J Gynecol Oncol.  2019 Jul;30(4):e54. 10.3802/jgo.2019.30.e54.

Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes

• Åžahin H
• Karatas F
• Coban G
• Özen O
• Erdem O
• Onan MA
• Ayhan A

• KMID: 2450233
• DOI: http://doi.org/10.3802/jgo.2019.30.e54

Abstract

OBJECTIVE
In this study, we aimed to evaluate the clinicopathological features, obstetric, and oncological outcomes of patients diagnosed with a uterine smooth muscle tumors of uncertain malignant potential (STUMP).
METHODS
A dual-institutional, database review was carried out to screen patients with STUMP who were treated with upfront surgery between January 2006 and December 2017. Data including age at the time of diagnosis, recurrence rate, disease-free survival, overall survival, and fertility outcomes were retrospectively analyzed.
RESULTS
Fifty-seven patients with STUMPs were included in the study. The median age at the time of diagnosis was 42 (range, 16 to 75) years. The median follow-up was 57 (range, 16 to 125) months. Eight patients (14%) had recurrence during follow-up. Recurrent STUMPs were seen in seven patients and leiomyosarcoma after 14 months in one patient. Seven patients with a recurrent STUMP survived, while the remaining patient died. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. The presence of uterine localization of tumor (subserosal vs intramural-submucosal) statistically significantly affected recurrence rates (odds ratio=5.72; 95% confidence interval=1.349-24.290; p=0.018). Ten of 27 patients who underwent myomectomy for uterine myoma had fertility desire. Seven pregnancies were recorded.
CONCLUSIONS
Our study results suggest that fertility-sparing approaches are feasible in patients with STUMP, although recurrence may be seen.

Keyword

Smooth muscle tumors, uterine; Hysterectomy; Recurrence; Myomectomy

MeSH Terms

Diagnosis
Disease-Free Survival
Female
Fertility*
Follow-Up Studies
Humans
Hysterectomy
Leiomyoma
Leiomyosarcoma
Muscle, Smooth*
Pregnancy
Recurrence
Retrospective Studies
Smooth Muscle Tumor*

Figure

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  Fig. 1. A smooth muscle tumors of uncertain malignant potential case with recurrent leiomyosarcoma. A cellular smooth muscle tumor with mild atypia (A) and necrosis of uncertain type (B) (Hematoxylin and eosin stain, ×40).

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  Fig. 2. Recurrent tumor as leiomyosarcoma with tumor cell necrosis (A) (H&E ×40) and severe atypia (B) (H&E ×200). H&E, hematoxylin and eosin stain.

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  Fig. 3. An atypical smooth muscle tumor containing bizarre cells with hyperchromatic nuclei. Scattered mitotic figures and karyorrhectic nuclei were also seen (hematoxylin and eosin stain, ×200).

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  Fig. 4. A smooth muscle tumor with mild atypia (A) and necrosis of infarct-type (B) (hematoxylin and eosin stain, ×100).

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  Fig. 5. A cellular smooth muscle tumor (A) (H&E ×100) with brisk mitotic activity (B) (H&E ×400). H&E, hematoxylin and eosin stain.

Reference

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