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Article: Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): A clinicopathologic analysis of 16 cases

TitleUterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): A clinicopathologic analysis of 16 cases
Authors
Issue Date2009
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.com
Citation
American Journal Of Surgical Pathology, 2009, v. 33 n. 7, p. 992-1005 How to Cite?
AbstractBackground: The current World Health Organization classification indicates that a uterine smooth muscle tumor that cannot be histologically diagnosed as unequivocally benign or malignant should be termed "smooth muscle tumor of uncertain malignant potential" (STUMP). STUMPs represent a heterogeneous group of rare tumors that have been the subject of only a few published studies, some of which lack detailed clinicopathologic details and/or follow-up data. More recently, it has been suggested that immunohistochemical staining may be helpful in the diagnosis of STUMPs. Design: The clinicopathologic features of 16 cases of STUMP that exhibited usual smooth muscle differentiation, diagnosed between 1992 and 2006 from 11 hospitals, were studied and classified into 4 subgroups using terminology and criteria described by Stanford investigators. Immunohistochemical stains for p16, p53, MIB1 (ki-67), and estrogen and progesterone receptors were performed. The results were compared with those in the literature. Results: The tumors were classified as follows: 6 as "atypical leiomyoma with limited experience", 7 as "smooth muscle tumor of low malignant potential", 2 as "atypical leiomyoma, low risk of recurrence," and 1 as "mitotically active leiomyoma, limited experience." Follow-up was 21 to 192 months (mean, 80.8 and median, 51.5). Only 2 tumors recurred, at 15 and 51 months, respectively; both were atypical leiomyoma with limited experience (multifocal moderate-to-severe atypia, no tumor cell necrosis, and mitotic counts of 4 and 5 mitotic figures /10 highpower fields, respectively). Both tumors had areas that were indistinguishable from benign leiomyoma and both had diffuse immunoreactivity for p16 and p53. Six other tumors that had focal staining for these markers all had a benign outcome. Both patients with recurrence were alive at last follow-up (at 40 and 74 mo). All the other patients were alive and disease-free. Conclusions: This and other studies suggest that uterine tumors classified as STUMPs using criteria proposed by Stanford investigators are usually clinically benign but should be considered tumors of low malignant potential because they can occasionally recur, in some cases, years after hysterectomy. After a mean follow-up of 80.8 months, only 2 of 16 tumors in this study recurred. Both of the latter tumors fulfilled the criteria for atypical leiomyoma with limited experience. Notably, the 2 recurrent tumors were the only ones that were strongly immunoreactive for p16 and p53, supporting earlier observations that these markers may be helpful in the prediction of the behavior of STUMPs. Patients diagnosed with STUMPs should receive long-term surveillance. © 2009 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/148605
ISSN
2015 Impact Factor: 4.951
2015 SCImago Journal Rankings: 2.393
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorPhilip, PCen_US
dc.contributor.authorCheung, ANYen_US
dc.contributor.authorClement, PBen_US
dc.date.accessioned2012-05-29T06:14:03Z-
dc.date.available2012-05-29T06:14:03Z-
dc.date.issued2009en_US
dc.identifier.citationAmerican Journal Of Surgical Pathology, 2009, v. 33 n. 7, p. 992-1005en_US
dc.identifier.issn0147-5185en_US
dc.identifier.urihttp://hdl.handle.net/10722/148605-
dc.description.abstractBackground: The current World Health Organization classification indicates that a uterine smooth muscle tumor that cannot be histologically diagnosed as unequivocally benign or malignant should be termed "smooth muscle tumor of uncertain malignant potential" (STUMP). STUMPs represent a heterogeneous group of rare tumors that have been the subject of only a few published studies, some of which lack detailed clinicopathologic details and/or follow-up data. More recently, it has been suggested that immunohistochemical staining may be helpful in the diagnosis of STUMPs. Design: The clinicopathologic features of 16 cases of STUMP that exhibited usual smooth muscle differentiation, diagnosed between 1992 and 2006 from 11 hospitals, were studied and classified into 4 subgroups using terminology and criteria described by Stanford investigators. Immunohistochemical stains for p16, p53, MIB1 (ki-67), and estrogen and progesterone receptors were performed. The results were compared with those in the literature. Results: The tumors were classified as follows: 6 as "atypical leiomyoma with limited experience", 7 as "smooth muscle tumor of low malignant potential", 2 as "atypical leiomyoma, low risk of recurrence," and 1 as "mitotically active leiomyoma, limited experience." Follow-up was 21 to 192 months (mean, 80.8 and median, 51.5). Only 2 tumors recurred, at 15 and 51 months, respectively; both were atypical leiomyoma with limited experience (multifocal moderate-to-severe atypia, no tumor cell necrosis, and mitotic counts of 4 and 5 mitotic figures /10 highpower fields, respectively). Both tumors had areas that were indistinguishable from benign leiomyoma and both had diffuse immunoreactivity for p16 and p53. Six other tumors that had focal staining for these markers all had a benign outcome. Both patients with recurrence were alive at last follow-up (at 40 and 74 mo). All the other patients were alive and disease-free. Conclusions: This and other studies suggest that uterine tumors classified as STUMPs using criteria proposed by Stanford investigators are usually clinically benign but should be considered tumors of low malignant potential because they can occasionally recur, in some cases, years after hysterectomy. After a mean follow-up of 80.8 months, only 2 of 16 tumors in this study recurred. Both of the latter tumors fulfilled the criteria for atypical leiomyoma with limited experience. Notably, the 2 recurrent tumors were the only ones that were strongly immunoreactive for p16 and p53, supporting earlier observations that these markers may be helpful in the prediction of the behavior of STUMPs. Patients diagnosed with STUMPs should receive long-term surveillance. © 2009 by Lippincott Williams & Wilkins.en_US
dc.languageengen_US
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ajsp.comen_US
dc.relation.ispartofAmerican Journal of Surgical Pathologyen_US
dc.subject.meshCyclin-Dependent Kinase Inhibitor P16 - Biosynthesisen_US
dc.subject.meshFemaleen_US
dc.subject.meshHistory, 16Th Centuryen_US
dc.subject.meshHumansen_US
dc.subject.meshImmunohistochemistryen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshNeoplasm Recurrence, Local - Epidemiology - Pathologyen_US
dc.subject.meshReceptors, Estrogen - Biosynthesisen_US
dc.subject.meshReceptors, Progesterone - Biosynthesisen_US
dc.subject.meshSmooth Muscle Tumor - Metabolism - Pathology - Surgeryen_US
dc.subject.meshTumor Markers, Biological - Analysisen_US
dc.subject.meshTumor Suppressor Protein P53 - Biosynthesisen_US
dc.subject.meshUbiquitin-Protein Ligases - Biosynthesisen_US
dc.subject.meshUterine Neoplasms - Metabolism - Pathology - Surgeryen_US
dc.titleUterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): A clinicopathologic analysis of 16 casesen_US
dc.typeArticleen_US
dc.identifier.emailCheung, ANY:anycheun@hkucc.hku.hken_US
dc.identifier.authorityCheung, ANY=rp00542en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.1097/PAS.0b013e3181a02d1cen_US
dc.identifier.pmid19417585-
dc.identifier.scopuseid_2-s2.0-67649497499en_US
dc.identifier.hkuros167728en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-67649497499&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume33en_US
dc.identifier.issue7en_US
dc.identifier.spage992en_US
dc.identifier.epage1005en_US
dc.identifier.isiWOS:000268043400004-
dc.publisher.placeUnited Statesen_US

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