Uterine smooth muscle tumors are usually classified as benign or malignant. According to the WHO, there is another group of intermediate neoplasms, known as uterine smooth muscle tumors of uncertain malignant potential. These are rare tumors that display some characteristics of malignancy, but do not fully meet the criteria of leiomyosarcoma. A 71-year-old female with complaints of left-sided abdominal pain was referred to a gynecologist. MRI revealed a heterogenous, ill-defined large mass (10x11,5 cm) with radiologic findings suggestive of leiomyosarcoma. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy. Histological examination revealed only atypical coagulative necrosis with no other signs of malignancy, excluding leiomyosarcoma and leading to the diagnosis of STUMP. Given the possibility of recurrence, close follow-up was recommended. Eight months later, the patient came for a check-up with complaints of lower abdominal pain. A whole-body CT scan was performed, but no signs of tumor recurrence were found. The patient was advised to continue monitoring every 12 months. There are no internationally accepted guidelines for diagnosing and treating of these neoplasms. Total hysterectomy with bilateral salpingo-oophorectomy is considered the most effective surgical treatment for women who are postmenopausal. Given the tumor’s potential to recur as either STUMP or leiomyosarcoma, with a recurrence rate of up to 20%, close follow-up is crucial.
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