Jena Sanghamitra, Sinha Neetesh K, Mishra Minakshi, Singh Vinita, Kumar Upadhyay Amitabh
Surgical Oncology, Tata Main Hospital, Jamshedpur, IND.
Pathology, Tata Main Hospital, Jamshedpur, IND.
Cureus. 2024 Nov 6;16(11):e73115. doi: 10.7759/cureus.73115. eCollection 2024 Nov.
Smooth muscle tumors of the uterus can range from benign leiomyoma (LM) to malignant leiomyosarcoma (LMS) histologically. Between these two entities lies a gray zone of smooth muscle tumors of undetermined malignant potential, commonly known as STUMP. Their diagnosis has always been a challenge for the pathologists. Once diagnosed, clinicians face difficulties in managing STUMP because of the lack of discrete treatment guidelines. Here, we report a case of a 52-year-old lady who presented in an emergency with severe menorrhagia. On examination, the patient was pale and there was a 4x3 cm size polyp protruding through the internal ostium. Hysteroscopy with endometrial biopsy and polypectomy were done. The polypectomy specimen was diagnosed as STUMP after a thorough histopathological examination and immunohistochemistry (IHC). The specimen was re-examined in two other reputed institutes, as there was a dilemma between the diagnosis of STUMP/leiomyosarcoma. The patient was treated with a radical hysterectomy, considering the upstaged diagnosis of leiomyosarcoma. The final histopathological diagnosis of the hysterectomy specimen was STUMP. The patient did not receive any adjuvant therapy. Presently, she is on follow-up every six months and has not developed any recurrence till now. The aim of reporting this case is to enrich the existing literature on this rare diagnosis and highlight the fact that STUMP can also present as a uterine polyp. This is probably the first case of STUMP presenting as a uterine polyp.
子宫平滑肌肿瘤从组织学上看可从良性平滑肌瘤(LM)到恶性平滑肌肉瘤(LMS)。在这两种实体之间存在一个恶性潜能未明的平滑肌肿瘤灰色地带,通常称为未定型平滑肌肿瘤(STUMP)。对病理学家来说,其诊断一直是个挑战。一旦确诊,由于缺乏明确的治疗指南,临床医生在管理STUMP时会面临困难。在此,我们报告一例52岁女性患者,因严重月经过多急诊就诊。检查时,患者面色苍白,有一个4×3厘米大小的息肉从子宫内口突出。进行了宫腔镜检查、子宫内膜活检及息肉切除术。经过全面的组织病理学检查和免疫组织化学(IHC),息肉切除标本被诊断为STUMP。由于在STUMP/平滑肌肉瘤的诊断上存在两难情况,该标本在另外两家知名机构进行了重新检查。考虑到平滑肌肉瘤的升级诊断,患者接受了根治性子宫切除术。子宫切除标本的最终组织病理学诊断为STUMP。患者未接受任何辅助治疗。目前,她每六个月接受一次随访,至今未出现任何复发情况。报告此病例的目的是丰富关于这种罕见诊断的现有文献,并强调STUMP也可表现为子宫息肉这一事实。这可能是首例表现为子宫息肉的STUMP病例。