Trachelectomy With Parasitized STUMP Tumor

INTRODUCTION: Uterine smooth muscle tumors of uncertain malignant potential (STUMP tumors) are a group of smooth muscle tumors that do not meet diagnostic criteria as definitively benign or malignant. STUMP tumors pose diagnostic challenges due to non-specific clinical presentation and imaging findings often similar to leiomyomas. We present a case of disseminated STUMP tumor after uncontained morcellation at the time of prior hysterectomy. OBJECTIVE: To present a robotic approach to trachelectomy with abnormal appearing parasitized fibroids noted intraoperatively, later confirmed to be STUMP tumor. METHODS: Demonstration of surgical technique and intraoperative decision-making of abnormal appearing pathology using a case example. Trachelectomy was performed with judicious use of the uterine manipulator to ensure complete trachelectomy. Resection of parasitized fibroids was performed with careful dissection of highly vascularized attachments. The abnormal-appearing left ovary was removed in a contained fashion. RESULTS: In the case presented, trachelectomy and resection of parasitized STUMP tumor were performed using a minimally invasive approach. Postoperatively, the patient underwent oncologic workup which confirmed residual disease in an omental nodule. Resection of residual omental STUMP tumor was performed with total omentectomy and confirmed on pathology. CONCLUSIONS: Uncontained morcellation can lead to the dissemination of STUMP throughout the peritoneal cavity. For STUMP tumors with evidence of dissemination, re-imaging even after hysterectomy can assess for residual disease. Resection of residual disease is recommended given limited data around STUMP progression and recurrence.