Uterine Smooth Muscle Tumors of Uncertain Malignant Potential (STUMP): About a Case.

Introduction and Importance: Smooth muscle tumors of uncertain malignant potential (STUMP) are smooth muscle tumors whose morphological characteristics do not allow them to be formally classified as benign or malignant. This differentiation is based on histological criteria. Some tumors may present unusual anatomo-pathological aspects, leading to problems of differential diagnosis, notably with leiomyosarcoma. Case Presentation: We report here the case of a 45-year-old Moroccan woman with no particular pathological history who consulted us for pelvic pain associated with abdominal enlargement, the anatomopathological result of which was in favor of a smooth muscle tumor of uncertain malignancy potential STUMP, its surgical management and evolution, in the gynecological-mammary surgery department of CHU Ibn Rochd in Casablanca. Clinical Discussion: STUMPs are very rare tumours; their incidence is not well documented, varying around 0.01% of all women undergoing gynaecological surgery for a presumed preoperative diagnosis of uterine myoma. Leiomyosarcomas are defined by the presence of spindle-shaped cells with moderate to severe nuclear atypia, more than ten mitoses in ten fields at 40 X magnification, presence of tumour necrosis. Two of these criteria are necessary for a diagnosis of malignancy. We speak of STUMP when one of the malignancy criteria is present and the second is difficult to assess. The clinical presentation of STUMP does not differ from that of other MSDs such as leiomyoma or leiomyosarcoma. There are no precise data on the metastatic nature of PUMTS. The therapeutic approach differs from one school to another, ranging from simple myomectomy to total hysterectomy or even bilateral adnexectomy. The prognosis for STUMP is better than for leiomyosarcoma. Given the uncertain nature and evolution of these tumours, patients should receive close, long-term clinical and radiological follow-up. Conclusion: STUMPs are rare tumours, usually of unexpected histological diagnosis after gynaecological surgery for preoperative diagnosis of uterine myoma. The final diagnosis is histological. Their therapeutic management poses a particular problem when the woman wishes to preserve her fertility. The prognosis for STUMPs remains intermediate between that of leiomyosarcomas and leiomyomas.