Uterine smooth muscle tumour of uncertain malignant potential (STUMP): Where are we now?

Uterine smooth muscle tumors of uncertain malignant potential (STUMP): A case report

INTRODUCTION

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) are extremely rare, defined as a uterine smooth muscle tumors that cannot be diagnosed as benign or malignant and does not satisfy all the criteria for leiomyosarcoma or leiomyoma.

CASE REPRESENTATION

A 48-year-old woman who presented with a history of heavy menstrual bleeding and pelvic pain. Physical examination revealed an enlarged uterus. Ultrasonography showed lobular and enlarged uterus containing multiples leiomyomas. A subtotal hysterectomy was performed. A Pathological analysis revealed a uterine mass diagnosed as a smooth muscle tumor of uncertain malignant.

DISCUSSION

Uterine STUMPs are rare and are commonly diagnosed by histopathological evaluation following myomectomy or hysterectomy. The most common clinical manifestations of uterine STUMP are the same as leiomyomas. Prognosis for the patient is unclear and there is a risk of recurrence with the tumors. However, considering their potential risk of recurrence and metastasis, it is advisable to maintain six-monthly controls for 5 years and then annual controls for 5 years more.

CONCLUSION

Due to the rarity of uterine STUMP, there are no specific guidelines for their treatment and control. The scientific literature needs to be constantly updated in order to identify masses suspected of malignancy before surgery and improve patient management and follow-up.

Smooth Muscle Tumor of Uncertain Malignant Potential Arising from Renal Vein

Smooth muscle tumors (SMTs) typically fall under either benign leiomyoma or malignant leiomyosarcomas based on histologic characteristics. SMTs that cannot be diagnosed as benign or malignant are then labeled as smooth muscle tumors of uncertain malignant potential (STUMP). A 31-year-old male presented with the right abdominal pain for 6 months. Imaging showed an enhancing soft-tissue mass arising from the right renal vein. A pre-operative biopsy confirmed STUMP of renal vein, and the patient underwent surgical resection of the mass with partial nephrectomy. Imaging and pathologic findings play a crucial role in an accurate pre-procedural diagnosis of unusual SMTs.

Spontaneous utero-cutaneous fistula between a benign uterine leiomyoma and abdominal skin: A case report

The case of a 56-year-old woman with a fibroid uterus who developed utero-cutaneous fistula is presented. The woman was para 0, had an unremarkable medical history, and had no prior diagnosis of a gynecologic pathology, no operative interventions involving the uterine wall or any other risk factor for fistula. Abdominal examination revealed an abdominal mass with overlying deep, purulent ulceration. ¹⁸F-FDG PET/CT scan was consistent with uterine leiomyoma, but a differential diagnosis of sarcoma was considered due to the presence of the fistula, patchy increased FDG uptake of the tumor and several mildly enlarged lymph nodes bilaterally in the inguinal and iliac region. Hysterectomy with bilateral salpingo-oophorectomy was performed. Histological diagnosis was of leiomyoma with focal bizarre atypia, degenerative and metaplastic changes and utero-cutaneous fistula. To the best of our knowledge, this is the first case report describing a benign leiomyoma forming a fistula between the uterus and abdominal surface.

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Utero-cutaneous fistula is a rare condition.

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We report a case of a 56-year-old woman with benign leiomyoma with a utero-cutaneous fistula.

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Degenerative leiomyoma can mimic malignancy in medical imaging.

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A multidisciplinary team approach is recommended in such unusual cases.

Risk of incidental genital tract malignancies at the time of myomectomy and hysterectomy for benign conditions

OBJECTIVE

To determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecological surgeries for pathologies presumed to be benign.

METHODS

Data of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A total of 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessed through the computer records, and the total number of genital tract malignancies was included.

RESULTS

The incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%, 0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomy was 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed by leiomyosarcoma and endometrial adenocarcinoma.

CONCLUSION

Postoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challenges to the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially in some subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, although little chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and always ensuring contained morcellation can minimize these chances.