Iranian Society of Gynecology Oncology


1 Obstetrics and Gynecology Department, Kashan University of Medical Sciences, Kashan, Iran

2 Department of Pathology, Kashan University of Medical Sciences, Kashan, Iran


Introduction: Uterine smooth muscle tumors are the most common human neoplasms. These tumors are clinically classified into two groups of benign and malignant. However, uterine smooth muscle tumors of uncertain malignant potential (STUMP) are another group between these two groups that cause many diagnostic problems. The present report aimed at introducing a case of STUMP mistaken with ovarian tumor in a female with polio.
Case Presentation: A 43-year-old female with the complaint of abdominal pain and distention, which had started 3 years ago, referred to our center, Kashan, Iran. Abdominal examination showed firm and irregular distention greater than term pregnancy. Ultrasonography, CT scan, and MRI of the abdomen and the pelvis revealed multiple intramural and subserosal fibroids in the uterus, and a large complex cyst in the abdomen and pelvis that probably originated from the ovary. Laparotomy results showed 2 tumors arising from the anterior surface of the uterus sized 15 × 25 cm, which were extended under the liver, and attached to the omentum and posterior peritoneum of the abdominal cavity wall with moderate ascites. The tumors, which weighted 10 kg along with the uterus, were removed and the patient was discharged after two days in good general health. The pathology report was as follows: uterine adenomyosis and smooth muscle tumors of uncertain malignant potential (STUMP).
Conclusions: STUMP has unpredictable various clinical presentations. Even imaging may mislead the clinicians. Therefore, in patients with pelvic tumors and even with a strong suspicion of ovarian and retroperitoneal tumors, this type of uterine tumors should also be considered, moreover, appropriate treatment should be considered to preserve or not to preserve fertility.


  1. AI-Nafussi A. Uterine smooth - muscle tumors: practical approach to diagnosis. J Crrent Dagn Pthol. 2004;10(2):140-56. [DOI:10.1016/S0968-6053(03)00072-3]
  2. Rosai J, Ackerman LV. Ackerman's Surgical Pathology. 9 ed. St. Louis, MO: Elsevier Mosby; 2004. pp. 1609-12.
  3. Cotran RS, Kumar V, Collins T. Robbins and Cotran's Pathologic Basis of Disease. 7 ed. Philadelphia: WB Saunders; 2005. p. 1089.
  4. 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(2):91-112. [DOI:10.1097/PAP.0b013e3181cfb901] [PMID]
  5. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol. 1994;18(6):535-58. [DOI:10.1097/00000478-199406000-00001] [PMID]
  6. Anderman S, Irge D, Sharon A, Groisman G, Hallak M. Uterine smooth muscle tumors of uncertain malignant potential: a therapeutic dilemma [abstract]. J Minim Invasive Gynecol. 2010;17:111-2. [DOI:10.1016/j.jmig.2010.08.549]
  7. Prayson RA, Goldblum JR, Hart WR. Epithelioid smooth-muscle tumors of the uterus: a clinicopathologic study of 18 patients. Am J Surg Pathol. 1997;21(4):383-91. [DOI:10.1097/00000478-199704000-00003] [PMID]
  8. 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. [DOI:10.1016/j.ygyno.2009.02.020] [PMID]
  9. 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;33(7):992-1005. [DOI:10.1097/PAS.0b013e3181a02d1c] [PMID]
  10. Ly A, McKenney JK, Longacre TA. Atypical leiomyoma of the uterus: a clinicopathologic study of 46 cases [abstract]. Mod Pathol. 2009;22:225A.
  11. Downes KA, Hart WR. Bizarre leiomyomas of the uterus: a comprehensive pathologic study of 24 cases with long-term follow-up. Am J Surg Pathol. 1997;21(11):1261-70. [DOI:10.1097/00000478-199711000-00001] [PMID]
  12. Dgani R, Piura B, Ben-Baruch G, Open M, Glezerman M, Nass D, et al. Clinical-pathological study of uterine leiomyomas with high mitotic activity. Acta Obstet Gynecol Scand. 1998;77(1):74-7. [DOI:10.1034/j.1600-0412.1998.770116.x] [PMID]