Smooth muscle tumors of uncertain malignant potential (STUMPs) represent a group of rare uterine neoplasms whose morphological features are between those of leiomyoma and leiomyosarcoma.1 STUMP recurrence poses a major challenge because no gold standard for treatment has been established. The present case highlights the effective use of intraoperative radiotherapy (IORT) as a salvage technique in a patient with twice recurrent STUMP, with the treatment resulting in more than 5 years of disease-free survival.
A 46-year-old woman presented with large myoma and compression symptoms and underwent laparoscopic myomectomy. Her pathology report revealed STUMPs requiring laparoscopic hysterectomy. Six months postoperation, the patient visited our outpatient department for dull intermittent right-lower-quadrant abdominal pain. Laboratory data revealed elevated C-reactive protein (58.5 mg/dL) and CA-125 levels (Figure 1A). Transabdominal sonography revealed a right adnexal mass measuring 5.44 × 5.29 cm2 with complex echogenicity. Abdominal computed tomography (CT) revealed a large cystic lesion in the right adnexa (Figure 1B). Therefore, laparoscopic surgery was performed, revealing multiple peritoneal nodules, a few bloody ascites, and a lesion on the right fallopian tube. Hence, peritoneal tumor excision, right salpingo-oophorectomy, and ascites collection were performed. Cytological analysis of the ascites revealed no malignant cells. However, histopathological analysis of the peritoneal tumor and right fallopian tube revealed STUMPs (Figure 1C). No subsequent events were observed throughout the patient's outpatient follow-up. However, 7 months postoperation, outpatient sonography revealed left-upper- and right-lower-quadrant abdominal masses with complex echogenicity. Therefore, abdominal CT was performed to confirm STUMP recurrence resulting in ileus (Figure 1D). Midline laparotomic tumor excision with IORT (20 Gy/1 fx) and seromuscular layer repair of the descending colonic wall were performed (Figure 1E). Histopathology again confirmed recurrent STUMPs (Figure 1F). After the operation, the patient regularly received outpatient ultrasound and CT scan follow-up and has remained recurrence-free for more than 7 years.
Pseudomyogenic hemangioendothelioma (PHE) is an indolent and low-grade tumor that often mimics other benign and malignant lesions, making accurate diagnosis crucial for effective patient management.1 The variable clinical presentations and pathological features of PHE pose diagnostic challenges for inexperienced radiologists.2 Here, we present a 17-year-old man with PHE, characterized by ultrasonography and magnetic resonance imaging, and confirmed by pathological examination.
A 17-year-old male presented to our hospital with a complaint of pain in his leg while walking for the past 10 months. During the physical examination, multiple palpable masses were detected in the right thigh, which were hard, ill-defined, and had poor mobility. High-frequency ultrasound revealed that the largest mass in the muscle of the right thigh was hypoechoic, well-defined, and irregular (Figure 1A), with a few blood flow signals both inside and around the mass (Figure 1B). Magnetic resonance imaging suggested that the largest mass appeared as a high signal on T1-weighted (Figure 1C) and T2-weighted imaging (Figure 1D), with significant enhancement (Figure 1E). Finally, the patient underwent a surgical resection of masses, and a pathological examination confirmed the diagnosis of PHE. Hematoxylin and eosin staining revealed a diffuse growth of epithelioid cells with abundant cytoplasm and slightly off-centered nuclei (Figure 1F). Immunohistochemical staining results were positive for ERG, Fli-1, INI-1, Vim, and partially positive for CD31. Weakly positive staining was observed for CK, SMA, Cal, desmon, while CD34, CD56, Desmin, MyoD1, Myogenin, S-100, WT-1, EMA, HMB-45, Melan-A were negative. The Ki-67 proliferation index was approximately 5%.
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