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The Large-Mass Phenotype of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP): A Clinicopathological Analysis of 37 Cases in Indonesia Using WHO 2021 and Modified Stanford Criteria Yuliza Ariani; Henny Mulyani; Noza Hilbertina; Yenita; Aswiyanti Asri; Tofrizal; Loli Devianti; Hera Novianti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1565

Abstract

Background: Uterine smooth muscle tumor of uncertain malignant potential (STUMP) presents a diagnostic dilemma, especially in Southeast Asian populations, where delayed presentation often leads to advanced tumor burden. This study aimed to characterize the clinicopathological profile of STUMP in Indonesia using the 2021 WHO Classification and modified Stanford parameters. Methods: A descriptive study analyzed 37 STUMP cases diagnosed between 2023 and 2025 at a tertiary referral center in West Sumatra. A panel of pathologists re-evaluated archival slides for atypia, mitotic activity, necrosis, and growth patterns, establishing inter-observer reliability. Fisher’s Exact Test was employed to correlate tumor size with morphological markers of aggression. Results: The cohort demonstrated a distinct large-mass phenotype, with 54.1% of tumors exceeding 10 cm and a median diameter of 14.5 cm. Pathological review classified 56.8% of cases into WHO Group 4 (atypia with ambiguous mitosis). A statistically significant correlation was identified between tumor size >10 cm and the presence of infiltrative growth margins (81.1%; p=0.034). Conclusion: Indonesian STUMP cases are distinctively characterized by massive size and high rates of infiltrative growth, likely driven by prolonged natural history. The prevalence of ambiguous mitotic figures underscores the utility of the WHO Group 4 category in resource-limited settings. These findings advocate for aggressive surgical management and wider resection margins in large-mass variants to mitigate local recurrence risk.
Co-Authors Adelia Rachmita, Prima Adrial Adrial, Adrial Afdol Rahmadi Afriani Agus Arijanto Anggrainy, Fenty Anindita, Reza Yoga Aswiyanti Asri Aswiyanti Asri Aswiyanti, Asri Azzahra Saidah Ramadhani C. Catur Widayati Cintalia, Meivina Daan Khambri Daan, Khambri Dariyani, Nuriz Defrin Defrin Dharmaji Chowmas Dini Andri Utami Dwi Yanti Fioni Putri Effendi, Hernita Etriyel Myh Fachry Abda El Rahman Hardian, Sonny Hardisman Harsby, Carmiyana Puja Hasmiwati Hendriani, Intania Dwiputri Henny Mulyani henny Mulyani Henny, Mulyani Hera Novianti Herawati, Destiana Herdiansyah, Januar Hermafasya, Ayu Octarin Hidayat, Nur Latifah Alfaina Husna Yetti Husna, Yetti Husna, Yetty Iftahillah Ismet Ismet, Ismet Isra Thristy Johan Kurnianda Ketang Wiyono Leonard, Randy liana, nana Loli Devianti M.Yoga Sefia Nurindra Maisa, Kamilah Nada Mayorita, Pamelia Meilinda Meilinda Monika Muhammad Fajar Musyarifah, Zulda Nanda, Cici Bayu Nita Afriani Noza Hilbertina Noza Hilbertina, Noza Noza, Hilbertina Nur Aristiani, Prita Nurfadly, Nurfadly Nursasi, Harnah Pasaribu, Ummi Rachmi Pemuda, Haris Purnamawati Hellen Widjaja Putri, Ratih Elsa R. Zuryati Nizar Rahmatina B Herman Ratih Kusumawardani Ratna Purwaningsih Ria Oktavia Ria Oktavia Rizanda Machmud Rizki Saputra Rizky Kurniawan Rony Rustam Salmiah Agus Salmiah Agus Sari, Rini Purnama Sembiring, Ranggi Heryagung Septia Haryani Setiadi, Fredrick Setiawati, Yessy Sofie, Femmy Sondang, Nora Sophian, Alfi Sri Utaminingsih Suchitra, Avit Sukri Rahman Suryati Suryati Susetyowati Syamel Muhammad Syamsiar, Syamsiar Tofrizal Triani, Ririn Agus Utami, Dini Andri Vitro Darma Yusra Wijaya, Septihani Michella Wildanur, Sri Yadi Sutikno Yaslinda Yaunin Yulistini, Yulistini Yuliza Ariani Yuniar Lestari Yusrawati Yusrawati