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Szklarz MT, Tessi C, Ruiz J, Rosiere NI, Lopez Imizcoz F, Weller S, Solernou VE, Monteverde ML, Corbetta JP. "Epstein-Barr virus associated smooth muscle tumour as an unusual cause of ureteric graft obstruction in a child". Pediatr Transplant 2021; 25:e14109. [PMID: 34363296 DOI: 10.1111/petr.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/12/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epstein-Barr virus (EBV) is a DNA virus with oncogenic potential, especially in immunocompromised patients. EBV can promote smooth muscle proliferation, resulting in EBV-associated smooth muscle tumors (EBV-SMT). METHODS We report a case of a 10-year-old child with end-stage renal disease secondary to hypoplastic crossed and fused kidneys who underwent kidney transplantation. EBV serology was unknown for the donor and negative for the recipient; three months after he had a primary EBV infection. Two years after the transplantation, percutaneous nephrostomy was performed because of a drop in the estimated glomerular filtration rate and severe dilatation of the graft. Nephrography showed contrast enhancement of the pelvis of the graft kidney and proximal ureter, with a clear blockage at the level of the mid ureter and no passage towards the bladder. A 1.5-cm tumor was found causing intraluminal compression of the mid ureter. RESULTS Complete resection of the tumor and distal ureter was performed leaving a short proximal ureter. A tension-free uretero-ureteroanastomoses was achieved using the native ureter. There were no surgical complications. Histologic evaluation showed spindle-shaped muscle cells, moderate pleomorphism, and inflammatory infiltration. Immunohistochemical staining was positive for muscle-specific actin. Epstein-Barr encoding region (EBER) in situ hybridization was positive, confirming the diagnosis of EBV-associated SMT. CONCLUSIONS EBV-SMT is an exceedingly rare oncological entity that may develop in either the graft or any other organ. The clinical findings are location related. EBV seroconversion following transplantation might be a risk factor for the development of SMT in solid organ recipients.
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Affiliation(s)
- María Tatiana Szklarz
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Catalina Tessi
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Javier Ruiz
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Nicolas Ignacio Rosiere
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Felicitas Lopez Imizcoz
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Santiago Weller
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | | | - Marta Lidia Monteverde
- Nephrology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Juan Pablo Corbetta
- Pediatric Urology Department. Hospital de Pediatria Pr, Dr Juan P Garrahan, Buenos Aires, Argentina
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2
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Lecoq N, Godefroid N, Berardis S, Froidure A, Poncelet A, Goubau C. Epstein-Barr Virus-associated Pulmonary Tumor: A Pediatric Case and Discussion of the Literature. J Pediatr Hematol Oncol 2021; 43:e957-e961. [PMID: 34133382 DOI: 10.1097/mph.0000000000002228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/30/2021] [Indexed: 11/26/2022]
Abstract
Epstein-Barr virus-associated smooth pulmonary tumor is a rare condition that mostly affects immunosuppressed patients. This case describes a young boy with a history of kidney transplantation who presented recurrent pneumonia. Multiple endobronchial soft tissue tumors affecting both right and left bronchial tree were found and partially removed by bronchoscopy. Immunohistologic analysis demonstrated Epstein-Barr virus-associated smooth pulmonary tumor. Immunosuppressive therapy was changed from tacrolimus to sirolimus. A few months later, new right upper lobe and inferior left lobe tumors were found. Recurrent left lower lobe pneumonia prompted lobectomy. In the present case, complete resection and change of immunosuppressive treatment were effective.
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Affiliation(s)
| | | | | | - Antoine Froidure
- Department of Pulmonology and Respiratory Medicine, Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Alain Poncelet
- Cardio-vascular and Thoracic Surgery, Cliniques Universitaires Saint Luc, Bruxelles
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3
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Penney SW, Bishop BN, Howell DL. Treatment response with sirolimus for a pediatric patient with an EBV-associated smooth-muscle tumor after bone marrow transplantation. Pediatr Blood Cancer 2019; 66:e27585. [PMID: 30614215 DOI: 10.1002/pbc.27585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 11/08/2022]
Abstract
Epstein-Barr virus-associated smooth-muscle tumors (EBV-SMTs) are unique and rare neoplasms described in immunocompromised patients. The case describes a nine-year-old female with a history of acute lymphoblastic leukemia with relapse and subsequent allogeneic bone marrow transplantation who presented with multiple EBV-SMTs of the liver. EBV utilizes the mammalian target of rapamycin (mTOR) pathway for tumor growth, and sirolimus, a mTOR inhibitor, has shown to result in a short-term response. We now report an extended treatment response with sirolimus in a pediatric patient with an EBV-SMT.
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Affiliation(s)
- Scott W Penney
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
| | - Bradie N Bishop
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
| | - Della L Howell
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
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4
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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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5
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Liu Y, Chintalapati S, Dietz R, Raza AS, Wang J, Raza AS. EBV-associated hepatic smooth muscle tumor of uncertain biologic behavior after heart transplantation in a pediatric patient: case report. J Gastrointest Oncol 2017; 8:E21-E25. [PMID: 28280632 DOI: 10.21037/jgo.2016.12.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare neoplasm recognized in immunocompromised patients. There are less than 30 cases of EBV-SMT reported in pediatric population following solid organ transplantation. Herein, we report a case of an 8-year-old female who was incidentally noted to have multiple lesions in the liver 8 years after heart transplantation. The tumor was composed of a cellular proliferation of spindle-shaped cells with low mitotic activity. The diagnosis of EBV-SMT was confirmed by in situ hybridization for EBV-encoded small RNA (EBER) transcripts. Multiple additional lesions were detected by whole body positron emission tomography-computed tomography (PET-CT) scan 4 months after the initial finding of the hepatic lesions. Immunosuppression was switched to a mechanistic target of rapamycin (mTOR) inhibitor. We conclude that EBV-SMT should be included in the differential diagnoses in post-transplantation patients and further investigations should be performed to evaluate additional lesions.
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Affiliation(s)
- Yan Liu
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Suneetha Chintalapati
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Robin Dietz
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Adnan S Raza
- Department of Internal Medicine, Methodist Hospital, Brooklyn, NY, USA
| | - Jun Wang
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Anwar Sultana Raza
- Department of Pathology and Human Anatomy, Loma Linda University Medical Center, Loma Linda, CA, USA
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6
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Arva NC, Schafernak KT. Rare Presentations of Epstein-Barr Virus--Associated Smooth Muscle Tumor in Children. Pediatr Dev Pathol 2016; 19:132-8. [PMID: 26230054 DOI: 10.2350/15-05-1627-cr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epstein-Barr virus (EBV) has oncogenic potential and has been implicated in the etiology of a wide range of malignancies. Certain EBV-driven neoplasms, such as smooth muscle tumors (SMTs), manifest typically in immunocompromised patients. In children, these neoplasms have been encountered in the setting of primary immune disorders, specifically severe combined and common variable immunodeficiency syndromes. Human immunodeficiency virus infection and posttransplant immunosuppression, in particular liver and kidney transplantation, likewise increase the risk in the pediatric population. The location of these neoplasms appears related to the type of immunodeficiency: in acquired immunodeficiency syndrome they are frequently located intracranially or intraspinally, whereas after transplant they usually involve the liver or lung. We report 2 distinct cases of EBV-related SMT, unique through their coassociated immunosuppressive state or location: the 1st occurred in a patient with immunodeficiency secondary to NEMO gene mutation following hematopoietic stem cell transplantation; the 2nd developed in the orbit after heart transplant.
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Affiliation(s)
- Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Kristian T Schafernak
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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7
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Jossen J, Chu J, Hotchkiss H, Wistinghausen B, Iyer K, Magid M, Kamath A, Roayaie S, Arnon R. Epstein-Barr virus-associated smooth muscle tumors in children following solid organ transplantation: a review. Pediatr Transplant 2015; 19:235-43. [PMID: 25572657 DOI: 10.1111/petr.12426] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2014] [Indexed: 12/12/2022]
Abstract
EBV-SMT are a rare entity following organ transplantation. Given the rarity of the tumor, there is no standard approach to diagnosis and treatment. A literature search identified 28 reported cases of EBV-SMT in addition to our own experience with one case. The aim of this review is to summarize the existing data regarding pathogenesis, diagnosis, and treatment.
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Affiliation(s)
- Jacqueline Jossen
- Pediatrics & Recanati-Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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8
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Conrad A, Brunet AS, Hervieu V, Chauvet C, Buron F, Collardeau-Frachon S, Rivet C, Cassier P, Testelin S, Lachaux A, Morelon E, Thaunat O. Epstein-Barr virus-associated smooth muscle tumors in a composite tissue allograft and a pediatric liver transplant recipient. Transpl Infect Dis 2013; 15:E182-6. [PMID: 24034213 DOI: 10.1111/tid.12126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/03/2013] [Accepted: 04/21/2013] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV) is known to establish latent infections in B-lymphocytes that can cause lymphoproliferative disorders particularly in immunocompromised patients. More recently, the development of rare EBV-associated smooth muscle tumors has been reported in transplant recipients. We herein describe 2 new cases of EBV-associated post-transplant smooth muscle tumors (EBV-PTSMT), including the first in a facial composite tissue graft recipient. Among the striking features shared by these 2 patients were their young ages, the fact that they were naïve for EBV before the transplantation, that they developed a post-transplant lymphoproliferative disorder before the diagnosis of EBV-PTSMT, and that they responded favorably to reduction of immunosuppression. Radiological and histologic features of EBV-PTSMT are shown. Finally, pathophysiology and therapeutic management of EBV-PTSMT are discussed based on a comprehensive review of the literature.
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Affiliation(s)
- A Conrad
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
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9
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Elawabdeh N, Cone BM, Abramowsky CR, Wrubel DM, Grossniklaus H, Walrath J, Bashir MZ, Shehata BM. Epstein-Barr virus associated smooth muscle tumors in post transplant pediatric patients two cases of rare locations, and review of the literature. Fetal Pediatr Pathol 2013; 32:184-91. [PMID: 23445451 DOI: 10.3109/15513815.2012.701265] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Epstein-Barr virus (EBV) may present few or no symptoms in immunocompetent individuals; however, in immunocompromised patients as in the case of AIDS and post-transplant patients, the virus occasionally stimulates neoplastic transformations. Epstein-Barr virus may play a role in the development of smooth muscle tumors (SMT). In the case of Epstein-Barr associated smooth muscle tumors (EBV+SMT), the virus is thought to be the leading factor to the tumorigenic pathway. We report two pediatric patients (6 and 13 years old) who underwent liver transplantation and developed EBV+SMT in the colon and orbit. These two cases represent rare locations for this kind of lesion.
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Affiliation(s)
- Nancy Elawabdeh
- Children's Healthcare of Atlanta, Pathology Laboratory, Atlanta, Georgia 30322, USA
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10
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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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12
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Suzuki K, Urushihara N, Fukumoto K, Watanabe K, Wada N, Takaba E. A case of Epstein-Barr virus-associated pulmonary leiomyosarcoma arising five yr after a pediatric renal transplant. Pediatr Transplant 2011; 15:E145-8. [PMID: 20456653 DOI: 10.1111/j.1399-3046.2010.01329.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
EBV-associated SMTs in immuno-compromised patients have recently been reported. We report on a case of EBV-associated pulmonary leiomyosarcoma arising five yr after renal transplantation. The patient was an eight-yr-old girl, who received a living related kidney transplant from her mother. She had had bilateral giant Wilm's tumors as an infant and underwent bilateral nephrectomy at one and two yr of age. At the age of seven, she suffered from bronchitis several times, and a year later, two nodules were detected in her left lung by X-ray and computed tomography. We suspected a recurrence of Wilm's tumor and performed surgical resection. The pathological finding was SMT with moderate mitosis and no evidence of Wilm's tumor. The fact that the tumors were positive for EBER suggested an association with the EBV. Six months later, there was a recurrence in her left lung. Surgical resection was performed, and immunosuppressive agents were reduced. Two yr after the second operation, she is well with no recurrence. We report the first case of EBV-associated pulmonary leiomyosarcoma in a pediatric patient after renal transplantation owing to a malignant tumor.
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Affiliation(s)
- Komei Suzuki
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
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13
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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: 14] [Impact Index Per Article: 1.1] [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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14
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Al Hussain T, Haleem A, Alsaad KO. Synchronous hepatic, mesenteric and pulmonary Epstein-Barr virus-associated smooth muscle tumors in a renal transplant recipient. Clin Transplant 2011; 24:579-84. [PMID: 20156224 DOI: 10.1111/j.1399-0012.2009.01206.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are distinct lesions that occur in immunocompromised patients. EBV-SMT following solid organ transplantation are rare and generally have an indolent biological behavior. Post-transplant EBV-SMT have been reported in various anatomical locations. This report describes a synchronous and multicentric development of EBV-SMT in liver, mesentery, and lung of a 33-yr-old male patient, 10 yr after a deceased allograft renal transplantation. The hepatic and mesenteric tumors were available for study. These tumors were composed of bland looking, desmin-positive, spindle-shaped cells which showed a strong nuclear staining for EBV with in situ hybridization technique. A literature review of post solid organ transplant EBV-SMT in the liver and lung, particularly regarding their pathogenesis, synchronicity and biological behavior would be provided.
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Affiliation(s)
- T Al Hussain
- Department of Pathology, Riyadh Military Hospital Department of Pathology and Laboratory Medicine, King Abdulaziz Medical City, and King Abdullah International Research Center, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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15
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Jung S, Lim J, Cho BS, Chae H, Kim M, Kim Y, Han K, Lee JW, Min WS. Significance of Epstein-Barr Virus DNA Quantitation in Donors of Hematopoietic Stem Cell Transplantation. Ann Lab Med 2010; 30:554-8. [DOI: 10.3343/kjlm.2010.30.6.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Seungwon Jung
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Byung Sik Cho
- Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Hyojin Chae
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Yonggoo Kim
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Kyungja Han
- Department of Laboratory Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Jong Wook Lee
- Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Woo Sung Min
- Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, The Catholic University of Korea School of Medicine, Seoul, Korea
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Rougemont AL, Alfieri C, Fabre M, Gorska-Flipot I, Papp E, Champagne J, Phan V, Fournet JC, Sartelet H. Atypical Epstein-Barr virus (EBV) latent protein expression in EBV-associated smooth muscle tumours occurring in paediatric transplant recipients. Histopathology 2009; 53:363-7. [PMID: 18631193 DOI: 10.1111/j.1365-2559.2008.03086.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Neuroimaging of Epstein-Barr virus infections in children. Pediatr Radiol 2008; 38:354-5. [PMID: 18231787 DOI: 10.1007/s00247-007-0744-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Accepted: 12/27/2007] [Indexed: 10/22/2022]
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Atluri S, Neville K, Davis M, Robertson KA, Marshalleck FE, O'Malley DP, Buckley RH, Nelson RP. Epstein-Barr-associated leiomyomatosis and T-cell chimerism after haploidentical bone marrow transplantation for severe combined immunodeficiency disease. J Pediatr Hematol Oncol 2007; 29:166-72. [PMID: 17356396 DOI: 10.1097/mph.0b013e31803b95b3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The clinical course of Epstein-Barr virus (EBV)-associated smooth muscle tumors is variable and there are no reports in patients with mixed T-cell chimerism after bone marrow transplantation (BMT). OBSERVATIONS A child with X-linked severe combined immunodeficiency disease developed multiple renal and pulmonary leiomyomata 8 years after haploidentical BMT. Epstein-Barr viral DNA was detectable in the blood and in situ hybridization for EBV-encoded RNAs was positive in the tumor. The tumors have been radiographically stable, chimerism remains mixed, and plasma EBV DNA has been repeatedly negative for over 2 years after donor lymphocyte infusion. CONCLUSIONS EBV-associated smooth muscle tumors may occur in patients who are partially reconstituted after BMT for severe combined immunodeficiency and may not require surgery or chemotherapy.
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Affiliation(s)
- Srilatha Atluri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Bonatti H, Hoefer D, Rogatsch H, Margreiter R, Larcher C, Antretter H. Successful Management of Recurrent Epstein-Barr Virus-Associated Multilocular Leiomyosarcoma After Cardiac Transplantation. Transplant Proc 2005; 37:1839-44. [PMID: 15919482 DOI: 10.1016/j.transproceed.2005.03.142] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND In contrast to Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disorders (PTLD), EBV-associated leiomyomatous tumors have thus far only rarely been described. CASE REPORT Two years after heart transplantation with ATG induction, cyclosporine (CsA; trough levels of 250 ng/mL)-based triple drug immunosuppression), a 23-year-old patient developed a small round lesion within the left lateral liver segment. The patient underwent ultrasound-guided biopsy followed by liver resection. Histological and immunohistological examination showed a leiomyosarcoma. In situ hybridization using EBV-specific EB endoplasmic reticulum-RNA showed an intensive signal in almost all tumor cells. The tumor stained for EB nuclear antigen (EBNA)-2-protein. Immunosuppression was drastically reduced, namely, CsA levels <100 ng/dL, prednisolone 5 mg, azathioprine withdrawn, and antiviral chemotherapy initiated with 10 days of IV gancyclovir and acyclovir followed by oral famcyclovir. During the follow-up, anti-EBV-IgM, anti-early antigen antibodies, and anti-EBNA antibodies were continuously monitored excluding significant EBV replication. Eighteen months post-liver resection, and high-resolution computed tomography scan demonstrated two paravertebral tumors. These lesions and a small nodule at the left ankle were resected revealing identical leiomyosarcomata. Immunosuppression was further reduced (CsA levels 75 ng/dL) and famcyclovir maintenance therapy started. Nevertheless, 2 years later the patient again developed tumor recurrence (perirectal, liver, and right adrenal gland); the tumors were surgically removed. The therapy was switched to Rapamycin and famcyclovir was continued. Three years after the last surgical intervention, the patient is well and recurrence-free. CONCLUSION Long-term survival in patients with posttransplant EBV-associated leiomyosarcoma can be achieved by combined surgical intervention, reduction of immunosuppression, switch to Sirolimus, and antiviral chemotherapy.
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Affiliation(s)
- H Bonatti
- Department of General and Transplant Surgery, University Hospital, Innsbruck, Austria.
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Boudjemaa S, Boman F, Guigonis V, Boccon-Gibod L. Brain involvement in multicentric Epstein-Barr virus-associated smooth muscle tumours in a child after kidney transplantation. Virchows Arch 2004; 444:387-91. [PMID: 15143769 DOI: 10.1007/s00428-004-0975-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV)-associated smooth muscle tumours (SMT) have been reported in young patients with induced immunosuppression associated with organ transplantation, acquired immunodeficiency syndrome or congenital immunodeficiencies. EBV-associated SMT are frequently multicentric or multifocal and often occur in unusual locations. We are reporting a case of EBV-associated multicentric SMT that occurred after kidney transplantation in a 2-year-old boy with a history of oligomeganephrony. Headaches and left VIth cranial nerve paralysis led to the discovery of a brain tumour 3 years after transplantation. There were multiple pulmonary, hepatic and splenic nodules and enlarged mesenteric lymph nodes. Histological examination revealed multicentric SMT of uncertain malignant potential. Further investigations using in situ hybridisation demonstrated EBV early RNAs in the nucleus of most tumour cells. The immunosuppressive therapy was reduced, and the child was treated with chemotherapy, but died 2 months later, due to neurological complications.
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Affiliation(s)
- Sabah Boudjemaa
- Department of Pathology, University School of Meidcine of Paris VI, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, France
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Monforte-Muñoz H, Kapoor N, Saavedra JA. Epstein-Barr virus-associated leiomyomatosis and posttransplant lymphoproliferative disorder in a child with severe combined immunodeficiency: case report and review of the literature. Pediatr Dev Pathol 2003; 6:449-57. [PMID: 14708738 DOI: 10.1007/s10024-003-8096-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The occurrence of smooth muscle neoplasms and lymphoproliferative disorders in immunocompromised patients is well recognized. We report the case of an 8-year-old girl with adenosine deaminase (ADA)-deficient severe combined immunodeficiency (SCID) status post-bone marrow transplant (BMT), in whom Epstein-Barr virus (EBV) was detected in innumerable leiomyomas involving the gallbladder (leiomyomatosis), and multifocal leiomyomas in liver, spleen, pancreas, intestinal tract, and lung. The leiomyomas of the gallbladder, liver, spleen, and lung were asymptomatic, while those located in the colon became clinically manifest by recurrent lower intestinal hemorrhage. The patient also developed extensive EBV-associated polymorphic lymphoproliferative disorder (PTLD) in nodal and extranodal sites. In addition, there were pulmonary and gastric adenovirus and small and large intestine cryptosporidum infections. Our case appears to be the first example of leiomyomatosis of the gallbladder coexisting with multifocal leiomyomas of the liver, spleen, pancreas, intestinal tract, and lung, as well as EBV-derived lymphoproliferative disorder in a young girl with ADA-deficient SCID. Awareness of the pattern of involvement and of the coexistence of benign leiomyomatous proliferations with lymphoproliferative disorder is of value when gallbladder, pancreatic, biliary tree, lung, and intestinal lesions become clinically manifest in these patients. The demonstration of EBV infection in both leiomyomata and the PTLD suggests a common pathogenesis that may have therapeutic and prognostic implications.
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Affiliation(s)
- Hector Monforte-Muñoz
- Department of Pathology-CHLA Box 43, Division of Anatomic Pathology, Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
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