OBJECTIVE: The Primary Objective of this study was to analyse reproductive outcomes in patients with STUMP (Smooth Muscle Tumour of Uncertain Potential) or ALM (Atypical Leiomyoma) who underwent fertility-preserving surgeries. Secondary Objectives were to analyse long-term prognosis for these patients and to study the basic demographic and pathological characteristics of patients with STUMP or ALM.
METHODS: This retrospective study was conducted at Amrita Institute of Medical Sciences. Cases of STUMP and ALM were retrieved from the hospital medical database between June 2014 and December 2022. Demographic parameters, clinical presentations, pathological features and clinical outcomes were analysed. Categorical variables were expressed in numbers and percentages. Normal distribution data were presented as mean while non-normal distribution was expressed as median and range.
RESULTS: Thirty-eight patients were included in the study with a diagnosis of STUMP or ALM in postoperative histology. Seven patients (18.4%) were nulliparous. Myomectomy was performed in 9 (23.6%), while hysterectomy was done in 29 patients (76.3%). Fertility-preserving surgeries were performed on six patients (15.7%). Of these six patients, 4(66.6%) conceived spontaneously and had successful pregnancies. Recurrences were found in 3 patients (7.8%) out of which one had undergone fertility-sparing surgery. All the patients with recurrences had previous history of myomectomies. Morcellation was reportedly done in 2 of these three patients.
CONCLUSIONS: Good reproductive outcomes have been demonstrated in patients diagnosed with STUMP or ALM and desiring fertility. However, these patients should be kept under follow-up care as they are prone for recurrences. Patients who have undergone morcellation mayhave an increased chance of recurrence.

Vulvar leiomyomas are extremely rare smooth muscle tumors that are easily mistaken for other lesions, as the differential diagnosis must consider a wide spectrum of benign and malignant lesions. We present the case of a 52-year-old woman with a three-year history of progressive abdominal distension and pain and an enlarging vulvar mass distorting the labia majora and causing gait disturbance. Imaging confirmed an enormous pelvic mass originating in the uterus, compatible with a leiomyoma/sarcoma, and large perineal and vulvar masses with similar characteristics. Histopathology after surgical removal revealed benign abdominal, vulvar, and perineal leiomyomas. This case highlights the rarity and diagnostic challenges of extra-uterine leiomyomas, particularly those in the vulvar region.

OBJECTIVE: to analyse the clinical-pathological characteristics, treatment, and evolution of uterine smooth muscle tumours with uncertain malignant potential (STUMP) diagnosed in the Salamanca University Hospital with the implementation of the 2014 WHO criteria.
METHODS: a retrospective descriptive study of patients diagnosed with STUMP from January 2015 to March 2023 at the Salamanca University Hospital. Demographic data, preoperative clinical data, treatment, complications, therapeutic results, anatomopathological findings and recurrence time were obtained.
RESULTS: a total of four patients were identified and included in the study. The mean age at diagnosis was 48 years (range 36-67). The surgical indications were abnormal uterine bleeding, compressive symptoms, and the growth of a pelvic mass suspected to be a degenerated myoma from the residual cervix after a subtotal hysterectomy 6 years earlier. In all cases, a laparotomic procedure was performed. A total hysterectomy, sub-total hysterectomy, and the excision of the cervix with STUMP localization were accomplished in two, one, and one patient, respectively. The mean diameter of the tumour pieces was 13 cm (range 8-17 cm), with a mean volume of 816 cc (range 234-1467 cc). The mean follow-up was 47 months, with no recurrence to date.
CONCLUSIONS: STUMPs are a heterogeneous group of tumours with a difficult-to-predict clinical evolution. In most cases, their diagnosis is histological after performing surgery for suspected leiomyoma. Due to their low incidence, there are no specific guidelines for their treatment and control. However, considering their potential risk of recurrence and metastasis, it is advisable to maintain six-monthly controls for 5 years and then annual controls for 5 years more.

We report a rare case of leiomyoma of the thyroid gland associated with psammoma bodies. The patient was a 9-year-old black African boy. Prior to this, only five cases of primary thyroid leiomyoma have been reported. Histologically, thyroid leiomyoma was characterised by bundles of spindle smooth muscle cells with blunt-ended nuclei. Psammoma bodies were widely distributed within the tumour. Immunohistochemistry showed positive immunoreactivity for smooth muscle actin, vimentin and desmin, but was negative for a cytokeratin cocktail. Further reports of similar cases is required to ascertain the clinical significance of this lesion.

Rare Epstein-Barr virus (EBV)+ smooth muscle tumours (SMT) manifest typically under immunosuppression. Three major subtypes are known: human immunodeficiency virus-associated (HIV-SMT), after transplantation (PTSMT) or associated with congenital immunodeficiency syndromes (CI-SMT). So far, there are no analyses which compare the clinico-pathological characteristics of all three subtypes. Case reports and case series on these three tumour types were collected (1990-2012). Meta-data analysis was performed for identification of similarities and differences. A total of 73 HIV-SMT, 66 PTSMT and 9 CI-SMT were evaluated. There was a slight female predominance (55-67%). Children were affected nearly equally in HIV-SMT (33%) and PTSMT (35%), while all CI-SMT occurred in children. HIV-SMT manifested preferentially in the central nervous system, gut/liver, skin, lungs/larynx/pharynx and adrenal glands. PTSMT were predominantly found in the liver, lungs/larynx/pharynx, gut/spleen and brain. CI-SMT were often found in lungs/larynx, brain, liver, adrenal glands and spleen. Antecedent EBV+ lymphoproliferations manifested more often in PTSMT. In all three tumour subtypes, survival analyses did not show any significant differences regarding surgical therapeutic approaches, the occurrence of multiple tumours, tumour size or sarcoma-like histological features. HIV-SMT had the poorest overall survival, which might be attributed to HIV-associated infectious complications.