CASE REPORT   

Minerva Obstetrics and Gynecology 2022 October;74(5):466-70

DOI: 10.23736/S2724-606X.22.05126-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Management of a giant uterine smooth muscle tumor of uncertain malignant potential in a 32-year-old woman: case report and review of the literature

Giosuè G. INCOGNITO ¹ ✉, Gisella D’URSO ¹, Dalila INCOGNITO ², Chiara LELLO ³, Alessia MICELI ⁴, Marco PALUMBO ¹

¹ Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy; ² Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy; ³ Department of Drug and Health Sciences, University of Catania, Catania, Italy; ⁴ Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy

Uterine smooth muscle tumors of uncertain malignant potential (STUMP) represent a group of rare uterine smooth muscle tumors not diagnosed unequivocally as benign or malignant. To data, diagnostic criteria, malignant potential, surgical management, and follow-up of these neoplasms remain controversial. Considering that STUMP and leiomyoma are not significantly different in terms of clinical presentation and preoperative sonographic characteristics, it might be difficult to distinguish between the two affections prior to pathological confirmation at surgery. All cases should be managed by multidisciplinary tumor teams and patients’ follow-up should comprise consultation with a gynecologic oncologist and a close surveillance because of the possibility of recurrence or metastasis. We present the case of a 32-year-old nulliparous woman admitted to our gynecology clinic. She was asymptomatic and only complained an increase in abdominal volume started during the past 6 months. A transabdominal and transvaginal pelvic ultrasound revealed a large heterogeneous tumor mass measuring 190×163 mm, color score 2, expanded in the left iliac fossa, suspected for benign uterine myoma. Subsequent magnetic resonance imaging confirmed a large pelvic-abdominal tumor located near the left posterior-lateral uterine wall with areas of necrosis, suggestive of subserosal leiomyoma with cystic degeneration. The patient underwent a median longitudinal laparotomy for excision of the pelvic mass. The patient was normally discharged five days after surgery in good health conditions. The final histological examination was compatible with STUMP. At present, the patient has had no relapses or metastases and she is undergoing follow-up.

KEY WORDS: Uterine neoplasms; Smooth muscle tumor; Leiomyoma; Leiomyosarcoma