INCIDENTAL STUMP DURING CESAREAN SECTION IN IVFEGG DONATION PREGNANCY: A CASE EMPHASIZING THE IMPERATIVE OF ROUTINE HISTOPATHOLOGICAL EVALUATION OF MYOMAS

Abstract

Uterine myomas are commonly benign tumors of the female reproductive system. Although many are diagnosed preoperatively, some are incidentally discovered during obstetric surgery, such as the cesarean section. This case illustrates the necessity of routinely sending any excised uterine myoma for histopathological evaluation to determine its true biological potential and guide further management. We report the case of a 45-year-old primiparous woman (G1P0A1) with a history of in vitro fertilization (IVF) and egg donation, admitted at 37+4 weeks of gestation for elective cesarean section. The procedure was uncomplicated, yet multiple small intramural and subserous myomas were incidentally observed and excised. Histopathological analysis revealed a Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP), characterized by areas of focal necrosis, mild cytologic atypia, and low mitotic activity-features straddling benign leiomyoma and malignant leiomyosarcoma designations. STUMP comprises a rare histologic category representing 0.3-0.9% of presumed fibroids, with unpredictable behavior. Recurrence rates vary from 7% to 36%, with occasional progression to leiomyosarcoma (median time to recurrence ~79 months) [1-5]. Because of this uncertain prognosis, we recommended followup imaging and multidisciplinary consultation. A postoperative MRI followed by hysterectomy revealed additional subserous leiomyomas and chronic granulomatous inflammation. Given the potential risk of progression, the patient underwent definitive hysterectomy with ovarian preservation. This case highlights the crucial role of histopathological evaluation in incidental uterine myomas. Even small lesions may harbor atypical or borderline features warranting close monitoring or definitive treatment. Early detection and accurate classification influence patient prognosis and enable timely surgical and therapeutic interventions. When STUMP is diagnosed, hysterectomy is often recommended as definitive management to reduce recurrence or malignant transformation risk.