Histopathological Outcomes of Myoma Uteri Surgery Over a 10-Year Period: A Retrospective Evaluation of Sarcoma, STUMP, and Benign Variants

Background: Myoma uteri has a high incidence, particularly during the reproductive years, and represents the most common indication for hysterectomy. In this retrospective study, we aimed to investigate the incidence of uterine sarcoma, smooth muscle tumor of unknown malignant potential (STUMP), and benign myoma variants in the histopathological examination of patients undergoing surgery for myoma uteri and to contribute to the existing literature. Methods: Between January 2013 and January 2023, 504 patients who underwent hysterectomy or myomectomy for myoma uteri at our hospital were included in this study. Demographic and clinical findings of the patients, accompanying chronic diseases, previous operation history, presenting complaints, cytology (Pap smear) results, myoma size as determined by ultrasonography, endometrial sampling results, blood tests, operation type, final pathology results, and presence of malignancy were retrospectively analyzed from our database. In 39 patients with STUMP, age, marital status, body mass index (BMI), gravidity, parity, abortion history, comorbidities, surgical history, Human Papilloma Virus (HPV) status, fibroid size, and endometrial biopsy results were analyzed individually. Results: The STUMP detection rate was 7.7% (n = 39), which may be related to regional demographic characteristics and the tertiary referral nature of our institution. No statistically significant associations were identified between histopathological outcomes and the following variables: patient age, menopausal status, tumor size, number of myomas, surgical approach, and preoperative imaging findings. Conclusion: Although most uterine leiomyomas are benign, only a small number of tumors with potential clinical significance, such as STUMP, can be detected. Since this situation cannot be predicted in the preoperative evaluation, that is, demographic and clinical data, pathological evaluation should be performed in patients diagnosed with leiomyoma. Surgical planning should be performed carefully, especially in patients with a desire for fertility, and STUMP cases should be followed closely. Keywords: leiomyoma, smooth muscle tumor of uncertain malignant potential, STUMP, uterine carcinoma, hysterectomy, myomectomy