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Case Reports
. 2021 Apr 28:9:2050313X211012516.
doi: 10.1177/2050313X211012516. eCollection 2021.

Uterine smooth muscle tumour of uncertain malignant potential and in vitro fertilization treatment in an infertile patient

Triantafyllidou Olga  1 , Kastora Stavroula Lila  2   3 , Georgios Kounidas  2 , Papazian Maria  1 , Vlahos Nikolaos  1
Affiliations
Case Reports

Uterine smooth muscle tumour of uncertain malignant potential and in vitro fertilization treatment in an infertile patient

Triantafyllidou Olga et al. SAGE Open Med Case Rep. .

Abstract

The term smooth uterine muscle of uncertain malignant potential (STUMP) indicates a group of uterine smooth muscle tumours that cannot be diagnosed unequivocally as malignant but does not fulfil the criteria for leiomyoma, or its variants. In this case, we present a woman treated for infertility who presented with an asymptomatic cervical mass, diagnosed as STUMP after three cycles of controlled ovarian stimulation. We reviewed the literature with particular emphasis on the effects of STUMP upon fertility, up-to-date guidance regarding the management of patients' wishing fertility-sparing approaches and obstetric outcomes. To the best of our knowledge, this is the first case report of STUMP in a patient that has undergone multiple in vitro fertilization treatments as well as the first to provide a putative biological basis for the efficacy of gonadotropin-releasing hormone agonists, in this patient group.

Keywords: Obstetrics/gynaecology; bioinformatics; genetics; oncology.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors state that the manuscript is original; all the authors were active participants, and take full responsibility for this article, which they have read and approved, and that it is not simultaneously under consideration by other publication. The authors report no conflicts of interest. Contribution to the paper of each author is indicated.

Figures

Figure 1.
Figure 1.
Patient MRI findings: (a) sagittal and (b) transverse sections. Patient identifiable information has been removed from the images. Black arrows indicate areas of interest.
Figure 2.
Figure 2.
Laparoscopic images depicting the stages of STUMP morcellation: (a) the presence of a smooth well-defined 5 cm mass attached to the left side of the cervix, (b) STUMP after opening the broad ligament, (c) solid adhesions of STUMP to adjacent tissues and (d) the bed of STUMP after its removal.
Figure 3.
Figure 3.
Histological examination of section. Smooth muscle neoplasm identified with epithelioid morphology (a) (H–E ×100) and diffuse low to moderate nuclear atypia throughout the tumour (b) and (c), (H–E ×400). The mitotic count was low with less than five mitoses or 10 HPF. Areas of necrosis were not observed. Immunohistochemically, the neoplastic cells stained positive for calponin (d) (×40) and were negative for p16 and p53.
Figure 4.
Figure 4.
Putative mechanism of STUMP size modulation through GnRH agonists. Putative pathway: GnRH agonist activates GnRH receptor which through currently unidentified, Gq/11 G-protein family members, activating Pten phosphatase which in turn activates Med12, Myocd and Rb1 leading to cell development and cell-cycle regulation potentially regulating and decreasing STUMP growth. Protein associations were mined and generated through the STRING V. 11 (https://string-db.org/), Cytoscape freeware platform and Agilent Literature plugin (V. 3.8) and the National Library of Medicine (US). Bethesda (MD): The Library; (15 July 2020). Available from: https://ghr.nlm.nih.gov/. Pathway was reconstructed through BioRender online design platform.
See this image and copyright information in PMC

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