, Welcome back. During colonoscopic guided biopsy a small cervical segment is taken & sent for HPE, during that biopsy you were diagnosed as having SMILE. Followed by that in LLETZ a large cervical segment from particular area of cervix was taken & sent for HPE. There can be possibility that your whole SMILE affected area was taken out during biopsy incidently & remaining area taken during LLETZ came back negative. But it does not mean that your biopsy or LLETZ reports were wrong, you would have to undergo repeated pap smear as advised by your doctor. All the Best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Monika Choudhary (10 hours later)

Thank you, could it be possible the punch biopsy at colposcopy could also have taken all the cgin also? Is SMILE a pre-cancer? I have read it is very rare.

Answered by Dr. Monika Choudhary (16 hours later)

Brief Answer: SMILE is precancerous Detailed Answer: Hello, Welcome back. SMILE is associated with H-CGIN( high grade cervical glandular intra-epithelial neoplasia) means it is pre-cancerous and, if seen on biopsy, should be an indication for further sampling of the cervix. Incidence of SMILE is rare but once it is diagnosed it is precancerous. So be careful & consult your doctor regularly.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar