| Abstract [eng] |
Objective. To describe a clinical case of a uterine smooth muscle tumor of uncertain malignant potential and review the scientific literature about the prevalence, diagnostic methods, treatment strategies, recurrence risk factors and treatment options of this uterine tumor. Methodology. A clinical case was described and analyzed. A scientific literature search was conducted using the PubMed and Scopus databases. Keywords were used for literature search and after applying inclusion and exclusion criteria, 55 publications were selected for the literature review. Zotero reference management program was used for organising and citing the selected articles. Clinical Case Report. A 71-year-old female was referred to a gynaecologist for a consultation due to a suspected uterine tumor. Transvaginal ultrasound revealed a large uterine mass with mixed echogenicity and blood flow. Pelvic magnetic resonance imaging demonstrated an intramural mass with irregular borders, heterogeneous structure, necrotic areas, hemorrhagic components and contrast accumulation – radiological findings suggestive of uterine leiomyosarcoma. The patient was advised to undergo a radical surgical treatment – total hysterectomy with bilateral salpingo-oophorectomy. Histological examination of the tumor revealed atypical coagulative necrosis, and the patient was diagnosed with uterine smooth muscle tumor of uncertain malignant potential. Since no definitive signs of malignancy were detected, adjuvant therapy was not applied and regular follow-up every 6 to 12 months was recommended. The patient returned for a follow-up consultation 10 months after the initial surgery, complaining of lower abdominal pain. A contrast-enhanced computed tomography scan of the neck, chest, abdomen, and pelvis was performed to evaluate for tumor recurrence or spread to adjacent organs, but no signs of potential recurrence or progression were observed. The patient was advised to return for follow-up after 12 months. At the 12-month follow-up, no signs of disease recurrence or progression were noted. Further annual follow-up was recommended. Conclusions. These tumors are commonly diagnosed during perimenopause or postmenopause, with the average patient age being 40 – 50 years. There are no universal guidelines for diagnosing and treating of these tumors. Preoperative diagnosis usually relies on ultrasonography and magnetic resonanse imaging, while definitive diagnosis is made postoperatively during histological examination. The standard treatment of this disease is surgical approach. Hysterectomy with bilateral salpingo-ooforectomy is recommended for patients after menopause. Despite generally favorable prognosis, tumor recurrence is reported in up to 20% of cases. Risk factors for recurrence include cytological atypia, coagulative necrosis, altered expression of immunohistochemical markers p16, p53, and Ki-67, as well as the use of morcellation during surgery. Treatment of recurrences involves radical surgery, and there is data on the use of chemotherapy, radiotherapy, and hormone therapy. |
