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Montik N, Grelloni C, Filosa A, Goteri G, Di Giuseppe J, Natalini L, Ciavattini A. Ultrasound Appearance of Intravascular Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Case Report. Diagnostics (Basel) 2024; 14:1438. [PMID: 39001332 PMCID: PMC11241662 DOI: 10.3390/diagnostics14131438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/25/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
A 43-year-old patient with a history of uterine fibromatosis was referred to our hospital for menometrorrhagia and pelvic pain. At the pelvic ultrasound, a highly-vascularized myometrial lesion in volumetric increase was described. An elongated, solid, hypoechoic, painless, and highly vascularized left parauterine mass was identified. On histological examination, a uterine smooth muscle tumor of uncertain malignant potential (STUMP) with intravascular invasion of the left uterine vein was diagnosed. The adnexa and peritoneum were free of disease. On a retrospective evaluation of the ultrasound images, we noticed that the intravascular lesion showed sonographic features comparable to the original mass. Moreover, the Color Doppler (CD) analysis revealed an interrupted blood flow within the left uterine vein. In this case, the ultrasound proved to be an accurate diagnostic tool. When inhomogeneous uterine masses are suspected, and a parauterine/paraadnexal mass surrounded by irregular vessels are identified, the sonographer should take into account a risk of intravascular invasion. The patency of uterine and ovarian vessels should be accurately evaluated, to guide a tailored patient surgical approach.
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Affiliation(s)
- Nina Montik
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy; (N.M.); (C.G.); (J.D.G.); (L.N.)
| | - Camilla Grelloni
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy; (N.M.); (C.G.); (J.D.G.); (L.N.)
| | - Alessandra Filosa
- Anatomic Pathology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy; (A.F.); (G.G.)
| | - Gaia Goteri
- Anatomic Pathology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy; (A.F.); (G.G.)
| | - Jacopo Di Giuseppe
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy; (N.M.); (C.G.); (J.D.G.); (L.N.)
| | - Leonardo Natalini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy; (N.M.); (C.G.); (J.D.G.); (L.N.)
| | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, 60123 Ancona, Italy; (N.M.); (C.G.); (J.D.G.); (L.N.)
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Chung YH, Liang PI, Tang FH. Successful intraoperative radiation therapy for a rapidly recurrent smooth muscle tumor of uncertain malignant potential. Kaohsiung J Med Sci 2024; 40:603-604. [PMID: 38623872 DOI: 10.1002/kjm2.12831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024] Open
Affiliation(s)
- Yu-Hsuan Chung
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peir-In Liang
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Hsiang Tang
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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3
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Bicanin-Ilic M, Ilic I, Dimitrijevic A, Mujkovic S, Jovic N, Rakic D, Arsenijevic N, Nikolic-Turnic T, Balovic G, Peric A, Mitrovic A, Nikolov A. Case report: Spontaneous rupture of leiomyosarcoma uteri 8 months after primary laparoscopic surgery of STUMP. Front Med (Lausanne) 2024; 11:1407546. [PMID: 38912336 PMCID: PMC11192603 DOI: 10.3389/fmed.2024.1407546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Leiomyosarcoma (LMS), together with smooth muscle tumors of uncertain malignant potential (STUMP) and benign leiomyomas, belongs to a heterogeneous group of uterine neoplasms. According to the World Health Organization, tumors originating from uterine smooth muscle fibers are the second most frequent tumors. It is challenging to distinguish between STUMP and LMS because of an overlap of symptoms, lack of a precise definition, and unequivocal information obtained using imaging diagnostic methods. Following myomectomy or hysterectomy with laparoscopic or laparotomy surgery and a definitive histological diagnosis of STUMP, the course of treatment is determined by the need to preserve fertility. In 2014, the U.S. Food and Drug Administration published an alert that unprotected laparoscopic morcellation is correlated with a 3-fold higher likelihood of dissemination of malignant cells and disease progression. Unprotected morcellation was independently associated with a higher risk of disease recurrence after demolition or conservative surgery, with a relative risk of 2.94. Conclusion Hematoperitoneum resulting from the spontaneous rupture of a uterine tumor is a rare gynecological emergency, with very few cases reported in the last decade.
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Affiliation(s)
- Marija Bicanin-Ilic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Igor Ilic
- Department of Radiology, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandra Dimitrijevic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Srdjan Mujkovic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Nikola Jovic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Dejana Rakic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Neda Arsenijevic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Tamara Nikolic-Turnic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- N.A. Semashko Public Health and Healthcare Department, F.F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Goran Balovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Center of Pediatric Surgery, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Andjela Peric
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandra Mitrovic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
| | - Aleksandar Nikolov
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Gynecology and Obstetrics, University Clinical Center Kragujevac, Kragujevac, Serbia
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Hadi B, Nori W, Ibrahem H, Helmi ZR. A Case Report of a Uterine Smooth Muscle Tumor of Undetermined Malignant Potential (STUMP): A Diagnostic Dilemma and Management Challenges. Cureus 2024; 16:e58067. [PMID: 38738100 PMCID: PMC11088454 DOI: 10.7759/cureus.58067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Uterine smooth muscle tumors of undetermined malignant potential (STUMPs) are an uncommon kind of uterine smooth muscle tumor. It is distinguished by histopathologic and morphologic characteristics that are in between those of a benign leiomyoma and a malignant leiomyosarcoma. From a clinical standpoint, the clinical presentation of STUMP is similar to that of a fibroid. The diagnosis is usually confirmed after surgery. Here, we report the case of a 39-year-old woman who experienced increased menorrhagia, back pain, and pressure sensations during the past six months. She had a well-defined, freely movable lump in her lower abdomen, measuring the size of a 22-cm uterus. The patient exhibited pallor, and her imaging scan showed the presence of an intramural posterior uterine solid mass indistinguishable from fibroid measuring 8.5 × 9 cm. Goserelin acetate (Zoladex 3.6 mg implant) was recommended for a duration of six months. The patient experienced a significant amelioration in menorrhagia and discomfort. However, no reduction in the size of the mass was observed. Myomectomy was made for the suspicion of a malignant transformation. The histology examination confirmed the diagnosis of a STUMP; a hysterectomy was undergone, and the procedure went smoothly. The patient was discharged home in good condition with instructions for long-term follow-up due to a risk of recurrence of about 7%. The lack of standardized and clear clinical and diagnostic criteria for STUMP adds challenges to their management.
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Affiliation(s)
- Ban Hadi
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
| | - Wasan Nori
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
| | - Hajer Ibrahem
- Oral Medicine, College of Dentistry, Ashur University, Baghdad, IRQ
| | - Zeena R Helmi
- Obstetrics and Gynecology, College of Medicine, Mustansiriyah University, Baghdad, IRQ
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Amal C, Fadwa A, Aicha G, Boufetal H, Mahdaoui S, Samouh N. Uterine smooth muscle tumor of uncertain malignant potential (STUMP) ABOUT a CASE. Int J Surg Case Rep 2024; 117:109556. [PMID: 38518473 PMCID: PMC10972788 DOI: 10.1016/j.ijscr.2024.109556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/12/2024] [Accepted: 03/16/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine smooth muscle tumor of uncertain malignant potential (STUMP) is rare tumor, and regarded as sub-classification in uterine smooth muscle tumors between benign and malignant criteria. They represent a heterogeneous group of rare tumors. PRESENTATION OF CASE We report a case of a STUMP tumor in a fifty-three-year-old patient who underwent surgery for a hysterectomy. DISCUSSION STUMP often presents with nonspecific clinical manifestation the only confirmatory examination is anatomopathological and may be supported by immunohistochemistry, hysterectomy is currently considered the gold standard of treatment. CONCLUSION Uterine STUMP tumor represents a therapeutic dilemma. A multidisciplinary approach is mandatory.
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Affiliation(s)
- Cherkaoui Amal
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco.
| | - Atfi Fadwa
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Gotni Aicha
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Houssine Boufetal
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Sakher Mahdaoui
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
| | - Naima Samouh
- Obstetrics and Gynecology Department, University Hospital Ibn Rochd, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Morocco
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Belloni A, Notarstefano V, Greco S, Pellegrino P, Giorgini E, Ciarmela P. FTIR Microspectroscopy as a new probe to study human uterine lesions: Characterization of tumor cell lines from uterine smooth muscle cells and evaluation of EPA and DHA in vitro treatments. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166873. [PMID: 37666437 DOI: 10.1016/j.bbadis.2023.166873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/05/2023] [Accepted: 08/31/2023] [Indexed: 09/06/2023]
Abstract
During their life, women are likely to develop uterine diseases, which often compromise their fertile and perimenopausal age. Besides benign lesions like leiomyomas, several malignant neoplasms can occur, such as the uterine leiomyosarcoma, which represents the most frequent malignancy among the rarest uterine cancers. It presents several variants similar to both benign and malignant neoplasms, and sometimes it shares symptoms with the benign counterpart. In this scenario, for a correct diagnosis and a successful prognosis, it is mandatory to detect new reliable markers which strengthen histopathological outcomes and let define a more appropriate and less harmful therapy. Based on this concerning evidence, in the present study, Fourier Transform Infrared Microspectroscopy has been exploited at a cellular level on uterine leiomyoma and leiomyosarcoma cell lines to (1) identify specific spectral biomarkers able to distinguish between benign and malignant lesions, and (2) evaluate the efficacy of eicosapentaenoic and docosahexaenoic acids (respectively EPA and DHA), already successfully tested. Results evidenced reliable differences in the spectral signature of benign and malignant cells, mainly in terms of lipids and nucleic acids composition. Moreover, even if EPA and DHA seemed to exert different effects on the tested cell lines, no cytotoxic and/or anti-apoptotic actions were observed after omega-3 based treatments.
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Affiliation(s)
- Alessia Belloni
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Valentina Notarstefano
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Stefania Greco
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
| | - Pamela Pellegrino
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
| | - Elisabetta Giorgini
- Department of Life and Environmental Sciences, Università Politecnica delle Marche, Ancona, Italy.
| | - Pasquapina Ciarmela
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy.
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Borella F, Mancarella M, Preti M, Mariani L, Stura I, Sciarrone A, Bertschy G, Leuzzi B, Piovano E, Valabrega G, Turinetto M, Pino I, Castellano I, Bertero L, Cassoni P, Cosma S, Franchi D, Benedetto C. Uterine smooth muscle tumors: a multicenter, retrospective, comparative study of clinical and ultrasound features. Int J Gynecol Cancer 2023:ijgc-2023-004880. [PMID: 38054268 DOI: 10.1136/ijgc-2023-004880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE To evaluate a wide range of clinical and ultrasound characteristics of different uterine smooth muscle tumors to identify features capable of discriminating between these types. METHODS This was a retrospective, multicenter study that included 285 patients diagnosed with uterine smooth muscle tumors (50 leiomyosarcomas, 35 smooth muscle tumors of uncertain malignant potential, and 200 leiomyomas). The patients were divided into three groups based on the histological type of their tumors, and the groups were compared according to the variables collected. RESULTS Leiomyosarcomas were more common in older and post-menopausal women. Compared with leiomyomas, smooth muscle tumors of uncertain malignant potential and leiomyosarcomas had similar ultrasound features such as absence of normal myometrium, multilocular appearance, hyper-echogenicity in case of uniform echogenicity, absence of posterior shadows, echogenic areas, and hyperechoic rim. Leiomyosarcomas were larger, had more cystic areas, and were associated with a higher prevalence of pelvic free fluid. Smooth muscle tumors of uncertain malignant potential were characterized by a higher frequency of International Federation of Gynecology and Obstetrics (FIGO) type 6-7, the absence of internal shadows, and, in the case of cystic area, the presence of a regular internal wall. Tumor outline varied among the three histological types. A color score of 1 was typical of leiomyoma, a color score 2 was mainly observed in leiomyomas and smooth muscle tumors of uncertain malignant potential, a color score 3 did not differ among the tumors, while a color of score 4 was related to leiomyosarcomas. When combining color scores 3 and 4, leiomyosarcomas and smooth muscle tumors of uncertain malignant potential showed a high percentage of both circumferential and intra-lesional vascularization. A cooked appearance was not statistically different among the tumors. CONCLUSIONS Based on our findings, specific ultrasonographic features as well as age and menopausal status are associated with different uterine smooth muscle tumor types. Integration of these data can help the pre-operative assessment of these lesions for proper management.
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Affiliation(s)
- Fulvio Borella
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Matteo Mancarella
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Mario Preti
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Luca Mariani
- Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Ilaria Stura
- Department of Public Health and Pediatric Sciences, University of Turin, Torino, Piemonte, Italy
| | | | - Gianluca Bertschy
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Beatrice Leuzzi
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Elisa Piovano
- Division of Gynecology and Obstetrics 2, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | | | | | - Ida Pino
- Preventive Gynecology Unit, Istituto Europeo di Oncologia, Milan, Italy
| | - Isabella Castellano
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Stefano Cosma
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Dorella Franchi
- Preventive Gynecology Unit, Istituto Europeo di Oncologia, Milan, Italy
| | - Chiara Benedetto
- Division of Gynecology and Obstetrics 1, Department of Surgical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
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Yue M, Hu J, Min X, Xu H. Uterine tumor resembling high-grade endometrial mesenchymal sarcoma with GATAD2B-MMRN1 fusion. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2023; 16:252-258. [PMID: 37818386 PMCID: PMC10560884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/24/2023] [Indexed: 10/12/2023]
Abstract
Uterine sarcomas are a group of rare malignant tumors of mesenchymal tissue of the uterus, and their diagnosis is often difficult because they have variable morphologies and no typical immunophenotype. This report describes a 48-year-old woman who underwent laparoscopic myomectomy and relapsed within 5 years with a large mass in the pelvic cavity. Morphologically, the tumor was composed of oval cells and small arteries, and the cells showed moderate to severe atypia. Immunohistochemical results showed that the tumor cells expressed desmin, smooth muscle actin, and h-caldesmon, which supported myogenic differentiation. They were strongly positive for Cyclin D1, estrogen receptors (ER), and estrogen receptors (PR), supporting their origin from uterine mesenchymal cells. Next-generation sequencing (NGS) revealed a GATAD2B::MMRN1 rearrangement. The patient was diagnosed with uterine sarcoma resembling high-grade endometrial mesenchymal sarcoma with a GATAD2B-MMRN1 fusion. We review the relevant literature and discuss the diagnostic and differential diagnostic points for this disease.
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Affiliation(s)
- Mengdie Yue
- The Postgraduate Training Base of Hubei Maternal and Child Health Hospital, Hubei University of MedicineWuhan, Hubei, China
- Department of Pathology, Hubei Maternal and Child Health HospitalWuhan, Hubei, China
| | - Junbo Hu
- Department of Pathology, Hubei Maternal and Child Health HospitalWuhan, Hubei, China
| | - Xiaohong Min
- Department of Pathology, Hubei Maternal and Child Health HospitalWuhan, Hubei, China
| | - Hui Xu
- Department of Pathology, Hubei Maternal and Child Health HospitalWuhan, Hubei, China
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Gomez NF, Zhao J, Smith B. Uterine epithelioid smooth muscle tumor of uncertain malignant potential. Int J Gynecol Cancer 2023; 33:1324-1325. [PMID: 37268311 DOI: 10.1136/ijgc-2022-004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Noah F Gomez
- Obstetrics and Gynecology, Sisters of Charity Hospital, Buffalo, New York, USA
| | - Jia Zhao
- Pathology, Sisters of Charity Hospital, Buffalo, New York, USA
| | - Brian Smith
- OBGYN Associates of Western New York, Buffalo, New York, USA
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10
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Tinelli A, D’Oria O, Civino E, Morciano A, Hashmi AA, Baldini GM, Stefanovic R, Malvasi A, Pecorella G. Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Comprehensive Multidisciplinary Update. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1371. [PMID: 37629661 PMCID: PMC10456637 DOI: 10.3390/medicina59081371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: The uterine smooth muscle tumors of uncertain malignant potential (STUMP) are tumors with pathological characteristics similar to leiomyosarcoma, but that do not satisfy histological criteria for leiomyoma. These are problematic lesions with intermediate morphologic features; thus, diagnosis and treatment are difficult. This narrative review aims to review data in the literature about STUMPs, particularly focusing on management and therapeutic options and strategies for women who desire to preserve fertility. Material and Methods: authors searched for "uterine smooth muscle tumor of uncertain malignant potential" in PubMed and Scopus databases, from 2000 to March 2023. Pertinent articles were obtained in full-text format and screened for additional references. Only articles in English language were included. Studies including full case description of patients with histopathological diagnosis of STUMP in accordance with Stanford criteria were included. Results: The median age was 43 years old. Symptoms are similar to those of leiomyomas, with a mean diameter of 8.0 cm. Total hysterectomy with or without bilateral salpingo-oophorectomy is the standard care for women if fertility desire is satisfied. Myomectomy alone can be considered for young patients. Although these tumors have not a high malignant potential, several studies described recurrence and metastases. Conclusions: STUMPs are complex uterine smooth muscle tumors, with a rare but reasoned clinical-diagnostic management. Considering the high clinical and histological complexity of these tumors, high level of expertise is mandatory.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), “Veris delli Ponti Hospital”, 73020 Scorrano, Italy
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, 00185 Rome, Italy;
| | - Emanuela Civino
- Department of Biological and Environmental Science and Technology, University of Salento, 73100 Lecce, Italy;
| | - Andrea Morciano
- Department of Gynaecology and Obstetrics, Pia Fondazione “Card. G. Panico”, 73039 Tricase, Italy;
| | - Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi 74800, Pakistan;
| | | | - Radomir Stefanovic
- Department of Histopathology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia;
| | - Antonio Malvasi
- Department of Biomedical Sciences and Human Oncology, University of Bari, 70121 Bari, Italy;
| | - Giovanni Pecorella
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University, 66421 Homburg, Germany;
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11
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Bosoteanu M, Deacu M, Voda RI, Orasanu CI, Aschie M, Vlad SE, Penciu RC, Chirila SI. Five-Year Retrospective Study of Uterine STUMP and Leiomyosarcoma. Clin Pract 2022; 12:897-907. [PMID: 36412673 PMCID: PMC9680293 DOI: 10.3390/clinpract12060094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
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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Affiliation(s)
- Madalina Bosoteanu
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanta, 900527 Constanta, Romania
| | - Mariana Deacu
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanta, 900527 Constanta, Romania
| | - Raluca Ioana Voda
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
- Correspondence:
| | - Cristian Ionut Orasanu
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Mariana Aschie
- Clinical Service of Pathology, “Sf. Apostol Andrei” Emergency County Hospital, 900591 Constanta, Romania
- Department of Pathology, Faculty of Medicine, “Ovidius” University of Constanta, 900527 Constanta, Romania
- Academy of Medical Sciences of Romania, 030167 Bucharest, Romania
| | - Sabina Elena Vlad
- Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology-CEDMOG, “Ovidius” University of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Ovidius” University of Constanta, 900527 Constanta, Romania
| | - Sergiu Ioachim Chirila
- Medical Informatics and Biostatistics, Faculty of Medicine, Ovidius University, 900527 Constanta, Romania
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Uterine smooth muscle tumor of uncertain malignant potential: A review of current knowledge. Taiwan J Obstet Gynecol 2022; 61:935-940. [DOI: 10.1016/j.tjog.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
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