Considerations about multidisciplinary therapeutic approach to STUMP uterine tumors

R.M. Sima, I. Mărgărit, A.D. Stănescu, L. Pleș

Rezumat: Introduction. The abbreviation “STUMPs” indicates the smooth uterine muscle of uncertain malignant potential tumors, in the group of uterine smooth muscle tumors (SMTs) that cannot be diagnosed unequivocally as benign or malignant. The diagnosis, medical approach and followup of this pathology are still controversial. Materials and method. We reviewed the medical databases using the MeSH words “STUMPs”, “smooth uterine muscle tumors” or “SMTs” to highlight the most important papers on this topic. Results. The literature research revealed 162 articles about STUMPs. The majority are case reports or case series, including less than 10 patients with long-term follow up. The preoperative imaging for STUMP diagnosis or differentiation from leiomyoma- leiomyosarcoma is difficult. The preoperative sonographic tumors appear in 83.3% of cases with well-defined margins, 66.7% hyperechoic, 100% heterogeneous and 66.7% of cases with acoustic shadowing. The patient’s age, fertility desire, imagistic characteristics, size and location of the tumor should be considered before the procedure. The pathologic features expressed a mean number of mitosis about 8, mild atypia in almost 66.7% of cases and necrosis in 33.3% of cases. The recurrence rate after myomectomy was 6.6%. STUMP diagnosis can be managed as a second myomectomy or hysterectomy. Other treatment options for recurrence include adjuvant chemotherapy, radiotherapy and progestins GnRH analogs. Conclusions. STUMP is classified as an intermediate pathological form of uterine tumors, between benign and malignant. Metastases after many years from the initial approach can appear, thus the patients diagnosed with STUMP should be followed on the long term.
Cuvinte cheie: STUMP, uterine smooth muscle tumors, histologic diagnosis, STUMP recurrence.