Uterine smooth muscle tumours of uncertain malignant potential: single-centre experience and review of the literature

Abstract

Introduction: Uterine smooth muscle tumours of uncertain malignant potential (STUMPs) are a rare histologically heterogeneous group of uterine smooth muscle tumours (SMTs). Their malignant potential and clinical differentiation between leiomyoma and leiomyosarcoma remain uncertain prior to surgical removal. Aim of the study: To investigate the patients and tumour characteristics of patients with STUMPs and to propose algorithms for optimal diagnosis, treatment, and follow-up management. Material and methods: This was a single-centre retrospective cohort study of all patients who underwent surgery for a preoperative diagnosis of uterine myoma at the University Hospital "Dr. Georgi Stranski", Pleven, Bulgaria during a period of 33 months (from January 2013 until October 2015). Data were obtained from the medical history records. We performed descriptive analysis to characterise the patient population (e.g. demographics, age, contraceptive use, and complaints that led to the diagnosis) and the tumour characteristics. Last data were obtained prior May 2019. Results: A total of 320 medical records were retrospectively evaluated. The preoperative diagnosis of myoma was confirmed in 279 of the cases (89.4%). In 27 (8.3%) cases the final histological result was completely different. In 14 (2.3%) a histological postoperative diagnosis of STUMP was identified. All 14 STUMP lesions were intramural with a median size of 7.5 cm (range 3.5 to 15 cm). The median age at diagnosis of STUMP was 45.4 years (range 36 to 52 years), and 92.9% (n = 13) of the patients were premenopausal. Ultrasound data of a rapidly growing myoma were a reason for diagnosis in only three patients (25%), whereas 92.9% of the patients (n = 13) presented with heavy menstrual bleeding with or without anaemia. After surgery, none of the patients with STUMP experienced a relapse of the disease within the median follow-up time of 48 months (R = 40-78). Conclusions: STUMP tumours are rare tumours, predominantly diagnosed in premenopausal women. They define a group of patients with very good long-term prognosis. Therefore, longer follow-up is needed to allow for conclusions on recurrence rate and survival.

Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma

“…Regarding p53 reactivity in STUMP, in the literature, the percentage of cases with positive expression varies between 0–42.3% ( Table 1 ) [ 5 , 25 , 28 , 29 , 30 , 31 ].…”

“…Current theories consider this lesional category to be a transitional phase from a leiomyoma to a leiomyosarcoma or to be an undiagnosed low-grade leiomyosarcoma [ 4 ]. This pathology is diagnosed more frequently in women during the fertile period, with an average patient age of 44 years [ 5 ]. Despite the fact that they are considered to carry a low malignant potential, these tumors have the ability to recur and metastasize.…”

“…Despite the fact that they are considered to carry a low malignant potential, these tumors have the ability to recur and metastasize. The recurrence rates reported in the literature are between 7% and 27%, with a total recurrence rate of 11% [ 5 , 6 , 7 ].…”

Колко Редки Са Редките Онкологични Болести?

“…По тази причина те не могат да бъдат представителни за България, но са най-голямата база данни, публикувана и анализирана до момента в България. В четири от статиите [13][14][15][16] обект на публикация са карциномите на маточната шийка с редки хистологични подвидове. Описани са техните морфологичнобиологични особености и значението им за клиничното поведение, като това е и най-голямата серия случаи, публикувани в литературата относно редки хистологични подвидове като lymphoepithelioma-like carcinoma (LELC) [14,17], мукоепидермоидния -MEC [16] и warty карцинома [13] на маточната шийка.…”

“…Обобщението на данните от България в погорецитираните публикации [12][13][14][15][16][17] допринася за по-лесно идентифициране на множество редки болести и дава възможност за тяхното адекватно лечение без допълнително забавяне поради редкия хистологичен подвид.…”