Surgical Challenges and Histopathological Diagnostic Dilemmas in Uterine Fibroid: Smooth Muscle Tumor of Uncertain Malignant Potential

Aim and background: Uterine leiomyoma, one of the most common uterine tumors, though usually asymptomatic, may not always be a benign one.Meticulous evaluation with appropriate postoperative management is a must for optimum outcomes.Case description: A 45-year-old P3L2D1 presented with acute retention of urine with pressure symptoms and severe anemia with a mass in the abdomen.Examination revealed a large uterine mass, approximately 28-30 weeks' gravid uterus in size, extending into the upper vagina.Magnetic resonance imaging (MRI) confirmed a large fibroid extending into the abdominal cavity and distending the cervical canal and upper vagina.The patient had a total abdominal hysterectomy with bilateral salpingo-oophorectomy, with a final diagnosis concluded as "Smooth muscle tumor of uncertain malignant potential" (STUMP), on histopathological examination.Conclusion: This case highlights the importance of patient selection, optimum preoperative evaluation, followed by postoperative evaluation, giving us an insight into the cellular abnormalities and their possibilities.