Multifocal EBV-associated smooth muscle tumors in a patient with cytomegalovirus infection after liver transplantation: a case report from Shiraz, Iran

Introduction Immunodeficient patients, including the recipients of solid organs, exhibit an increase in the incidence of neoplasms. Post-transplant smooth muscle tumor (PTSMT) is a distinct and infrequent entity of these groups of neoplasms. Epstein–Barr virus (EBV) is considered to be involved in the etiology of this neoplasm. Case report A 28-year-old man who underwent liver transplantation presented with abdominal pain and diarrhea for several months. He had a history of resistant systemic cytomegalovirus (CMV) infection after transplantation. Radiologic evaluation and colonoscopy revealed multiple liver, spleen, lung, and colon lesions. Microscopic assessment of colon and liver lesions using IHC study were in favor of spindle cell proliferation with mild atypia and a mild increase in mitotic rate without any necrosis, with features of smooth muscle tumor. Considering the transplantation history, EBER chromogenic in situ hybridization (CISH) study on paraffin blocks was requested, which demonstrated EBV RNA in tumor cell nuclei, suggesting EBV-associated smooth muscle tumor. In addition, PCR for CMV on paraffin blocks was positive. PCR for EBV and CMV viremia were negative. The dosage of immunosuppressive agents was reduced, and currently, he is being followed, with slow expansion in the size of the lesions. Conclusion Although the incidence of post-transplant smooth muscle tumors (PTSMTs) is low, it should be remained in the differential diagnosis in post-transplantation patients, especially dealing with multifocal tumors. As strong stimulant for smooth muscle tumors, close follow-up and screening for EBV and CMV infection and early treatment at the time of diagnosis are recommended to avoid these virus-induced tumors.

Multifocal EBV-Associated and CMV-Correlated Post-Transplant Smooth Muscle Tumor: A Case After Liver Transplantation

IntroductionImmunodeficient patients, including the recipients of solid organs, exhibit an increase in the incidence of neoplasms. Post-transplant smooth muscle tumor (PTSMT) is a distinct and infrequent entity of these groups of neoplasms. Epstein–Barr virus (EBV) is considered to be involved in the etiology of this neoplasm.Case reportA 28-year-old man who underwent liver transplantation presented with abdominal pain and diarrhea for several months. He had a history of resistant systemic cytomegalovirus (CMV) infection after transplantation. On physical examination, he had mild abdominal tenderness. Spiral chest and abdominopelvic CT scan with contrast showed a liver lesion with ring enhancement; furthermore, it showed a solid lesion in the spleen and multiple small lesions in lower lobes of both lungs. Colonoscopy revealed multiple small raised polypoid lesions throughout the rectum and colon. Microscopic evaluation of colon mucosa biopsy using IHC study was in favor of spindle cell neoplasm with high proliferative index. He underwent a right hemicolectomy. A microscopic study showed spindle cell proliferation with mild atypia and a mild increase in mitotic rate without any necrosis, with features of smooth muscle tumor. Trucut biopsy of liver mass was also in favor of smooth muscle tumor. According to transplantation history and considering the possibility of EBV-associated smooth muscle tumor, EBV encoded RNA (EBER) chromogenic in-situ hybridization (CISH) study on paraffin block of colon lesions was requested, which demonstrated EBV RNA in tumor cell nuclei and immunoblasts of the adjacent lymph node, suggesting EBV-associated smooth muscle tumor. In addition, PCR for CMV was requested on paraffin block of the colon lesions, which also showed a positive result. PCR for EBV and CMV viremia were negative. The dosage of immunosuppressive agents was reduced, and currently, he is being followed, with slow expansion in the size of the lesions.Conclusion Although the incidence of post-transplant smooth muscle tumors (PTSMTs) is low, it should be remained in the differential diagnosis in post-transplantation patients, especially dealing with multifocal tumors. As strong stimulant for smooth muscle tumors, close follow-up and screening for EBV and CMV infection and early treatment at the time of diagnosis are recommended to avoid these virus-induced tumors.

Juvenile Idiopathic Arthritis With Epstein-Barr Virus-Associated Smooth Muscle Tumor in a 6-Year-Old Girl: A Rare Case Report

Herein, we reported a rare case of Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) combined with juvenile idiopathic arthritis (JIA) in a 6-year old girl without HIV, organ transplantation, or congenital immunodeficiency. The patient suffered from pain in the bilateral hip joints, which drastically affected her physical activity. Consequently, she was diagnosed with JIA (September 2019). She was given methotrexate and methylprednisolone pills via oral route and a subcutaneous injection of Recombinant Human Tumor Necrosis Factor-α Receptor II;lgG Fc Fusion Protein for 4 weeks that successfully relieved the pain. In May 2020, the pain reoccurred and was accompanied by occasional headaches. After extensive pathological examination, the patient was diagnosed with EBV-SMT. The imaging examinations after admission showed multiple lesions in the skull, lungs, and vertebral body. Biopsy of the L2 vertebral body was then performed to clarify the diagnosis. Finally, the in-situ hybridization of the tumor of the lumbar vertebrae suggested a non-HIV/transplantation-related EBV-SMT. Consequently, the patient received surgery without chemotherapy and radiotherapy, after which her conditions improved.

LEIOMYOSARCOMA MIMICKING AN ADRENAL GLAND TUMOR

Leiomyosarcoma is a malignant smooth muscle tumor. It is the second most common primary retroperitoneal tumor behind liposarcoma. The retroperitoneal léiomyosarcoma represents 11% of all retroperitoneal malignant tumors. The age of discovery is between 40 and 60 years.

Stump tumors: clinical, histological and therapeutic aspects a case report

Smooth uterine muscle tumor of uncertain malignant potential (STUMP) belongs to a unique entity that is rare and known by its complexity. Histology is the gold standard for the diagnosis. The aim of the study was to expose the latest researches in the field, about the clinical and radiological aspects to find a way to recognize these tumors way before surgery in order to discuss the best therapeutic strategy, by way of a clinical case report.