STUMP: It could be uterine cancer, but nobody can tell

Real-life STUMP pathology reports (second and third opinions)

Some basic definitions and links have been added, while names of doctors and labs have been removed.

Surgical pathology report 1

This is a challenging case.

The sections show a myometrial smooth muscle neoplasm with no nuclear atypia and zero mitotic figures per ten high-power fields (50 high power fields counted).

The most concerning feature, however, is the presence of abundant necrosis with abrupt transitions between viable and necrotic cells, ghost tumor cell outlines:, and perivascular spacing. Other areas have an appearance suggesting an infarct [Tissue death because of an interrupted blood supply], however, with a hyalinized [glassy or transparent appearance] zone surrounding the necrosis.

Given the presence of ambiguous necrosis, I would regard this tumor as a smooth muscle tumor of uncertain malignant potential (STUMP), and would recommend close clinical follow-up.

Due to the difficult nature of this case, I have shared it with my colleague [doctor name], who concurs with the above interpretation.

Surgical pathology report 2

Sections of uterus have a benign endometrium without evidence of glandular hyperplasia or neoplasia. Sections of the myometrial mass have extensive hemorrhagic necrosis. Collections of bland spindled nuclei focally arrange themselves in Verocay body-like formations. There is no associated nuclear pleomorphism. No mitotic figures are identified.

The interface with the subjacent myometrium is smooth without areas of infiltration. The differential diagnosis in this case would include an infarcted leiomyoma as well as an infarcted smooth muscle tumor of low malignant potential. A smooth muscle tumor of low malignant potential is favored given the current subclassification of so-called uterine stump (smooth muscle tumor of uncertain malignant potential). The smooth muscle tumor of low malignant potential is characterized by none to mild atypic, loss than ten mitoses [cell divisions] per ten high-power fields [magnification level under a microscope], and tumor cell necrosis [cell death]. As noted above, tumor cell necrosis is prominent in this case.

Of such cases in the literature four of 15 recurred. Material from this case had been previously referred to [major pathology lab]. Their favored diagnosis was one of a smooth muscle tumor of uncertain malignant potential. A pertinent reference in this regard would include Phillip, PC IP et al. 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 Mar;17(2):91-112)

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6 Responses

  1. Hi Ms. Price,

    I am battling with the same diagnosis. I believe it’s because I took Depo Provera for a year before the myomectomy and this is known to cause an increase in mitosos and atypia. The chief of pathology at my hospital insists that it is STUMP because of the immunohistochemical stains. I am P53 negative and ER and PR positive so it’s supposed to have a more favorable outcome than a true Leiomyosarcoma. I had my fibroid taken out whole with an open myomectomy. One month later, I had a total hysterectomy including the cervix. Since I have no ovaries now I am taking Arimidex as an adjuvent therapy to starve these cells.My first baseline scan showed NED and I go foe chest X-rays every 6 months. There is an article by Dr. Hewedi that I found comforting because the focus is more on the immunohistochemicals as opposed to just looking at atypia and mitosis. Thank you for your article.

    1. I have just received the same diagnosis after I had my hysterectomy. Meeting with the oncologist next week and will take it from there. To the extent anyone has learned something about these that was helpful, or if there is something I should ask the oncologist about, it would be great if you could share. My family is in Europe, and I am having the results sent there as well, to see what the recommendations are there. Trying to cast a wide net, although I realize answers will probably be few.
      Thank you for posting this, it has been helpful in confirming my understanding of the diagnosis.

  2. Hi, I have just been diagnosed with STUMP and have spindle cell neoplasm occurrence as well. I’ve taken a crash course on these terms over the last week. Next week I’m going to see an oncologist at a cancer clinic. I already had a hysterectomy a couple months ago but kept my ovaries. I’ve been finding that it does not seem that there are too many of us out there with this sort of diagnosis, so I was glad to find some information here.

    1. I took out my ovaries to avoid making more estrogen, which can feed the tumor. I got a third opinion at Johns Hopkins Hospital in Maryland and they called it Atypical Leiomyoma. They were the only ones that could tell that my mitotic rate was lower. My fibroid was degenerating so it mimicked mitotic rates. I avoid all estrogen and soy. Soy can act as an estogen in your body. Flax, sesame seeds and tofu are the worst for us with this condition. If you have no necrosis and are ER positive and P53 negative, they say it’s less aggressive.

      Best of health to you.

      My email is [email protected]
      if you would like to discuss some more.

  3. I just got this diagnosis too. I’m waiting for a CT scan. My doc says if the scan is negative I can keep my uterus (I had a myomectomy) and just keep getting scanned regularly. I’m nervous though. I’ve been having trouble keeping weight on, which is worrisome. I’ve started an FB group for us if anyone’s interested.

  4. I have had two re-occurrences with two surgical procedures. I have three clusters currently that are being managed by hormone inhibitors. This seems to be stopping their growth.

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