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Jin J, Chen Z, Cao Z, Zhou S, Zhang X, Yao H. Epstein-Barr virus-associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature. Head Neck 2022; 44:2886-2903. [PMID: 36069494 PMCID: PMC9826281 DOI: 10.1002/hed.27184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/07/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023] Open
Abstract
We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein-Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.
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Affiliation(s)
- Jian‐Di Jin
- Department of Infection, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zhe Chen
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zai‐Zai Cao
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Shui‐Hong Zhou
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Xiu‐Ming Zhang
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Hong‐Tian Yao
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
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Primary sarcomas of the larynx: A report of three cases and literature review. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211104008u] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Primary sarcomas are uncommonly seen in larynx and comprise
around 1% of all laryngeal malignant tumors. We present three cases of
patients with different types of laryngeal sarcomas and discuss about
diagnostic and treatment difficulties. Case outline. Each patient presented
with hoarseness and shortness of breath. Computed tomography scans showed
large transglottic tumors of the larynx with no signs of cervical
lymphadenopathy and definitive diagnoses of sarcomas were made by
pathologists. Each patient underwent total laryngectomy with clear resection
margins. Patient with laryngeal leiomyosarcoma developed large locoregional
relapse of malignant disease and pulmonary metastasis four months after
surgery and patient with laryngeal osteosarcoma was diagnosed with
inoperative locoregional relapse of malignant disease three months after
surgery. Both patients died within six months after surgery. On the other
hand, patient with laryngeal chondrosarcoma was disease-free during
three-year follow-up. Conclusion. Primary laryngeal sarcomas have low
incidence and they differ from SCC by their biological characteristics and
behavior. Radical surgical resection remains the mainstay of treatment with
uncertain outcome due to their high potential for recurrence or metastatic
spread.
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Whaley RD, Thompson LDR. Epstein-Barr Virus-Associated Smooth Muscle Tumors of Larynx: A Clinicopathologic Study and Comprehensive Literature Review of 12 Cases. Head Neck Pathol 2021; 15:1162-1171. [PMID: 33891274 PMCID: PMC8633162 DOI: 10.1007/s12105-021-01328-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Abstract
Laryngeal mesenchymal neoplasms are rare, with smooth muscle tumors comprising a small subset. Specifically, Epstein-Barr virus (EBV)-associated smooth muscle tumors are exceptionally rare, lacking a comprehensive evaluation of their clinical and histologic features. Two patients (a 59 year old male and 51 year old female) had received renal transplants 156 and 240 months, respectively prior to onset of laryngeal symptoms. Supraglottic polypoid masses were identified and removed conservatively. Histologically, the tumors were hypercellular, showing alternating light and dark areas, the latter composed of primitive appearing round cells, while a more characteristic spindled tumor cell population was noted in the remaining areas. Cytoplasmic vacuoles were noted adjacent to the nucleus. There was no tumor necrosis or pleomorphism, but increased mitotic figures (11-12/2 mm2) were seen, without atypical forms. The tumor cells were strongly immunoreactive with smooth muscle actin and smooth muscle myosin heavy chain and with Epstein-Barr virus encoded RNA (EBER) by in situ hybridization. These patients were reviewed in the context of a thorough English literature review, which demonstrates a wide age range at presentation without a sex predilection, but with most patients from specific ethnic groups (Chinese, Thai, Pilipino). Three-quarters of patients are part of multifocal disease and the majority are post-renal transplantation patients. Conservative management seems to yield the best overall outcome for these indolent tumors. In conclusion, EBV-associated smooth muscle tumors should be considered in any immunocompromised patient with a head and neck smooth muscle tumor, especially when EBER is documented by in situ hybridization. Conservative management may be employed, even when multifocal tumors are documented.
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Affiliation(s)
| | - Lester D. R. Thompson
- Department of Pathology, Southern California Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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Tardieu L, Meatchi T, Meyer L, Grataloup C, Bernard-Tessier A, Karras A, Thervet E, Lazareth H. Epstein-Barr virus-associated smooth muscle tumor in a kidney transplant recipient: A case-report and review of the literature. Transpl Infect Dis 2020; 23:e13456. [PMID: 32881184 DOI: 10.1111/tid.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Epstein-Barr virus (EBV) is a herpesvirus linked to pre-malignant lymphoproliferative diseases and up to nine distinct human tumors. The most frequent EBV-associated malignancies are lymphomas and nasopharyngeal carcinoma. By promoting smooth muscle proliferation, EBV can induce EBV-associated smooth muscle tumors (SMT) which remain a very rare oncological entity. This study reports one case report of SMT and aims to offer the largest review of literature on post-transplantation-SMT (PT-SMT) in kidney transplant recipients, with a focus on therapeutic management and evolution of graft function. METHODS Case reports and case series of PT-SMT in kidney transplant recipients were collected from 1996 to 2019. RESULTS A total of 59 PT-SMT were evaluated. The median time at diagnosis was 74.6 months after kidney transplantation. The most frequent localizations were liver and lung. EBV seroconversion was notified in all six patients with previously negative status. Preferred therapeutic option was surgery (65.9%), associated with a reduction in immunosuppression (77.2%), which includes switch to mTOR inhibitors (29.5%), and discontinuation of MMF (32%). In our review, 13% of patients experienced rejection, 8.7% lost their graft and went back on hemodialysis; 8.8% of patients died of PT-SMT. CONCLUSION PT-SMT is a rare but serious condition in kidney transplant recipients. EBV seroconversion following transplantation appears as a risk factor in developing PT-SMT in solid-organ recipients. In the absence of guidelines, therapeutic management for PT-SMT is challenging and exposes the patient to high risk of graft loss.
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Affiliation(s)
- Laurène Tardieu
- Service de Néphrologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Tchao Meatchi
- Service d'Anatomopathologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lara Meyer
- Service de Néphrologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Grataloup
- Service de Radiologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Alice Bernard-Tessier
- Service d'Anatomopathologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Eric Thervet
- Service de Néphrologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Hélène Lazareth
- Service de Néphrologie, Hôpital Européen Georges Pompidou, APHP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Aida N, Ito T, Maruyama M, Saigo K, Akutsu N, Aoyama H, Kitamura H, Kenmochi T. A Case of Epstein-Barr Virus-Associated Leiomyosarcoma Concurrently With Posttransplant Lymphoproliferative Disorders After Renal Transplantation. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619867330. [PMID: 31391783 PMCID: PMC6669837 DOI: 10.1177/1179547619867330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV) infection might induce not only posttransplantation lymphoproliferative disorder (PTLD) but also leiomyosarcoma. We report a case of EBV-associated leiomyosarcoma concurrently with PTLD after renal transplantation. The patient was a 30-year-old woman who underwent living donor kidney transplantation at 27 years of age. Preoperative EBV viral capsid antibody immunoglobulin M, immunoglobulin G (IgG), and EBV nuclear antigen IgG were negative. Multiple lung and liver tumors were detected 1.5 years after transplantation. She was diagnosed with PTLD after tumor biopsy. Her EBV DNA was 110 copies/mL detected by real-time polymerase chain reaction when PTLD was diagnosed. She received dose reduction of immunosuppressive therapy and several chemotherapies. Because her hepatic lesion was still progressive while pulmonary lesion was reduced, a liver tumor biopsy was performed, but the biopsy specimens were necrotic. A left lateral segmentectomy was performed as a third biopsy for treatment-resistant hepatic lesion 2.5 years after her first PTLD diagnosis. Pathologically, she was diagnosed with EBV-associated leiomyosarcoma. She was treated with sirolimus, but died 7 months after the operation. This is the first case of the coincidence of leiomyosarcoma associated with EBV and PTLD. This case was exceedingly rare; however, we must consider the coincidence of leiomyosarcoma associated with EBV and PTLD when encountering treatment-resistant PTLD.
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Affiliation(s)
- Naohiro Aida
- Department of Transplantation and Regenerative Medicine, Graduate School of Medicine, Fujita Health University, Toyoake, Japan
- Naohiro Aida, Department of Transplantation and Regenerative Medicine, Graduate School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake 470-1192, Aichi, Japan.
| | - Taihei Ito
- Department of Transplantation and Regenerative Medicine, Graduate School of Medicine, Fujita Health University, Toyoake, Japan
| | - Michihiro Maruyama
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Saigo
- Department of Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Naotake Akutsu
- Department of Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Hiromichi Aoyama
- Department of Surgery, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Hiroshi Kitamura
- Department of Pathology, National Hospital Organization Chiba-East Hospital, Chiba, Japan
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, Graduate School of Medicine, Fujita Health University, Toyoake, Japan
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Stubbins RJ, Alami Laroussi N, Peters AC, Urschel S, Dicke F, Lai RL, Zhu J, Mabilangan C, Preiksaitis JK. Epstein-Barr virus associated smooth muscle tumors in solid organ transplant recipients: Incidence over 31 years at a single institution and review of the literature. Transpl Infect Dis 2018; 21:e13010. [PMID: 30298678 DOI: 10.1111/tid.13010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Epstein-Barr virus (EBV) associated smooth muscle tumors (EBV-SMT) are a rare complication of solid organ transplantation (SOT). Incidence data related to this EBV-SMT are limited. EBV DNA is universally present in these tumors. How these cells get infected with EBV, whether this is a result of primary EBV infection vs reactivation, and how persistent active EBV infection post-transplant influences EBV-SMT pathogenesis remains unknown. METHODS Among 5006 SOT recipients (474 pediatric, 4532 adult) receiving SOT at our center between Jan 1984 and Dec 2015, three cases of post-transplant EBV-SMT were identified. RESULTS All cases were pediatric heart transplants who were EBV seronegative prior to transplant, and experienced primary EBV infection with persistently elevated EBV viral loads, despite antiviral therapy. Two are deceased at 3.2 and 0.9 years post-diagnosis, while one remains alive 6.2 years post diagnosis. The overall local incidence of post-transplant EBV-SMT at our institution was 0.7 (95% CI, 0.2-1.7) per 1000 patient years, and 2.6 (95% CI, 0.6-6.7) per 1000 patient years in pediatric heart transplants. A literature review identified 36 pediatric and 51 adult cases of post-transplant EBV-SMT. CONCLUSIONS We hypothesize that pre-transplant EBV seronegativity, followed by primary EBV infection and persistently high EBV viral loads, represents a unique risk factor for post-transplant EBV-SMT. Pediatric heart transplant recipients were found to be disproportionately affected by post-transplant EBV-SMT at our institution.
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Affiliation(s)
- Ryan J Stubbins
- Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nassiba Alami Laroussi
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Anthea C Peters
- Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Urschel
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Frank Dicke
- Section of Cardiology, Department of Pediatrics, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Raymond L Lai
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - James Zhu
- Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Curtis Mabilangan
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jutta K Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Laryngeal Epstein-Barr Virus-Associated Smooth Muscle Tumor in an Undernourished Child. Head Neck Pathol 2018; 13:722-726. [PMID: 30120720 PMCID: PMC6854134 DOI: 10.1007/s12105-018-0960-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/16/2018] [Indexed: 12/30/2022]
Abstract
Smooth muscle tumors associated with Epstein-Barr virus infections (EBV-SMT) of laryngeal origin are exceedingly rare and have been reported in few adult patients, but not in children. This reported case describes a lesion found in the larynx of an 8-year-old Guatemalan undernourished girl. Microscopically, the lesion showed a highly cellular mesenchymal spindle cell tumor, containing frequent lymphocytes. The immunohistochemical analysis revealed positivity for α-smooth muscle actin and h-caldesmon. In addition, most of the tumor cells were positive for EBV by in situ hybridization. To the best of the author's knowledge, this is the first literature-reported case of laryngeal EBV-SMT occurring in an undernourished child.
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Selçuk ÖT, Renda L, Erol B, Osma Ü, Eyigor H, Öztürk H. A case of laryngeal leiomyosarcoma and review of the literature. Ann Maxillofac Surg 2016; 5:274-6. [PMID: 26981488 PMCID: PMC4772578 DOI: 10.4103/2231-0746.175772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Leiomyosarcoma (LMS) of the larynx is a very rare malignancy that originates from blood vessel, smooth muscle or from the heterotopic mesenchymal tissue in the larynx. The histological diagnosis of LMS depends on the immunohistochemical investigation. The case is here presented of an 82-year-old man with shortness of breath and hoarseness. Indirect laryngoscopy showed a pedunculated large glottic lesion causing airway obstruction. Direct laryngoscopy was performed and biopsies were taken. From the pathological examination, the diagnosis of LMS was made. This case is presented of laryngeal LMS with the clinical, radiological, and histological findings.
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Affiliation(s)
- Ömer Tarik Selçuk
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Levent Renda
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Bekir Erol
- Department of Radiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Üstün Osma
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hülya Eyigor
- Department of Ear, Nose, Throat, Head and Neck Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Hülya Öztürk
- Department of Patology, Antalya Training and Research Hospital, Antalya, Turkey
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Petersson F. Epstein-Barr virus–associated smooth muscle tumor—report of 3 tumors including 1 intracerebral case with a prominent intratumoral B-lymphocytic component and plasma cells. Ann Diagn Pathol 2013; 17:91-8. [DOI: 10.1016/j.anndiagpath.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/01/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
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Sarcomas other than Kaposi sarcoma occurring in immunodeficiency: interpretations from a systematic literature review. Curr Opin Oncol 2012; 24:537-46. [PMID: 22729152 DOI: 10.1097/cco.0b013e328355e115] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW In immunodeficiency, an increased sarcoma risk is confirmed for Kaposi's sarcoma. Whether rates of other sarcoma subtypes are elevated in the setting of immunodeficiency is not known. We therefore reviewed published case reports on HIV and AIDS patients and organ transplant recipients with sarcomas. For comparison, we assessed sarcomas in the U.S. general population using Surveillance Epidemiology End Results (SEER) data. RECENT FINDINGS A total of 176 non-Kaposi sarcoma were identified, 75 in people with HIV and AIDS and 101 in transplant recipients. Leiomyosarcomas (n = 101) were the most frequently reported sarcomas, followed by angiosarcomas (n = 23) and fibrohistiocytic tumors (n = 17). Leiomyosarcomas were reported with two age peaks, in children and young adults. Epstein-Barr virus (EBV) was detected in the tumor cells in 85 and 88% of leiomyosarcomas in HIV-infected people and transplant recipients, respectively. Angiosarcomas and fibrohistiocytic tumors were most frequently reported in men. Among kidney transplant recipients, 20% of sarcomas arose at the site of an arteriovenous fistula. In comparison, leiomyoscarcomas, angiosarcomas, and fibrohistiocytic tumors comprised 16.9, 3.8, and 18.7% of sarcomas in the U.S. general population. SUMMARY Leiomyosarcoma and angiosarcoma may occur disproportionately in immunodeficiency. Leiomyosarcomas appear causatively linked to EBV, whereas angiosarcomas might be correlated with an arteriovenous fistula. Additional studies are necessary to understand the contribution of immunodeficiency to the cause of these sarcomas.
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Jonigk D, Laenger F, Maegel L, Izykowski N, Rische J, Tiede C, Klein C, Maecker-Kolhoff B, Kreipe H, Hussein K. Molecular and clinicopathological analysis of Epstein-Barr virus-associated posttransplant smooth muscle tumors. Am J Transplant 2012; 12:1908-17. [PMID: 22420456 DOI: 10.1111/j.1600-6143.2012.04011.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Epstein-Barr virus (EBV)-associated posttransplant smooth muscle tumors (PTSMT) are very rare complications. We aimed to provide a clinicopathological characterization which is based on our own case series (n = 5) as well as previously reported PTSMT cases (n = 63). Meta-analysis of PTSMT and molecular analysis of tumor cells from our cohort was performed. Most PTSMT developed in kidney-transplanted patients (n = 41/68, 60%). Liver/transplant liver was the main site of manifestation (n = 38/68, 56%). Tumors occurred after a median interval of 48 months (range 5-348) and developed earlier in children than in adults. Most tumors showed no marked cellular atypia, low mitosis rate and no tumor necrosis. Gene expression analysis of 20 EBV-related genes, including two microRNAs, revealed overexpression of MYC (p = 0.0357). Therapy was mainly based on surgical resection or reduced immunosuppression but no significant differences in overall survival were evident. Lower overall survival was associated with multiorgan involvement (n = 33/68, 48.5%) and particularly with intracranial PTSMT manifestation (n = 7/68, 10%; p < 0.02), but not transplant involvement (n = 11/68, 16%). In summary, PTSMT differ from conventional leiomyosarcomas by their lack of marked atypia, unusual sites of involvement and defining EBV association. Surgery and reduced immunosuppression show comparable clinical results and prognosis is associated with intracranial manifestation.
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Affiliation(s)
- D Jonigk
- Institute of Pathology, Hannover Medical School (MHH), Hanover, Germany.
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Petrilli G, Lorenzi L, Paracchini R, Ubiali A, Schumacher RF, Cabassa P, Facchetti F. Epstein-Barr virus-associated adrenal smooth muscle tumors and disseminated diffuse large B-cell lymphoma in a child with common variable immunodeficiency: a case report and review of the literature. Int J Surg Pathol 2011; 22:712-21. [PMID: 21454372 DOI: 10.1177/1066896911399901] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article reports the clinical and the histological features in a 7-year-old girl affected by common variable immunodeficiency (CVID) who developed multiple Epstein-Barr virus-associated tumors, represented by bilateral adrenal smooth muscle tumors (EBV-SMT) and multifocal diffuse large B-cell lymphoma. The EBV-SMTs showed features compatible with a benign or at least a low-malignant potential neoplasm. A peculiar feature observed in both EBV-SMTs was the occurrence of numerous lymphocytes intermingled with the spindle cells, which consisted of CD3+ CD5+ T-cells, with a predominant cytotoxic CD8+ component. Interestingly, EBV status differed in the neoplasms, since the EBV-SMTs were negative for LMP1 and positive for EBER, whereas the B-cell lymphoma expressed both EBV markers. Furthermore, EBV-LMP1 deletion was positive only in the EBV-SMTs, thus indicating that these tumors were the consequence of 2 distinct, EBV-dependent transformations. Similarly, lymphocyte clonality assay also showed different clonal bands in different sites (skin and nasal cavity), suggesting the development of intratumoral mutations. Finally, the authors review all 127 previously reported EBV-SMT, with discussion of their clinical and pathological features.
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