Prognostic significance of atypical mitotic figures in smooth muscle tumors of uncertain malignant potential (STUMP) of the uterus and uterine adnexa

Abstract Purpose: Uterine smooth muscle tumors of uncertain malignant potential (STUMP) is a heterogeneous group of tumors with histological and biological diversity that cannot be defined as a benign leiomyoma or malignant leiomyosarcoma. The study aims to investigate the diagnostic methods, treatment management and prognosis of STUMP patients in a 13-year period. Methods: We retrospectively reviewed the clinicopathologic information of 31 STUMP patients in Peking University People’s Hospital. Statistical analyses were conducted to compare the difference of clinical characteristics between the women in myomectomy group and those in hysterectomy group. Results: The most common clinical presentation was menstrual disorder. The tumors were mainly manifested as hypoechoic, non-cystic nodules with low blood flow signal by pelvic doppler ultrasonography. Most tumors carried Ki-67 index ranging from 10% to 30%. Immunohistochemical markers such as ER, PR, p16 and Desmin was positively expressed in tumors. At the first operation, 21 cases underwent myomectomy and 10 cases underwent hysterectomy. The patients in myomectomy group were younger than those in hysterectomy group. In the follow-up period, two cases experienced a relapse in the form of STUMP within 36 months. One case died of cardiovascular accident while the other cases were alive. Six of 21 women in myomectomy group desired pregnancy and two healthy live births were recorded.Conclusion: The diagnosis of STUMP primarily depends on histopathologic features. Fertility-sparing surgery may be a treatment selection for patients with fertility desire. Patients with STUMP, especially in the case of myomectomy, should be informed of recurrence risk and monitored closely.

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Recurrence after total laparoscopic hysterectomy without morcellation for smooth muscle tumors of uncertain malignant potential: A rare case report

10.26226/morressier.5b6d513c5aff74007b2b483d ◽

2018 ◽

Author(s):

SEIRO SATOHISA ◽

Shuetsu Abe

Keyword(s):

Smooth Muscle ◽

Case Report ◽

Rare Case ◽

Laparoscopic Hysterectomy ◽

Malignant Potential ◽

Total Laparoscopic Hysterectomy ◽

Uncertain Malignant Potential ◽

Smooth Muscle Tumors ◽

Rare Case Report

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Clinical outcome of atypical uterine smooth muscle tumors

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.15028 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 15028-15028 ◽

Cited By ~ 2

Author(s):

B. Pothuri ◽

S. M. Kehoe ◽

T. Wright ◽

T. Herzog

Keyword(s):

Smooth Muscle ◽

Clinical Outcome ◽

Retrospective Chart Review ◽

Malignant Potential ◽

Low Grade ◽

Uncertain Malignant Potential ◽

Histologic Diagnosis ◽

Cellular Atypia ◽

Smooth Muscle Tumors

15028 Background: Smooth muscle tumors of uncertain malignant potential (STUMP) and atypical leiomyomas have increased mitotic activity, cellular atypia and necrosis but the degree is less than that used to define uterine leiomyosarcomas. Our objective is to evaluate the clinical outcome of patients with uterine masses histologically defined as smooth muscle tumors of uncertain malignant potential or atypical leiomyomas. Methods: A thorough search of our institution’s pathology database from 1990 to 2005 was performed. A retrospective chart review was performed to obtain initial and subsequent treatments, documented recurrences and clinical outcomes. Pathology reports and slides were reviewed and the presence of atypia, necrosis and number of mitosis was recorded. Statistical analysis was performed by Student’s T-test. Results: Eighteen patients with a histologic diagnosis of atypical leiomyoma were identified with 14 STUMP, 2 bizarre leiomyomas, 1 myxoid and 1 mitotically active leiomyoma. The mean age of these patients was 41.8 years (range: 25–77) and was significantly younger than those with leiomyosarcoma (mean age was 54 years, p < 0.001). The histologic characteristics of the tumors included the presence of atypia at 50%, necrosis at 82% and mitoses at 94%. The rate of necrosis and number of mitosis was significantly less in the atypical group as compared to the leiomyosarcoma group (p values < 0.05). However the rate of cellular atypia was not statistically different between the two groups. The median follow-up period was 25 months, range 1–138 months. One of the eighteen patients developed a pelvic and pulmonary recurrence at which time a low grade leiomyosarcoma was diagnosed. The recurrence occurred 32 months after the initial diagnosis of a mitotically active leiomyoma. Sixteen patients demonstrated no recurrence or metastatic disease at the time of follow-up. Conclusions: Atypical leiomyomas appear to be diagnosed in younger women which leads to challenging treatment issues involving fertility preservation. While these tumors generally behave in a benign fashion, they have histologic characteristics that may allow for progression or recurrence. Close follow-up is warranted for patients who are diagnosed with atypical leiomyomas and smooth muscle tumors of uncertain malignant potential. No significant financial relationships to disclose.

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Smooth muscle tumors of uncertain malignant potential

Arkhiv patologii ◽

10.17116/patol2019810315 ◽

2019 ◽

Vol 81 (3) ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Yu. Yu. Andreeva ◽

L. V. Moskvina ◽

G. A. Frank ◽

L. E. Zavalishina ◽

O. V. Babenko ◽

...

Keyword(s):

Smooth Muscle ◽

Malignant Potential ◽

Uncertain Malignant Potential ◽

Smooth Muscle Tumors

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