Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Histopathology. 2018 Aug;73(2):284-298. doi: 10.1111/his.13515. Epub 2018 May 21.
The current World Health Organisation classification defines smooth muscle tumours of uncertain malignant potential (STUMPs) as neoplasms that cannot be diagnosed reliably as benign or malignant according to generally accepted criteria. This has led to the application of various sets of criteria; consequently, consistent and reliable outcome data are lacking. The aims of this study were: (i) to compare the frequency of adverse outcome in STUMP on the basis of enhanced criteria; and (ii) to perform failure analysis to identify feature(s) helpful in predicting outcome METHODS AND RESULTS: Cases of STUMP diagnosed between 1994 and 2009 were retrieved and follow-up data were collected. Morphological parameters were scored and correlated with outcome. Twenty-two subjects with a median follow-up of 74.5 months (range, 26-166 months) formed the study group. Their age ranged from 31.9 years to 51.8 years (median, 45.3 years). Sixteen subjects underwent hysterectomy and six underwent myomectomy. Adverse outcomes were noted in eight (36.4%) cases. In cases with adverse outcomes, notable features included moderate-severe nuclear atypia (seven), epithelioid features (one), infiltrative or irregular margins (five), atypical mitoses (two), and vascular intrusion (three) CONCLUSIONS: The frequency of adverse outcomes in our series (36.4%) was higher than that in previously published reports (7-26.7%), suggesting that the use of more stringent criteria can exclude some patients from further follow-up. Although 'significant' nuclear atypia was not discriminatory, its frequent association with adverse outcomes has pathobiological implications. The presence of necrosis was not particularly associated with adverse outcomes. Atypical mitoses, epithelioid differentiation, vascular involvement and infiltrative/irregular margins appear to herald adverse outcomes, and therefore merit inclusion in the diagnostic regimen.
当前的世界卫生组织分类将不确定恶性潜能的平滑肌肿瘤（STUMP）定义为根据普遍接受的标准无法可靠诊断为良性或恶性的肿瘤。这导致了各种标准的应用；因此，缺乏一致和可靠的结果数据。本研究的目的是：（i）根据强化标准比较 STUMP 不良结局的频率；（ii）进行故障分析以确定有助于预测结局的特征。
检索了 1994 年至 2009 年诊断的 STUMP 病例，并收集了随访数据。对形态学参数进行评分，并与结局相关联。22 例中位随访时间为 74.5 个月（范围，26-166 个月）的患者组成研究组。他们的年龄为 31.9 岁至 51.8 岁（中位数，45.3 岁）。16 例患者行子宫切除术，6 例行子宫肌瘤切除术。8 例（36.4%）出现不良结局。在有不良结局的病例中，显著特征包括中度至重度核异型性（7 例）、上皮样特征（1 例）、浸润性或不规则边缘（5 例）、非典型有丝分裂（2 例）和血管侵犯（3 例）。
我们的系列研究中（36.4%）不良结局的发生率高于以前发表的报道（7-26.7%），这表明使用更严格的标准可以排除一些患者进行进一步随访。尽管“显著”核异型性没有鉴别意义，但它常与不良结局相关，具有病理生物学意义。坏死的存在与不良结局没有特别相关。非典型有丝分裂、上皮样分化、血管受累和浸润/不规则边缘似乎预示着不良结局，因此值得纳入诊断方案。
