Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Systematic Review of the Literature in the Last 20 Years

IF 2.8 4区医学 Q2 ONCOLOGY

Current oncology Pub Date : 2024-09-05 DOI:10.3390/curroncol31090388

Carmen Elena Bucuri, Razvan Ciortea, Andrei Mihai Malutan, Valentin Oprea, Mihai Toma, Maria Patricia Roman, Cristina Mihaela Ormindean, Ionel Nati, Viorela Suciu, Dan Mihu

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引用次数: 0

Abstract

Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) is a rare uterine tumor primarily affecting perimenopausal and postmenopausal women, typically aged between 45 and 55 years. Characterized by ambiguous histological features, STUMPs present diagnostic challenges as they cannot be definitively classified as benign or malignant based on morphology alone. This systematic review aims to elucidate the clinical, pathological, immunohistochemical, and treatment-related characteristics of STUMPs through an analysis of the literature from the past 20 years. The study follows PRISMA guidelines, utilizing comprehensive searches of PubMed and Scopus databases, yielding 32 studies that meet the inclusion criteria. From the analysis of these studies, it was revealed that the clinical presentations vary from common symptoms such as abnormal uterine bleeding and pelvic pain to incidental detection of uterine mass. Histologically, STUMPs demonstrate features overlapping with both leiomyomas and leiomyosarcomas, including mild nuclear atypia, low mitotic indices, and focal necrosis. Immunohistochemical markers such as p16 and p53 have been investigated for prognostic significance. Elevated p16 expression, often associated with aggressive behavior, was observed in a subset of STUMPs. Surgical management, typically involving hysterectomy or tumorectomy, is the primary treatment, though the extent of resection is variable. Adjuvant therapies are not routinely recommended, but long-term surveillance is advised, especially for high-risk patients. Recurrence rates for STUMPs are approximately 12%, with factors such as high mitotic counts and coagulative necrosis indicating higher risk. This review highlights the complexity of STUMP diagnosis and management, emphasizing the need for more precise diagnostic criteria and individualized treatment strategies. Understanding the morphological, immunohistochemical, and clinical behavior of STUMPs can improve patient outcomes and guide future research in this diagnostically challenging area.

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恶性潜能不确定平滑肌瘤（STUMP）：过去 20 年文献的系统性回顾

恶性潜能不确定平滑肌瘤（STUMP）是一种罕见的子宫肿瘤，主要影响围绝经期和绝经后妇女，通常年龄在 45 岁至 55 岁之间。STUMP的特点是组织学特征不明确，无法仅根据形态学将其明确分为良性或恶性，因此给诊断带来了挑战。本系统性综述旨在通过分析过去 20 年的文献，阐明 STUMPs 的临床、病理、免疫组化和治疗相关特征。本研究遵循 PRISMA 指南，利用 PubMed 和 Scopus 数据库进行了全面检索，结果有 32 项研究符合纳入标准。对这些研究的分析表明，其临床表现各不相同，既有异常子宫出血和盆腔疼痛等常见症状，也有偶然发现的子宫肿块。从组织学角度看，STUMPs 的特征与子宫肌瘤和子宫肌肉瘤重叠，包括轻度核不典型性、低有丝分裂指数和灶性坏死。免疫组化标记物（如 p16 和 p53）对预后的意义进行了研究。在一部分 STUMPs 中观察到 p16 表达升高，这通常与侵袭行为有关。手术治疗通常包括子宫切除术或肿瘤切除术，是主要的治疗方法，但切除范围不尽相同。不建议常规采用辅助疗法，但建议进行长期监测，尤其是对高危患者。STUMP的复发率约为12%，有丝分裂计数高和凝固性坏死等因素表明复发风险较高。本综述强调了 STUMP 诊断和管理的复杂性，强调需要更精确的诊断标准和个体化的治疗策略。了解 STUMP 的形态学、免疫组化和临床表现可改善患者的预后，并为这一诊断难题领域的未来研究提供指导。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current oncology ONCOLOGY-

CiteScore

3.30

自引率

7.70%

发文量

664

审稿时长

1 months

期刊介绍： Current Oncology is a peer-reviewed, Canadian-based and internationally respected journal. Current Oncology represents a multidisciplinary medium encompassing health care workers in the field of cancer therapy in Canada to report upon and to review progress in the management of this disease. We encourage submissions from all fields of cancer medicine, including radiation oncology, surgical oncology, medical oncology, pediatric oncology, pathology, and cancer rehabilitation and survivorship. Articles published in the journal typically contain information that is relevant directly to clinical oncology practice, and have clear potential for application to the current or future practice of cancer medicine.