Uterine smooth muscle tumor of uncertain malignant potential: A retrospective analysis
Division of Gynecologic Oncology, Baylor College of Medicine, Houston, TX, USA. Gynecologic Oncology
(Impact Factor: 3.77).
04/2009; 113(3):324-6. DOI: 10.1016/j.ygyno.2009.02.020
This retrospective study was designed to evaluate the clinicopathologic features and outcomes of a cohort of patients diagnosed with uterine smooth muscle tumor of uncertain malignant potential (STUMP) seen at a single institution.
All patients diagnosed with uterine STUMP and seen between 1990 and 2005 at The University of Texas M. D. Anderson Cancer Center were identified using the institution's databases. Variables of interest included age at diagnosis, recurrence rate, and disease-free and overall survival.
Forty-one patients with uterine STUMP were identified and included in the study. The mean age at diagnosis was 43 years (range 25-75 years). The mean follow-up time was 45 months (range 1-171 months). Three patients (7.3%) had a recurrence during the follow-up period. One of the three patients who had recurrent disease was found to have a leiomyosarcoma at the time of recurrence. Recurrence rates were similar for women who underwent myomectomy and those who underwent hysterectomy. All three patients with recurrence were alive and disease-free at a mean follow-up time of 121 months.
Our results suggest that in this cohort of patients with uterine STUMP the recurrence rate was 7%. Recurrences can be in the form of STUMP or leiomyosarcoma.
Available from: Gianluca Di Luigi
- "For these reasons a new classification is catching on: smooth muscle tumors of uncertain malignant potential (STUMP) are a heterogeneous group of neoplasms, from both the his tological and clinical point of view. Due to the rarity of these tumors, the literature on the topic is limited; a consensus on their diagnosis, malignant potential, monitoring, and treat ment has still not been reached     . The clinical behaviour of these neoplasms is also poorly understood. "
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ABSTRACT: The malignant transformation of a uterine leiomyoma is still debated and, if it occurs, it is very rare. The case of a patient affected by one small leiomyoma is described. Diagnosis was made postoperatively on histopathological examination. The case reported here is meant to underline the need to keep all uterine myomas in check since the transition into leiomyosarcomas (LMSs) may occur with an evolution over a time period which has not been established so far. Specific receptors for luteinizing hormone/human chorionic gonadotropin (LH/hCG) have also been identified in the myometrium of several animal species, including humans. Conventional LMSs express estrogen receptors (ER), progesterone receptors (PR), and androgen receptors (AR) in 30-40% of cases. In comparison with other more common uterine malignancies, uterine LMSs bear some resemblance to type 2 endometrial carcinomas and high-grade serous carcinomas of ovary/fallopian tube origin, based on their genetic instability, frequent p53 abnormalities, aggressive behavior, and resistance to chemotherapy. It could be useful to understand with further researches if hormonal stimulation could be a contributing factor of uterine leiomyoma transformation into LMS. Until today the oncogenic mechanisms underlying the development of uterine LMSs remain elusive.
Available from: Kristyna Kubinova
- "The absence of histopathologic confirmation is another limitation of UAE in contrast to myomectomy or hysterectomy despite the fact that malignant transformation of leiomyomas probably does not exist. Although the incidence of uterine sarcomas and smooth muscle tumors with uncertain malignant potential is very low, they cannot be completely ignored, and several cases of undiagnosed uterine malignancy treated with UAE have already been described.39,40 The problem is that exclusion of a malignant or atypical tumor of uterine muscle origin, especially in patients with multiple fibroids, is very difficult and not always reliable, even using Doppler ultrasonography and magnetic resonance imaging (MRI).41 "
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ABSTRACT: Uterine artery embolization (UAE) is a minimally invasive procedure with large symptomatic potential in treatment of women with uterine leiomyomas. Due to specificities of this method and possible complications the appropriate indication is crucial. Patient' symptoms, age, plans for pregnancy, and surgical and reproductive history play a major role in decision-making regarding appropriate subjects for UAE. Close cooperation between the gynecologist and the interventional radiologist is necessary. UAE is usually offered as an alternative to surgical treatment. In patients with no fertility plans, it is a less invasive option than abdominal hysterectomy, with a comparable effect on fibroid-related symptoms and quality of life. The need for reintervention is markedly greater in patients after UAE (up to 35% within 5 years) than after hysterectomy. Women with large symptomatic fibroids wishing to retain the uterus and ineligible for minimally invasive (laparoscopic or vaginal) hysterectomy are good candidates for UAE. However, studies comparing UAE with minimally invasive hysterectomy are lacking. Use of UAE in younger women desiring pregnancy is more controversial, mainly because of the significant risk of miscarriage (as high as 64% in some studies) as well as the increased risk of other complications of pregnancy, such as preterm delivery, abnormal placentation, and post-partum hemorrhage. The risk of infertility or subfertility following UAE is unknown. Even poor candidates for myomectomy should be carefully selected for UAE after counseling about all possible adverse effects on fertility. Good prospective studies focused on fertility comparing UAE with no treatment or with myomectomy are needed but would be ethically questionable. This review summarizes the current knowledge regarding the benefits and potential risks of UAE from the point of view of the gynecologist, who should be responsible for proper indication of this treatment.
- "CS is managed more aggressively than endometrial cancer, and a wealth of literature has included CS in the discussion on uterine sarcoma 3,5,6. In contrast, STUMP is treated as a borderline tumour with a favourable prognosis but in rare cases can recur as LMS years after hysterectomy 7,8. The latter is characterized by a more aggressive biology because of the LMS component. "
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ABSTRACT: The aim of the study was to elucidate the differential metabolic activities in aggressive and indolent subtypes of uterine sarcomas, which may aid in managing these heterogeneous tumours.
We retrospectively analysed the PET/computed tomography scans of consecutive patients (N=18) diagnosed with uterine sarcoma at our unit. The patients were divided into indolent (N=4) and aggressive (N=14) tumour groups, and the maximum standardized uptake values (SUVmax) of all lesions (n=134) were measured. The SUVmax of the lesions were compared between the two tumour groups using the Mann-Whitney U-test. We calculated the optimal cutoff value as determined by receiver operating characteristic analysis. A P-value less than 0.05 was considered statistically significant.
The mean SUVmax of aggressive (n=104) and indolent tumours (n=30) were significantly different (8.0±7.3 vs. 1.9±0.9 respectively; P<0.001). A cutoff of SUVmax greater than 4.0 was able to exclude indolent tumours, with 100% specificity and positive predictive value (sensitivity 72%, negative predictive value 50% and accuracy 78%; area under the curve 97%). By applying this same cutoff value on the most metabolic active lesion in each patient, we were able to correctly classify all but one patient into either the aggressive or indolent tumour group with 100% specificity and positive predictive value (sensitivity 93%, negative predictive value 80% and accuracy 94%).
Aggressive and indolent uterine sarcoma subtypes have differential metabolic activities that can be used to classify them and this can aid in patient management for preoperative surgical planning and treatment stratification.
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