Abstract
Smooth muscle Tumors of unknown malignant potential (STUMP) are a heterogenous group of uterine tumors which are clinically benign witha low malignant potential. They are extremely rare and have been reported in 0.01% of histological specimens. The clinical symptoms of STUMP mimic those of leiomyoma and so histopathological analysis forms the only reliable diagnostic method with imaging techniques and immunohistochemistry being supplementary. A multidisciplinary management is mandatory for early detection and to establish the treatment of choice in women with STUMP. Surgery forms the mainstay of treatment and the role of adjuvant therapy is less clear. The disease is known to recur/metastasize and patients with STUMP should be on long term surveillance.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Tavassoli FA, Devilee P. World Health Organization classification of Tumors: tumors of the breast and female genital organs. Lyon: International Agency for Research on Cancer Press; 2003. p. 236–9.
Kempson RL. Sarcomas and related neoplasms. In: Noris HJ, Hertig AT, Abel MR, editors. The uterus. Baltimore: Williams and Wilkins; 1973.
Picerno TM, Wasson MN, Gonzalez Rios AR, et al. Morcellation and the incidence of occult uterine malignancy: a dual institution review. Int J Gynecol Cancer. 2016;26(1):149–55.
Bulun SE. Uterine fibroids. N Engl J Med. 2013;369:1344–55.
Zivanoic O, Jacks LM, Lasonos A, Leitao MM, et al. A nomogram to predict post-resection 5-year overall survival for patients with leiomyosarcoma. Cancer. 2012;118:660–9.
Mehine M, Kaasinen E, Heinonen HR, Makinen N, Kampjarvi K, et al. Characterization of uterine leiomyomas by whole genome sequencing. PANS. 2015;113:1315–20.
Hodge JC, Pearce KE, Clayton AC, Taran FA, Stewart EA. Uterine cellular leiomyomata with chromosome 1p deletions represent a distinct entity. Am J Obstet Gynecol. 2014;210:572.
Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994 Jun;18(6):535–58.
Tavassoli FA, Devilee P. World health Organization classification of tumors: tumors of the breast and female genital organs. Lyon: IARC Press.
Ip PP, Tse KY, Tam KF. Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy. Adv Anat Pathol. 2010 Mar;17(2):91–112.
Guntupalli SR, Ramirez PT, Anderson ML, Milam MR, Bodurka DC, Malpica A. Uterine smooth muscle tumor of uncertain malignant potential: a retrospective analysis. Gynecol Oncol. 2009;113(3):324–6.
Deodhar KK, Goyal P, Rekhi B, et al. Uterine smooth muscle tumor of uncertain malignant potential and atypical leiomyoma: a morphological study of these grey zones with clinical correlation. Indian J Pathol Microbiol. 2011;54:706–11.
Xiropotamou On, Tsili AC, Vrekousis TH et al. Uterine smooth muscle tumor of uncertain malignant potential: an entity difficult to diagnose. https://www.eurorad.org/case/12733.
Ng JSY, Han A, Chew SH, Low J. A clinicopathologic study of uterine smooth muscle tumor of uncertain malignant potential. Ann Acad Med Singap. 2010;39:625–8.
Yamashita Y, Torashima M, Takahashi M, et al. Hyperintense uterine leiomyoma at T2 weighted MR imaging: differentiation with dynamic enhanced MR imaging and clinical implications. Radiology. 1993;189:721–5.
Tanaka YO, Nishida M, Tsunoda H, Okamoto Y, Yoshikawa H. Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging. 2004;20(6):998–1007.
Sato K, Yuasa N, Fujita M, Fukishima Y. Clinical application of diffusion weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma. Am J Obstet Gynecol. 2014;210:358.
Bonneau C, Thomasin-Naggaua I, Dechow S, Cortez A, et al. value of ultrasonography and MRI imaging for the characterization of uterine mesenchymal tumors. Acta Oster Gynecol Scand. 2014;93(3):261–5.
de Vos S, Wilczynski SP, Fleischhacker M. Koeffler. p53 alterations in uterine leiomyosarcomas versus leiomyomas. Gynecol Oncol. 1994 Aug;54(2):205–8.
Hong T, Shimada Y, Uchida S, Itami A, Li Z, Ding Y, Kaganoi J, Komoto I, Sakurai T, Imamura M. Expression of angiogenic factors and apoptotic factors in leiomyosarcoma and leiomyoma. Int J Mol Med. 2001 Aug;8(2):141–8.
Jeffers MD, Farquharson MA, Richmond JA, McNicol AM. p53 immunoreactivity and mutation of the p53 gene in smooth muscle tumors of the uterine corpus. J Pathol. 1995 Sep;177(1):65–70.
Nordal RR, Kristensen GB, Stenwig AE, Trope CG, Nesland JM. Immunohistochemical analysis of p53 protein in uterine sarcomas. Gynecol Oncol. 1998;70:45–8.
Wang M, Xu Y, Zhang T. Smooth muscle neoplasms of the uterus – a 51 cases study. Zhonghua Bing Li Xue Za Zhi. 1996;25:263–5.
Chen L, Yang B. Immunohistochemical analysis of p16, p53 and ki67 expression in uterine smooth muscle tumors. Int J Gynecol Pathol. 2008;27:326–32.
Atkins KA, Arronte N, DArus CJ, Rice LW. The use of p16 in enhancing the histologic classification of uterine smooth muscle tumors. Am J Surg Pathol. 2008;32:98–102.
Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Mayerhofer K. Bcl-2 receptor expression in patients with uterine smooth muscle tumors: an immune-histochemical analysis comparing leiomyoma, uterine smooth muscle tumor of uncertain malignant potential, and leiomyosarcoma. J Soc Gynecol Investig. 2001;11:187–91.
Won HS, Chun HG, Lee K. Retroperitoneal smooth muscle tumor of uncertain malignant potential after hysterectomy: a case report. J Med Case Rep. 2011;5:214.
Zhai YL, Kobayashi Y, Mori A, Orii A, Nikaido T, Konishi I, et al. Expression of steroid receptors, Ki-67, and p53 in uterine leiomyosarcomas. Int J Gynecol Pathol. 1999;18:20–8.
Mittal K, Demopoulos RI. MIB-1 (Ki-67), p53, estrogen receptor, and progesterone receptor expression in uterine smooth muscle tumors. Hum Pathol. 2001;32:984–7.
Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Mayerhofer K. Estrogen and progesterone receptor expression in patients with uterine smooth muscle tumors. Fertil Steril. 2004;81:1062–6.
Gannon BR, Manduch M, Childs TJ. Differential immunoreactivity of p16in leimyosarcomas and leiomyoma variants. Int J Gynecol Pathol. 2008;27:68–73.
Odunsi K, Pejovic T. Gynecological cancers multidisciplinary approach to diagnosis and treatment of uterine sarcoma. New York: Demos Publishing Company; 2013. p. 83–93.
Ayaz D, Diniz G, Kahraman DS, Sayhan S, Uncel M, et al. The evaluation of the caveolin-1 and At-rich interactive domain 1 alpha expressions in uterine smooth muscle tumors. Indian J Pathol Microbiol. 2016;59:301–4.
Vahedpoor Z, Khamechian T, Zandi N. STUMP mistaken with ovarian tumor mistaken with ovarian tumor in a female with polio. J Obstet Gynecol Cancer Res. 2017;2:e9425.
Zhang Q, Ubago J, Li L. Molecular analysis of 6 different types of uterine smooth muscle tumors: emphasis in atypical leiomyoma. Cancer. 2014;120:3165–77.
Ly A, Mills AM, McKenny JK. Atypical leiomyoma of the uterus: a clinicopathological study of 51 cases. Am J Surg Pathol. 2013;37:643–9.
Canciani GN, Burbos N, Duncan TJ, Lonsdale R, Nieto JJ. Late presentation of metastatic smooth muscle neoplasm of the uterus with low malignant potential. J Gynecol Oncol. 2012;23:69–71.
Miller J, Shoni M, Siegert C. Benign metastasizing leiomyomas to the lungs: an institutional case series and a review of the recent literature. Ann Thorac Surg. 2016;101:253–8.
Kotsupoulos IC, Barbetakis N, Asteriou C, et al. Uterine smooth muscle tumor of uncertain malignant potential: a rare cause of multiple pulmonary nodules. Indian J Med Paediat Oncol. 2012;33(3):176–8.
Kropp L, Siegal GP, Frampton GM, Rodriguez MG, McKee S, et al. Primary intraosseous smooth muscle tumor of uncertain malignant potential: original report and molecular characterization. Rare Tumors. 2016;4:2016–3613.
Shapiro A, Ferenczy A, Turcotte R, Bruchim I, Gotlieb WH. Uterine smooth muscle tumor of uncertain malignant potential metastasizing to the humerus as a high grade leiomyosarcoma. Gynecol Oncol. 2004;94:818–20.
Philip PC, Tse KY, Tam KF. Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern malignancy. Adv Anat Pathol. 2010;17(2):91–111.
Kalogiannidis I, Stavrakis T, Dagklis T, Petousis S, et al. A clinicopathological study of atypical leiomyomas: Benign variant leiomyoma or smooth muscle tumor of uncertain malignant potential. Oncol Lett. 2016;11:1425–8.
Peeters N, Hulbosch S, Ballaux F, Baekelandt J. STUMP: analysis of diagnoses and therapies illustrated by two case reports. Eur J Gynecol Oncol. 2016;37:367–73.
Rommel B, Holzmann C, Bullerdiek J. Malignant mesenchymal tumors of the uterus-time to advocate a genetic classification. Expert Rev Anticancer Ther. 2016;111:1155–66.
Andrea DA, Gizzo S, Musaro A, Quaranta M, Noventa M, et al. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): pathology, follow-up and recurrence. Int J Clin Exp Pathol. 2014;7(11):8136–42.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Mehta, S., Mann, A. (2020). Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP). In: Mehta, S., Gupta, B. (eds) Recent Advances in Endometrial Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-15-5317-2_17
Download citation
DOI: https://doi.org/10.1007/978-981-15-5317-2_17
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-15-5316-5
Online ISBN: 978-981-15-5317-2
eBook Packages: MedicineMedicine (R0)