Hemoperitoneum due to spontaneous bleeding from a smooth muscle tumor of uncertain malignant potential: A rare case report. (February 2023)

• Record Type: Journal Article
• Authors: Zachomitros, Fotios; Tsakiridis, Ioannis; Peitsidis, Nikolaos; Michos, Georgios; Dagklis, Themistoklis; Kalogiannidis, Ioannis
• Is Part Of: International journal of surgery case reports. Volume 103(2023)
• Publication Date: 2023-02
• Subjects: Smooth muscle tumors of uncertain malignant potential -- STUMP -- Hemoperitoneum -- Fibroid uterus; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2023.107910
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Smooth muscle tumors of uncertain malignant potential (STUMPs) are uncommon tumors representing an extremely rare cause of hemoperitoneum. Case presentation: We report a case of a 48-year-old Caucasian, premenopausal woman that presented in the emergency department with acute abdominal pain. There was no remarkable past medical and surgical history except from a known uterine leiomyoma. The ultrasound and the computed tomography imaging showed an intraperitoneal fluid collection and a heterogenous uterine mass. The patient underwent emergent exploratory laparotomy; a subserosal uterine tumor was identified with an actively bleeding vessel on its surface. The uterine lesion was completely excised and the histopathology set the diagnosis of a STUMP. After consultation on the significance of this finding with the patient, an abdominal total hysterectomy and bilateral salpingo-oophorectomy were scheduled and performed and the subsequent histopathology detected no malignancy. Clinical discussion: This case demonstrates that a STUMP may be a rare cause of acute intraperitoneal bleeding. Careful evaluation of clinical history, imaging findings and, if needed, surgical exploration are important for the diagnosis, while appropriate follow-up is also of major importance for the management of these rare tumors. Conclusion: We presented an extremely rare case of hemoperitoneum due to spontaneous bleeding from a STUMP. From an oncological perspective, this case poses a diagnostic, management and follow-up challenge. Highlights: STUMPs represent a rare type of uterine tumors. STUMPs may be an extremely rare cause of intraperitoneal bleeding. There is no consensus on the appropriate management of STUMPs, but close follow-up should be considered.