Coexistence of Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP), Symplastic Leiomyoma, and Squamous Cell Carcinoma in Situ in a Nulliparous Patient: A Case Report
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Abstract
Background: Smooth muscle tumors of uncertain malignant potential (STUMPs) constitute a rare and diagnostically challenging subset of uterine mesenchymal neoplasms. Their clinical behavior is unpredictable, and preoperative distinction from benign leiomyomas or leiomysarcomas remains difficult. Coexistence with cervical squamous neoplasia is exceedingly uncommon and sparsely documented.
Case Presentation: We report the case of a 36-year-old nulliparous woman with a 12-year history of symptomatic uterine leiomyomatosis who presented with severe abnormal uterine bleeding and life-threatening anemia. Imaging over the years demonstrated progressively enlarging uterine masses, including a large pedunculated lesion occupying the entire pelvis. Emergency total hysterectomy was performed due to hemodynamic instability. Gross examination revealed three distinct tumors: a large transcervical polypoid mass, a bilobulated subserosal tumor and an intramural leiomyoma. Histopathological evaluation demonstrated a colliding tumor composed of a transcervical symplastic leiomyoma associated with cervical squamous intraepithelial neoplasia with foci of early stromal invasion, and a subserosal STUMP characterized by focal necrosis and cytologic atypia but low mitotic activity. The postoperative course was favorable, and the patient was referred to gynecologic oncology for long-term surveillance.
Discussion: This case is notable for the unusual coexistence of a STUMP, a symplastic leiomyoma, and cervical squamous neoplasia with microinvasion in a patient significantly younger than the typical age reported for STUMPs. The case highlights the diagnostic difficulty, unpredictable biological behavior, and lack of standardized management or follow-up guidelines for STUMP, emphasizing the importance of individualized treatment and monitoring due to recurrence risk.
Conclusion: Uterine STUMPs remain a management challenge given their uncertain malignant potential, radiologic ambiguity, and absence of clear follow-up recommendations. This case underscores the necessity for personalized surveillance strategies, particularly when multiple synchronous uterine neoplasms are present.
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