md-medicaldata

Authors

 

Milan Popović^1,2, Zoran Nikin^2,3, Goran Malenković^4,5, Nevena Stanulović^2,3, Tatjana Ivković-Kapicl<sup>2,3

1</sup>Univerzitet u Novom Sadu, Medicinski fakultet, Katedra za histologiju i embriologiju
²Institut za onkologiju Vojvodine, Služba za patološko-anatomsku i laboratorijsku dijagnostiku, Sremska Kamenica, Srbija
³Univerzitet u Novom Sadu, Medicinski fakultet, Katedra za patologiju
⁴Univerzitet u Novom Sadu, Medicinski fakultet, Katedra za zdravstvenu negu
⁵Institut za onkologiju Vojvodine, Klinika za operativnu onkologiju, Sremska Kamenica, Srbija

 

UDK: 618.14-006

The paper was received / Rad primljen: 29.12.2020.

Accepted / Rad prihvaćen: 31.12.2020.

 

Correspondence to:

dr Milan Popović
Katedra za histologiju i embriologiju
Medicinski fakultet, Univerzitet u Novom Sadu
Hajduk Veljkova 3, 21 000 Novi Sad
Hajduk Veljkova 3, 21 000 Novi Sad
e-mail: milan.popovic@mf.uns.ac.rs

 

 

Sažetak

Pacijentkinja, 48 godina starosti, na CT snimku abdomena i male karlice ima tumorsku masu na uterusu dimenzija 29x22x32 cm koja ispunjava celu malu karlicu i abdomen, do 3 prsta iznad umbilikusa koja datira od pre 2 godine. Nakon izvršene totalne histerektomije patohistološkom analizom nadjena je ovalna tumorska tvorevina mase 9750 g i dimenzija 36 x 25 x 20 cm koja u potpunosti zauzima stromu cerviksa i istmus materice. Raspoznatljivi deo tela materice je dimenzija 7,5 x 7 x 3,5 cm, a prečnik vaginalne porcije grlića 8,5 cm. Tumorsko tkivo je sagrađeno od snopova izduženih mišičnih vlakana uobičajenog izgleda, dok je delom miksoidno izmenjeno, sa znacima blage do umerene atipije. Mitotska aktivnost je slabo naglašena (1 mitoza na 10 vidnih polja velikog uveličanja). Na osnovu histomorfoloških karakteristika nalaz odgovara minimalno atipičnoj glatkomišićnoj neolazmi niskog mitotskog indeksa (engl. Smooth muscle tumor of uncertain malignant potential - STUMP).

Ključne reči:

materica, neoplazma porekla glatkog mišinog tkiva, STUMP

 

Abstract

A 48-year-old patient, on a CT scan of the abdomen and small pelvis, has a tumor mass on the uterus measuring 29x22x32 cm that fills the entire small pelvis and abdomen, up to 3 fingers above the umbilicus dating from 2 years ago. After a total hysterectomy, pathohistological analysis revealed an oval tumor weighing 9750 g and measuring 36 x 25 x 20 cm, which completely occupies the stroma of the cervix and the isthmus of the uterus. The recognizable part of the body of the uterus is 7.5 x 7 x 3.5 cm, and the diameter of the vaginal portion of the cervix is 8.5 cm. Tumor tissue is composed of bundles of elongated muscle fibers of normal appearance, while it is partly myxoid-altered, with signs of mild to moderate atypia. Mitotic activity is weakly emphasized (1 mitosis per 10 high magnification visual fields). Based on histomorphological characteristics, the finding corresponds to a minimally atypical smooth muscle neoplasm of low mitotic index, the smooth muscle tumor of uncertain malignant potential – STUMP.

Key words:

uterus, smooth muscle neoplasm, STUMP

 

 

References:

1. Kurman RJ, Carcanjiu ML, Simon HC, Young RH. WHO classification of tumors of female reproductive organs. 4th ed. Lyon:IARC Press; 2014.
2. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994;18:535-58.
3. Amant F, Moerman P, Vergote I. Report of an unusual problematic uterine smooth muscle neoplasm, emphasizing the prognostic importance of coagulative tumor cell necrosis. Int J Gynecol Cancer. 2005;15:1210-2.
4. Kempson RL. Sarcomas and related neoplasms. In: Norris HJ, Hertig AT, Abell MR, editors. The uterus. Baltimore: Williams & Wilkins; 1973.
5. Blom R, Guerrieri C, Stâl O, Malmström H, Simonsen E. Leiomyosarcoma of the uterus: a clinicopathologic, DNA flow cytometric, p53, and mdm-2 analysis of 49 cases. Gynecol Oncol. 1998;68:54–61.
6. de Vos S, Wilczynski SP, Fleischhacker M, Koeffler P. p53 alterations in uterine leiomyosarcomas versus leiomyomas. Gynecol Oncol. 1994;54:205–8.
7. Jeffers MD, Farquharson MA, Richmond JA, McNicol AM. p53 immunoreactivity and mutation of the p53 gene in smooth muscle tumours of the uterine corpus. J Pathol. 1995;177:65–70.
8. Layfield LJ, Liu K, Dodge R, Barsky SH. Uterine smooth muscle tumors: utility of classification by proliferation, ploidy, and prognostic markers versus traditional histopathology. Arch Pathol Lab Med. 2000;124:221–7.
9. Niemann TH, Raab SS, Lenel JC,Rodgers JR, Robinson RA. p53 protein overexpression in smooth muscle tumors of the uterus. Hum Pathol. 1995;26:375–9.
10. Zhai YL, Kobayashi Y, Mori A, Orii A, Nikaido T, Konishi I, Fujii S. Expression of steroid receptors, Ki-67, and p53 in uterine leiomyosarcomas. Int J Gynecol Pathol. 1999;18:20–8.
11. Atkins KA, Arronte N, Darus CJ, Rice LW. The use of p16 in enhancing the histologic classification of uterine smooth muscle tumors. Am J Surg Pathol. 2008;32:98–102.
12. Bodner-Adler B, Bodner K, Czerwenka K, Kimberger O, Leodolter S, Mayerhofer K. Expression of p16 protein in patients with uterine smooth muscle tumors: an immunohistochemical analysis. Gynecol Oncol. 2005;96:62–6.
13. Ip PP, Cheung AN, Clement PB. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): a clinicopathologic analysis of 16 cases. Am J Surg Pathol. 2009;1;33(7):992-1005.
14. Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Mayerhofer K. Estrogen and progesterone receptor expression in patients with uterine smooth muscle tumors. Fertil Steril. 2004;81:1062–6.
15. Mittal K, Demopoulos RI. MIB-1 (Ki-67), p53, estrogen receptor, and progesterone receptor expression in uterine smooth muscle tumors. Hum Pathol. 2001;32:984–7.
16. White MP, Rahimi S, Garely A, Buhl A, Dean RM. Uterine smooth muscle tumors of uncertain malignant potential (STUMP): review of pathophysiology, classification, diagnosis, treatment, and surveillance. J Healthc Commun. 2017;2:40.
17. Ip PPC, Cheung ANY: Pathology of uterine leiomyosarcomas and smooth muscle tumours of uncertain malignant potential. Best Pract Res Clin Obstet Gynaecol. 2011; 25(6): 691-704.
18. Guntupalli SR, Ramirez PT, Anderson ML, Milam MR, Bodurka DC, Malpica A: Uterine smooth muscle tumor of uncertain malignant potential: a retrospective analysis. Gynecol Oncol. 2009;113(3): 324-6.
19. Mowers EL, Skinner B, McLean K, Reynolds RK. Effects of morcellation of uterine smooth muscle tumor of uncertain malignant potential and endometrial stromal sarcoma: case series and recommendations for clinical practice. J Minim Invasive Gynecol. 2015;22:601-6.
20. Ip PP, Tse KY, Tam KF. Uterine smooth muscle tumors other than the ordinary leiomyomas and leiomyosarcomas: a review of selected variants with emphasis on recent advances and unusual morphology that may cause concern for malignancy. Adv Anat Pathol. 2010;17:91–112.
21. Vilos GA, Marks J, Ettler HC, Vilos AG, Prefontaine M, Abu-Rafea B: Uterine smooth muscle tumors of uncertain malignant potential: diagnostic challenges and therapeutic dilemmas. Report of 2 cases and review of the literature. J Minim Invasive Gynecol.2012;19(3): 288-95.
    

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