Giant uterine mass with uterine smooth muscle tumor of uncertain malignant potential: A case report

Jang, Tae-Kyu; Kwon, Sang-Hoon; Cho, Chi-Heum; Lee, Hye Won; Shin, So Jin

doi:10.1016/j.gore.2020.100663

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…They are diagnosed more frequently in premenopausal women, with an average age of 44 years [ 14 ]. The incidence of these tumors is not very well documented, varying by around 0.01% in patients treated surgically for the presumptive diagnosis of uterine leiomyoma [ 15 ]. In the current research, we observed that the age at diagnosis of patients with this tumor varied between 43 and 48 years, with an average of 45.…”

Section: Discussionmentioning

confidence: 99%

The Role of Pathogenesis Associated with the Tumor Microclimate in the Differential Diagnosis of Uterine Myocytic Tumors

Boşoteanu

Deacu

Aşchie

et al. 2023

JCM

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Myocytic tumors of the uterus present vast morphological heterogeneity, which makes differential diagnosis between the different entities necessary. This study aims to enrich the existing data and highlight new potential therapeutic targets regarding aspects related to the pathogenic process and the tumor microenvironment in order to improve the quality of life of women. We performed a 5-year retrospective study, including particular cases of uterine myocyte tumors. Immunohistochemical analyses of pathogenic pathways (p53, RB1, and PTEN) and tumor microclimate using markers (CD8, PD-L1, and CD105), as well as genetic testing of the PTEN gene, were performed. The data were statistically analyzed using the appropriate parameters. In cases of atypical leiomyoma, a significant association was observed between PTEN deletion and an increased number of PD-L1+ T lymphocytes. For malignant lesions and STUMP, PTEN deletion was associated with the advanced disease stage. Advanced cases were also associated with an increased mean CD8+ T cell count. An increased number of lymphocytes was associated with an increased percentage of RB1+ nuclei. The study corroborated clinical and histogenetic data, highlighting the importance of the differential diagnosis of these tumors to improve the management of patients and increase their quality of life.

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Section: Discussionmentioning

confidence: 99%

The Role of Pathogenesis Associated with the Tumor Microclimate in the Differential Diagnosis of Uterine Myocytic Tumors

Boşoteanu

Deacu

Aşchie

et al. 2023

JCM

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“…STUMP tumors are characterized by clinical and histological heterogeneity [ 12 ]. They have a frequency of approximately 0.01%, their prevalence being difficult to assess due to their rarity and variable/subjective diagnostic criteria [ 12 , 13 ]. The incidence of uterine leiomyosarcoma is between 0.35–0.8/100,000, with a prevalence of 3–7/100,000 [ 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma

Boşoteanu

Deacu

Vodă

et al. 2022

Clinics and Practice

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Taking into account the unpredictable evolution of uterine STUMP and leiomyosarcomas, there are no clearly established therapeutic protocols to date, the only certified treatment being total hysterectomy. We performed a 5-year retrospective study including cases of malignant tumors and those with uncertain malignant potential originating in the smooth muscle tissue of the uterine body. The clinical data, pathological aspects, and the immunohistochemical results were statistically analyzed using SPSS Statistics Version 26. The main associations of the p53 gene were identified with age, atypia, and the occurrence of metastases. The average number of CD8+ T cells correlated with the hormonal status of the patients, the presence of diabetes, and alteration of thyroid function, but also with the severity of the atypia. The therapeutic method was represented by total hysterectomy, and 30% of the patients with leiomyosarcoma also benefited from adjuvant chemotherapy. The average period until death was 25.66 months. The present study showed that the mutant expression of p53 could have a role in assessing the clinical evolution of patients, given the association with exitus and metastasis. In addition, the average number of CD8+ T cells corresponded to severe atypia, indicating the possibility of applying targeted immunotherapies in these cases.

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“…It can be asymptomatic or present with a wide range of symptoms including heavy menstrual bleeding, fatigue, painful periods, non-cyclic pain, painful intercourse, pelvic pressure, urinary incontinence, constipation, infertility, abortion, and pregnancy complications [4]. Therefore, diagnosis of STUMP is clinically difficult and definite diagnosis can be confirmed after surgery [5].…”

Section: Introductionmentioning

confidence: 99%

“…The term uterine smooth muscle tumor of uncertain malignant potential was firstly used by Kempson in 1973 [1]. World Health Organization (WHO) defines STUMP as intermediate group of uterine smooth muscle tumors which cannot be assigned to either a benign or a malignant tumor, but concern of malignancy remains [5]. Etiology and risk factors of STUMP have not been identified yet.…”

Section: Introductionmentioning

confidence: 99%

Uterine smooth muscle tumors of uncertain malignant potential: a retrospective evaluation of clinical pathology and immunohistochemistry features

Akbarzadeh-Jahromi,

Todarbary,

Aslani

et al. 2024

Surg Exp Pathol

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Background Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is a group of uterine smooth muscle tumors which cannot be classified as a subtype of leiomyoma or leiomyosarcoma. Diagnosis, prognosis, and treatment of these tumors are challenging due to recurrence, potential of malignancy, and metastasis. Methods A retrospective cohort study was conducted in southern Iran during 2011 to 2020. We included records of 21 patients with STUMP and 24 patients with leiomyoma by simple randomized sampling in the tertiary health care centers in Shiraz, southern Iran. Slides were reviewed by an expert pathologist for examining mitosis, necrosis, and atypia, and also proper blocks were selected for immunohistochemistry (IHC) staining. Results From 45 participants, 21 (46.7%) and 24 (53.3%) patients were in the STUMP and normal leiomyoma groups, respectively. Odds ratio and 95% confidence interval (OR (95% C.I)) of pathologic size in the range of 5–10 cm was significantly higher in the STUMP group compared with normal leiomyoma. (CI: 7.22 (1.44–36.22)). Additionally, hyaline necrosis 0.05 (0.0-0.91), mild to moderate atypia 0.02 (0.0-0.4), moderate to severe atypia 0.01 (0.0-0.22), focal atypia 0.01 (0-0.26) and diffuse atypia 0.01 (0-0.26) were significantly fewer in normal leiomyoma compared to the STUMP group. Negative P16 0.01 (0.0007-0.24) and negative Bcl2 0.22 (0.06–0.81) were significantly higher in the normal leiomyoma group compared with the STUMP group. The cut-off points for predicting STUMP were 2.5% (sensitivity = 62% and specificity = 100%) and 45% (sensitivity = 43% and specificity = 96%) for P16 and bcl2, respectively. Conclusion The category and management of STUMP continues to progress. The diagnosis for STUMP mainly depends on the histopathological manifestations. No single IHC marker such as P53, P16, and Bcl-2 has proved robust enough in separating STUMP from other leiomyoma variants; however, according to our study, we suggest combination use of P16 and Bcl-2 (cut off 2.5 and 45%, respectively) to distinguish equivocal cases of STUMP.

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Giant uterine mass with uterine smooth muscle tumor of uncertain malignant potential: A case report

Abstract: Highlights STUMP is a rare disease histologically, and giant STUMP is extremely rare. To our knowledge, present case represents the largest STUMP reported. After successful surgery, the patient is alive without evidence of recurrence.

Cited by 9 publications

References 18 publications

The Role of Pathogenesis Associated with the Tumor Microclimate in the Differential Diagnosis of Uterine Myocytic Tumors

The Role of Pathogenesis Associated with the Tumor Microclimate in the Differential Diagnosis of Uterine Myocytic Tumors

Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma

Uterine smooth muscle tumors of uncertain malignant potential: a retrospective evaluation of clinical pathology and immunohistochemistry features

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