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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 890-891

Authors' reply to Gowrishankar


Department of Pathology, Polo Labs, Associated with Ivy Hospital, Ajitgarh, Punjab, India

Date of Submission30-Oct-2020
Date of Decision10-Nov-2020
Date of Acceptance16-Nov-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Kriti Chauhan
Department of Pathology, Polo Labs, Associated with Ivy Hospital, F-317, Industrial Area, Sector 74, Sahibzada Ajit Singh Nagar, Ajitgarh - 160 071, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/crst.crst_345_20

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How to cite this article:
Chauhan K, Kathuria K. Authors' reply to Gowrishankar. Cancer Res Stat Treat 2020;3:890-1

How to cite this URL:
Chauhan K, Kathuria K. Authors' reply to Gowrishankar. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Jan 25];3:890-1. Available from: https://www.crstonline.com/text.asp?2020/3/4/890/305009



We thank Dr. Gowrishankar for her comments on our article titled, “Cervical adenocarcinoma – A paradigm shift.”[1] With regard to the author's comment about the images being suboptimal for understanding the histological details, we would like to help by highlighting the key features in the photographs.

[Figure 1]a is a scanner image of the endocervical polyp showing some atypical proliferation of cells on the surface (black arrow). It is enclosed by the benign ectocervix on the top and endocervix on the left side (yellow arrow) with dilated cystic glands.
Figure 1: (a) Low-power view of the endocervical polyp showing the stratified mucin-producing intraepithelial lesion at the surface of the polyp (black arrow) along with the adjacent benign endocervix and ectocervix (yellow arrow) (H and E, ×100). (b) High-power view of SMILE (H and E, ×400)

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[Figure 1]b is a high-power view of the area marked by the black arrow in (a) showing the stratified mucin-producing intraepithelial lesions (SMILE) in the form of groups of stratified, immature epithelial cells with peripheral palisading. The cells show cytoplasmic clearing which is suggestive of intracytoplasmic mucin with ill-formed glandular structures with luminal eosinophilic secretions.[2]

[Figure 2]a is a low-power view of a different area from the polyp revealing the invasive stratified mucin-producing carcinoma (iSMILE) showing invasive tumor nests with similar histological features as described above (marked with a star) surrounded by a fibrous stroma.
Figure 2: (a) Low-power view of invasive stratified mucin-producing carcinoma (black star) (H and E, ×100). (b) High-power view of the invasive nests of stratified mucin-producing intra-epithelial lesion showing numerous mitotic figures (red arrow) and peripheral palisading of cells (black star) (H and E, ×400)

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[Figure 2]b is a high-power view of an infiltrating tumor nest showing numerous mitotic figures (red arrow) and peripheral palisading (star) characteristic of human papillomavirus (HPV) association in SMILE.[3]

[Figure 3]a is a low-power view of the SMILE and iSMILE, and [Figure 3]b and c are the respective low- and high-power views of the co-existing adenocarcinoma in situ which shows well-defined glandular lumina (yellow star) lined by stratified columnar epithelium along with multiple mitotic figures (red arrow) and apoptotic bodies, suggestive of HPV association.[4]
Figure 3: (a) Low-power view of the stratified mucin-producing intraepithelial lesion (black solid star) and the invasive nests below it (H and E, ×100). (b) Low-power view of adenocarcinoma in situ (red solid star). (c) High-power view of adenocarcinoma in situ showing mitotic figures (red solid arrow) and mucin (yellow star) (H and E, ×400)

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[Figure 4]a is a high-power view of the SMILE highlighting the nuclear features (atypia, hyperchromasia, and prominent nucleoli). [Figure 4]b and c show co-existing foci of mucinous adenocarcinoma (abundant clear cytoplasm pushing the nucleus) with apoptotic bodies, mitoses, and intratumoral neutrophils.
Figure 4: (a) Another low-power view of the stratified mucin-producing intraepithelial lesion showing vesicular nuclei (white solid arrow) (H and E, ×100). (b) High-power view of the usual endocervical adenocarcinoma with a black arrow pointing at a mitotic figure present adjacent to the mucinous subtype (green solid star) (H and E, ×400). (c) Low-power view of the mucinous human papillomavirus-associated carcinoma showing intracellular mucin (green star) and apoptotic bodies admixed with neutrophils (black circle) (H and E, ×100)

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No special stains (mucin) were used in this study to highlight the fact that only hematoxylin and eosin-stained slides are sufficient for making a diagnosis of HPV-associated (HPVA) carcinomas and differentiating them from the non-HPVA ones without the help of any ancillary techniques. Histologic subtype is secondary to the presence of nuclear atypia, mitoses, and apoptosis in the diagnosis of HPVA. We also aimed to familiarize the practicing pathologists with the rare entity, “SMILE,” so that it is not misdiagnosed as adenocarcinoma in situ or cervical intraepithelial neoplasia.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chauhan K, Kathuria K. Cervical adenocarcinoma – A paradigm shift. Cancer Res Stat Treat 2020;3:590-3.  Back to cited text no. 1
  [Full text]  
2.
Lei R. Invasive stratified mucin-producing carcinoma: A clinicopathological analysis of three cases. Cancer Biol Ther 2019;20:1403-7.  Back to cited text no. 2
    
3.
Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, et al. International Endocervical Adenocarcinoma Criteria and Classification (IECC): A new pathogenetic classification for invasive adenocarcinomas of the endocervix. Am J Surg Pathol 2018;42:214-26.  Back to cited text no. 3
    
4.
Fukui S, Nagasaka K, Iimura N, Kanda R, Ichinose T, Sugihara T, et al. Detection of HPV RNA molecules in stratified mucin-producing intraepithelial lesion (SMILE) with concurrent cervical intraepithelial lesion: A case report. Virol J 2019;16:76.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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