2nd Department of Obstetrics and Gynecology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Clinical Department of Surgery, "Constantin Papilian" Emergency Clinical Military Hospital, 22 G-ral Traian Mosoiu, 400132 Cluj-Napoca, Romania.
Curr Oncol. 2024 Sep 5;31(9):5242-5254. doi: 10.3390/curroncol31090388.
Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) is a rare uterine tumor primarily affecting perimenopausal and postmenopausal women, typically aged between 45 and 55 years. Characterized by ambiguous histological features, STUMPs present diagnostic challenges as they cannot be definitively classified as benign or malignant based on morphology alone. This systematic review aims to elucidate the clinical, pathological, immunohistochemical, and treatment-related characteristics of STUMPs through an analysis of the literature from the past 20 years. The study follows PRISMA guidelines, utilizing comprehensive searches of PubMed and Scopus databases, yielding 32 studies that meet the inclusion criteria. From the analysis of these studies, it was revealed that the clinical presentations vary from common symptoms such as abnormal uterine bleeding and pelvic pain to incidental detection of uterine mass. Histologically, STUMPs demonstrate features overlapping with both leiomyomas and leiomyosarcomas, including mild nuclear atypia, low mitotic indices, and focal necrosis. Immunohistochemical markers such as p16 and p53 have been investigated for prognostic significance. Elevated p16 expression, often associated with aggressive behavior, was observed in a subset of STUMPs. Surgical management, typically involving hysterectomy or tumorectomy, is the primary treatment, though the extent of resection is variable. Adjuvant therapies are not routinely recommended, but long-term surveillance is advised, especially for high-risk patients. Recurrence rates for STUMPs are approximately 12%, with factors such as high mitotic counts and coagulative necrosis indicating higher risk. This review highlights the complexity of STUMP diagnosis and management, emphasizing the need for more precise diagnostic criteria and individualized treatment strategies. Understanding the morphological, immunohistochemical, and clinical behavior of STUMPs can improve patient outcomes and guide future research in this diagnostically challenging area.
平滑肌肿瘤，性质不确定（STUMP）是一种罕见的子宫肿瘤，主要影响围绝经期和绝经后妇女，典型年龄在 45 岁至 55 岁之间。STUMP 的特点是组织学特征不明确，仅通过形态学无法明确将其分类为良性或恶性，因此存在诊断挑战。本系统综述旨在通过分析过去 20 年的文献，阐明 STUMP 的临床、病理、免疫组织化学和治疗相关特征。本研究遵循 PRISMA 指南，对 PubMed 和 Scopus 数据库进行全面检索，共纳入 32 项符合纳入标准的研究。通过对这些研究的分析，结果表明 STUMP 的临床表现从常见的症状，如异常子宫出血和盆腔疼痛，到偶然发现子宫肿块不等。组织学上，STUMP 表现出与平滑肌瘤和平滑肌肉瘤重叠的特征，包括轻度核异型性、低有丝分裂指数和局灶性坏死。免疫组织化学标志物，如 p16 和 p53，已被用于研究其预后意义。在一部分 STUMP 中观察到 p16 表达升高，通常与侵袭性行为相关。手术治疗，通常包括子宫切除术或肿瘤切除术，是主要治疗方法，但切除范围因病例而异。通常不建议辅助治疗，但建议长期监测，特别是对高危患者。STUMP 的复发率约为 12%，高有丝分裂计数和凝固性坏死等因素表明风险更高。本综述强调了 STUMP 诊断和管理的复杂性，强调需要更精确的诊断标准和个体化治疗策略。了解 STUMP 的形态学、免疫组织化学和临床行为可以改善患者的预后，并指导这一具有挑战性的诊断领域的未来研究。
