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The Clinicopathological Study of 21 Cases With Uterine Smooth Muscle Tumors of Uncertain Malignant Potential: Centralized Review Can Purify the Diagnosis
  1. Derman Basaran, MD*,
  2. Alp Usubutun, MD,
  3. Mehmet Coskun Salman, MD,
  4. Mehmet Ali Narin, MD*,
  5. Gokhan Boyraz, MD,
  6. Osman Turkmen, MD*,
  7. Gunsu Comert Kimyon, MD*,
  8. Alper Karalok, MD*,
  9. Dilek Bulbul, MD§,
  10. Taner Turan, MD*,
  11. Nejat Ozgul, MD and
  12. Kunter Yuce, MD
  1. *Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital; Departments of
  2. Clinical Pathology, and
  3. Obstetrics and Gynecology, Hacettepe University Faculty of Medicine; and
  4. §Department of Clinical Pathology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Ankara, Turkey.
  1. Address correspondence and reprint requests to Derman Basaran, MD, Department of Gynecologic Oncology, Etlik Zubeyde Hanim Women's Health Teaching and Research Hospital, Etlik St, Kecioren, Ankara 06010, Turkey. E-mail:


Objective The objective of this study was to investigate the clinicopathological features and factors associated with recurrence in patients with uterine smooth muscle tumor of uncertain malignant potential (STUMP).

Methods Forty-six cases diagnosed between 2000 and 2014 from 2 tertiary centers underwent blind slide review. Initial diagnosis included smooth muscle tumors with equivocal diagnosis, STUMPs, and cases that were named as leiomyosarcomas (LMS) or low-grade LMS despite not fulfilling the Stanford criteria.

Results In total, 21 patients with a final diagnosis of STUMP were available. Fifteen (68.1%) of 22 patients with an initial diagnosis of STUMP, 4 (22.2%) of 18 cases with an equivocal smooth muscle tumor diagnosis, and 2 (33.3%) of 6 cases with an initial diagnosis of LMS were interpreted as STUMP after slide review. The mean age at diagnosis was 43 years (range, 20–64 years). The mean follow-up time was 65.9 months (range, 10–154 months). Four patients (19.0%) developed recurrent disease. Recurrent tumors were LMS in 3 patients (75%). One patient (4.8%) with recurrence succumbed to disease. There was no difference in patients' age (P = 1.0) or type of initial surgery (uterus conserving versus hysterectomy) (P = 0.57) between patients who recurred and did not recur.

Conclusions Uterine STUMPs can harbor significant uncertainty regarding the original diagnosis and clinical outcomes. Recurred cases may have an aggressive clinical course associated with multiple relapses and death. Uterine mesenchymal tumors other than ordinary myomas and overt sarcomas deserve a second opinion in centers with experience because the real diagnosis may vary significantly.

  • Uterus
  • Smooth muscle tumor of low malignant potential
  • Recurrence

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  • The authors declare no conflicts of interest.