Relapse of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: a case report with a review of the literature.

International Journal of Research and Innovation in Social Science (IJRISS) | Volume VI, Issue I, January 2022 | ISSN 2454–6186

Relapse of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential: a case report with a review of the literature.

Sassi I, Naija L, Ghalleb M, Chabchoub A, Jaidane O, Hechiche M, Slimane M, Rahal K
Surgery department, Salah Azaiez Institute , Tunis Tunisia

Abstract:
Introduction:
Smooth muscle tumors of uncertain malignant potential (STUMP) are sporadic. We report a rare case of relapse of a uterine STUMP and discuss diagnostic and therapeutic issues.

Case report:
A 25-year-old North African woman was treated for a uterine STUMP by myomectomy. Four years later she consulted with pelvic pain associated with pollakiuria. Observations during the surgery led us to perform a hysterectomy and the histopathological examination confirmed the relapse of a STUMP.

Conclusion:
Smooth muscle tumors of uncertain malignant potential of the uterus are rare. The surgery remains the standard protocol for the treatment. The risk of relapse is uncommon but a regular follow-up is recommended.

Key words:
Uterine STUMP, Relapse, Genetic

INTRODUCTION

Smooth muscle tumors of the uterus are frequent and mostly benign. Some tumors may present unusual histological aspects that cannot be categorized as benign or malignant lesions. Thus, in 2003, the WHO classified these tumors as smooth muscle tumors of uncertain malignant potential (STUMP) [1].
STUMP are rarely reported in the literature. They are sporadic, and the exact incidence rate is unknown due to the small number of studied cases. It is difficult to categorize them by imaging, particularly for voluminous tumors, such as in our case.
Through this case, we aim to report our experience and shed further light on a rare issue of a relapse of a uterine STUMP through a literature review.

CASE REPORT

A 25-year-old unmarried North African woman whose twin sister was operated on for a benign leiomyoma of the uterus within the same year. With a personal history of mitral shrinkage and myomectomy in 2016. The anatomopathological examination concluded a smooth muscle tumor of uncertain malignant potential. The patient was lost to follow-up for four years, and in 2020 she presented with pelvic pain associated with pollakiuria, all of which had been evolving for two years.
The clinical examination found a 20cm abdominal mass.
We did not perform the gynecological examination because the patient was a virgin. The rectal examination showed a substantial mobile abdominopelvic mass. An MRI showed a globular uterus increased in size, occupying almost the entire abdominopelvic cavity measuring 260x228x161mm seat of numerous uterine myomas (Figure1), the largest of which measures 188x89mm, in heterogeneous T2 hyper-signal, hypo-signal T1, hyper-signal diffusion with restriction of ADC and heterogeneous enhancement. After multidisciplinary consultation, the decision was to perform an exploratory laparotomy which showed small uterus pushed back above the iliac bifurcation with a 60 mm posterior fundal mass of soft consistency, coming into contact with the iliac vessels laterally and the cecum posteriorly and pushing back the bladder (Figure 2). The two adnexa and the rest of the abdominopelvic cavity were without any anomaly.
We performed an inter-adnexal hysterectomy (Figure 3) given to these intraoperative findings, recurrence, and histological type (STUMP). The anatomopathological examination showed the presence of fasciculated architectural tumor proliferation. It was made of smooth muscle bundles intersecting at right angles. The tumor cells were elongated, presenting significant focal atypia with an estimated mitotic index of 7 mitosis/10 fields at high magnification (CFG), presence of necrosis foci. All concluded to a STUMP. After a multidisciplinary meeting, we decided to perform clinical and radiological surveillance every three months.
No sign of recurrence was seen after ten months of follow-up.

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