Uterine smooth muscle tumor of uncertain malignant potential: a three-case report

Abstract

Based on the degree of cytologic atypia, mitotic activity, and other features, uterine smooth muscle tumors have historically been grouped into two classes: benign leiomyomas and malignant leiomyosarcomas. However, this separation holds true more in principle than in practice because the tumor's biological potential may not always be determined with certainty, complicating diagnosis, and therapy. We report three cases of patients with uterine smooth muscle tumors of uncertain malignant potential. Surgery was radical in two and conservative in one. During the follow-up, one patient developed diffuse lung metastases. The two other patients have not shown any signs of relapse to date. Uterine smooth muscle tumors of uncertain malignant potential may have an unpredictable clinical course and may metastasize to seemingly low-grade neoplasms in distant sites even after several years and even in the absence of important negative prognostic predictors, such as coagulative tumor cell necrosis. At present, no final consensus has been reached on the choice of the best strategy for surgery and adjuvant therapy.

Leiomyosarcoma with Synchronous Clear Cell Ovarian Carcinoma

“…If the patient exhibited disease recurrence, this event would indeed be exceptional since a leiomyosarcomaveryrarelyarisesfromaleiomyoma [6].Pre- LeiomyosarcomaandClearCell OvarianCancer 697 patientswithpositivelymphnodes [18].Nevertheless,inthe currentinvestigation,alymphadenectomywasnotperformed becausethepatientwasafflictedwithtwohigh-gradelesions and thus, the procedure would have unlikely altered the prognosis. First-linechemotherapytreatmentforpatientswithuterine leiomyosarcomacompriseseithergemcitabineanddocetaxel ordoxorubicininconjunctionwithifosfamide [20,21].Inthe presentstudy,weelectedtousedocetaxelandgemcitabinein lieuofpaclitaxelandcarboplatinbecausetheformerregimen hasdemonstratedreasonableactivityinthetreatmentofboth leiomyosarcomaandovariancancer [22].Thereisalsospeculation that aromatose inhibitors may effectuate clinical improvement [23].Sinceleiomyomascanpotentiallyrecurafter aprotractedlengthoftime,molecularmarkersandimmunohistochemical expression have been considered in surveillance;however,neitherhavebeenproveneffectiveatpredicting the lesion's behavior [10,12]. Further investigation of hormone receptor positivity in uterine leiomyomas may benefitpatientoutcomes.…”

“…The majority of leiomyomas are predominantly benign but theclinicalnatureoftheselesionsmaybeconsiderablymore divergent.Thus,asubsetofthempotentiallyhasahistologic propensity for malignant transformation and subsequent diseaserecurrence [4,[9][10][11][12][13].…”

“…viousstudieshavedocumentedtherecurrenceofanatypical leiomyoma [7,10,14,15], although none of them involved recurrentdisease20yearsfollowingthepatient'sinitialtreatment. While disease recurrence was our initial presumption, wedonotprecludethepossibilitythattheoriginaluterinelesionwasasarcomaorthattheleiomyosarcomaisofcolonic origin.Thepresenceofbenignsmoothmuscleproliferations throughoutthesmallandlargebowelinconjunctionwiththe previous hysterectomy may also confound our supposition thattheoriginalleiomyomaunderwentmalignanttransformation.…”

Retroperitoneal recurrence of uterine smooth muscle tumor of uncertain malignant potential as leiomyosarcoma

“…Guntupalli et al [1] reported three patients (7.3%) had a recurrence during the follow-up period, one patient presented with a pelvic mass and a pulmonary nodule, and two patients presented with retroperitoneal and pelvic masses. Berretta et al [2] presented a report of 3 cases with STUMPs. One patient developed diffuse lung metastases 9 years after the original diagnosis.…”

“…Diagnosis of STUMP can be difficult for pathologists, and understanding of clinical behavior of these tumors is poor [1]. Histologically, uterine smooth muscle tumors (SMTs) are categorized as leiomyomas and leiomyosarcomas, based on the combination of histological parameters, such as mitotic activity, cytological atypia, and coagulative tumor cell necrosis (CTCN) [2]. We report on a case of leiomyosarcoma with lymphatic dissemination of retroperitoneal leiomatosis, from previous hysterectomy state for treatment of STUMP.…”