Malign Potansiyeli Belirsiz Uterin Düz Kas Tümörü (STUMP): Tersiyer Bir Merkezde Yaklaşık Üç Yıllık Deneyim

Öz

Amaç: Tersiyer bir jinekolojik onkoloji merkezinde tedavi edilen, malign potansiyeli belirsiz uterin düz kas tümörü (STUMP) tanılı hastaların klinikopatolojik özelliklerini, immünohistokimyasal profilini, cerrahi yönetimini ve kısa dönem sonuçlarını tanımlamak; miyomektomi ve histerektomi uygulanan hastaları karşılaştırmak. Gereç ve Yöntem: Bu retrospektif tek merkezli kohort çalışmasına, Ocak 2023 ile Eylül 2025 tarihleri arasında tersiyer bir merkezde STUMP patolojik tanısı alan 32 hasta dahil edildi. Tahmini kan kaybı (EBL), perioperatif hemoglobin değerlerinden Gross ve Nadler formülleri kullanılarak hesaplandı. Miyomektomi (n=16) ve histerektomi (n=16) grupları karşılaştırıldı. Bulgular: Ortanca yaş 45 yıl, hastaların %78,1’i premenopozaldı ve ortanca tümör çapı 7,0 cm idi. Ortanca mitoz sayısı 4/10 büyük büyütme alanı idi; tümör hücre nekrozu olguların %46,9’unda mevcuttu. Ortanca Ki-67 indeksi %8; östrojen ve progesteron reseptörü pozitifliği sırasıyla %75,0 ve %62,5; p53 olguların %96,9’unda wild-type idi. Ortanca EBL 730 mL ve ortanca hastanede kalış süresi 3 gündü. Miyomektomi grubu histerektomi grubundan daha gençti (40 yıla karşı 48 yıl; p=0,001) ve bu grupta minimal invaziv yaklaşım daha sık uygulandı (p=0,020); diffüz p16 pozitifliği yalnızca histerektomi grubunda gözlendi (p=0,031). Hemoglobin düşüşü ve EBL gruplar arasında farklılık göstermedi. Miyomektomi uygulanan 16 hastanın 8’i (%50,0) takipte tamamlayıcı histerektomi geçirdi. Ortanca 17 aylık takip süresince hiçbir hastada rekürrens gözlenmedi (0/32). Sonuç: STUMP kısa dönemde iyi bir klinik seyir gösterdi; cerrahi yaklaşım öncelikli olarak hastanın fertilite isteği ve menopozal durumuna göre belirlendi. Bu sınırlı takip süresince rekürrens gözlenmemesi uzun dönem onkolojik güvenlik kanıtı olarak yorumlanmamalıdır; STUMP rekürrensleri karakteristik olarak çalışmamızın gözlem süresinden daha geç ortaya çıkmaktadır. Bu nedenle tüm hastalar için uzun dönem, yapılandırılmış takip esastır.

Anahtar Kelimeler

• Histerektomi
• İmmünohistokimya
• Malign potansiyeli belirsiz düz kas tümörü
• Miyomektomi
• STUMP
• Uterin neoplaziler

Etik Beyan

Çalışma için 12/05/2026 tarihinde Ankara Etlik Şehir Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır. Karar no: AEŞH-BADEK2-2026-427.

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Nearly Three-Year Experience at a Tertiary Center

Öz

Objective: To describe the clinicopathological features, immunohistochemical profile, surgical management, and short-term outcomes of uterine smooth muscle tumor of uncertain malignant potential (STUMP), and to compare myomectomy and hysterectomy. Materials and Methods: This retrospective single-center cohort study included 32 patients treated at a tertiary center who had a pathological diagnosis of STUMP between January 2023 and September 2025. Estimated blood loss (EBL) was calculated from perioperative hemoglobin values using the Gross and Nadler formulas. Myomectomy (n=16) and hysterectomy (n=16) groups were compared. Results: The median age was 45 years, 78.1% were premenopausal, and the median tumor diameter was 7.0 cm. The median mitotic count was 4/10 high-power fields, with tumor cell necrosis in 46.9%. The median Ki-67 index was 8%; estrogen and progesterone receptors were positive in 75.0% and 62.5%, and p53 was wild-type in 96.9%. The median EBL was 730 mL and the median hospital stay was 3 days. The myomectomy group was younger than the hysterectomy group (40 vs 48 years; p=0.001), and a minimally invasive approach was more frequent in this group (p=0.020); diffuse p16 positivity occurred exclusively in the hysterectomy group (p=0.031). Hemoglobin drop and EBL did not differ between groups. Eight myomectomy patients (50.0%) underwent completion hysterectomy. No recurrence occurred over a median follow-up of 17 months (0/32). Conclusion: STUMP followed a favorable short-term course, with the surgical approach guided primarily by the patient’s fertility preference and menopausal status. The absence of recurrence over this limited follow-up period should not be interpreted as evidence of long-term oncological safety, because STUMP recurrences characteristically develop later than the observation period of the present study. Long-term, structured surveillance therefore remains essential for all patients.

Anahtar Kelimeler

• Hysterectomy
• Immunohistochemistry
• Myomectomy
• Smooth muscle tumor of uncertain malignant potential
• STUMP
• Uterine neoplasms

Etik Beyan

Approval for the study was obtained from the Ankara Etlik City Hospital Clinical Research Ethics Committee on 12/05/2026. Decision no: AEŞH-BADEK2-2026-427.

Kaynakça

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