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Zheng Q, Wang C, Zhang Y, Xu H, Yuan F, Yi H. EBV-Associated Smooth Muscle Tumors With Autoimmune Hemolytic Anemia and Hepatitis B Infection: Report of a Previously Undescribed Neoplasm With Review. Int J Surg Pathol 2024; 32:1197-1203. [PMID: 38166493 DOI: 10.1177/10668969231217631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is rare in adults. The presence of intratumoral T lymphocytes and primitive rounded cells characterized this neoplasm. We report a 24-year-old Chinese man who developed EBV-SMT in the right adrenal gland with hepatitis B infection and autoimmune hemolytic anemia without a history of HIV infection, primary immune deficiency, organ transplantation, or malignant tumor. This patient had an unknown immunodeficient state. EBV-SMTs are commonly located in the liver, lung, and gastrointestinal tract but rarely in the adrenal gland. We reviewed 10 reported literature on EBV-SMT in the adrenal gland. It is imperative to distinguish EBV-SMT from conventional somatic smooth muscle tumors. The discovery of EBV-SMT forces the clinician to conduct a thorough evaluation of immune function and immune status surveillance, and these patients are vulnerable to subsequent malignant tumors.
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MESH Headings
- Humans
- Male
- Smooth Muscle Tumor/pathology
- Smooth Muscle Tumor/diagnosis
- Smooth Muscle Tumor/virology
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/pathology
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/virology
- Young Adult
- Epstein-Barr Virus Infections/complications
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/pathology
- Hepatitis B/complications
- Hepatitis B/diagnosis
- Hepatitis B/virology
- Herpesvirus 4, Human/isolation & purification
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Affiliation(s)
- Qiaoli Zheng
- Department of Pathology, Zhu Hai People's Hospital, Zhuhai Hospital affiliated with Jinan University, Zhuhai, China
| | - Chaofu Wang
- Department of Pathology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yuxiu Zhang
- Department of Pathology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Haimin Xu
- Department of Pathology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Fei Yuan
- Department of Pathology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Hongmei Yi
- Department of Pathology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
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A Rare Case of a Primary Leiomyoma of the Clivus in an Immunocompetent Patient and a Review of the Literature Regarding Clival Lesions. Diagnostics (Basel) 2022; 13:diagnostics13010009. [PMID: 36611301 PMCID: PMC9818954 DOI: 10.3390/diagnostics13010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Leiomyomas are common lesions that are usually located in the genitourinary and gastrointestinal tracts. Primary leiomyomas at the skull base are uncommon. They are composed of well-differentiated smooth muscle cells without cellular atypia. The diagnosis of a leiomyoma has to be confirmed by immunohistochemistry. The tumor tissue is immunoreactive for SMA, S100 and cytokeratin. Leiomyomas mainly occur in immunocompromised patients. Most tumor tissues are positive for EBV. The presented case is that of a 56-year-old immunocompetent woman with a tumor on the clivus. The radiological images suggested chordoma or fibrous dysplasia. Transnasal transsphenoidal surgery was performed. The tumor tissue consisted of well-differentiated smooth muscle cells with elongated nuclei. Immunohistochemistry revealed a positive reaction for desmin, SMA and h-Caldesmon and a negative reaction for S100, beta-catenin, PGR and Ki67. The leiomyoma diagnosis was subsequently established. To the best of our knowledge, the case of a primary leiomyoma on the clivus of an immunocompetent patient is the first to be described. We also extensively reviewed the literature on the immunohistopathological and radiological differential diagnosis of clival lesions.
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Schutte T, Stege CAM, Smits MM, Franssen LE, Donker ML, de Leeuw DC. Midostaurin as the Most Likely Cause of Bilateral Adrenal Masses in a Patient with Acute Myeloid Leukemia. Clin Drug Investig 2022; 42:791-797. [PMID: 35948754 PMCID: PMC9364849 DOI: 10.1007/s40261-022-01186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Tim Schutte
- Department of Medical Oncology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - Claudia A M Stege
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Mark M Smits
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Laurens E Franssen
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marjolein L Donker
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - David C de Leeuw
- Department of Hematology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
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师 琴, 汤 文, 贺 湘, 田 鑫. [Epstein-Barr virus-associated smooth muscle tumor in a girl]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:739-742. [PMID: 34266534 PMCID: PMC8292655 DOI: 10.7499/j.issn.1008-8830.2103152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
A girl, aged 7 years, was admitted due to pain in both lower limbs for more than one year. Lumbar MRI showed soft tissue masses in the paravertebral region. Cerebral MRI showed nodular masses in the cavernous sinus at both sides. Chest CT showed high-density nodules in the outer basal segment of the right inferior lobe and the anterior segment of the left upper lobe of the lung. Biopsy of lumbar lesions showed Epstein-Barr (EB) virus-related smooth muscle tumor. Genetic testing showed a de novo mutation, c.725_730delAGAGTA (p.K242_S243del), in the ITK gene. The masses in the lumbar vertebra were removed by surgery, and then the pain in both lower limbs disappeared. This article reports a case of EB virus-related smooth muscle tumor with a deletion mutation in the ITK gene, which provides experience for the diagnosis and treatment of this disease.
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Affiliation(s)
- 琴 师
- />湖南省人民医院/湖南师范大学附属第一医院儿童医学中心血液肿瘤科, 湖南长沙 410005Department of Hematology and Oncology, Children's Medical Center, Hunan Provincial People's Hospital/First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - 文芳 汤
- />湖南省人民医院/湖南师范大学附属第一医院儿童医学中心血液肿瘤科, 湖南长沙 410005Department of Hematology and Oncology, Children's Medical Center, Hunan Provincial People's Hospital/First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - 湘玲 贺
- />湖南省人民医院/湖南师范大学附属第一医院儿童医学中心血液肿瘤科, 湖南长沙 410005Department of Hematology and Oncology, Children's Medical Center, Hunan Provincial People's Hospital/First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
| | - 鑫 田
- />湖南省人民医院/湖南师范大学附属第一医院儿童医学中心血液肿瘤科, 湖南长沙 410005Department of Hematology and Oncology, Children's Medical Center, Hunan Provincial People's Hospital/First Affiliated Hospital of Hunan Normal University, Changsha 410005, China
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Lau KW, Hsu YW, Lin YT, Yeap MC, Lee CC, Chen KT. Case history on Epstein-Barr Virus-associated smooth muscle tumor (EBV-SMT) of cranio-cervical junction in an immunocompetent patient. Br J Neurosurg 2021; 37:1-5. [PMID: 34057864 DOI: 10.1080/02688697.2021.1932745] [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: 09/26/2020] [Accepted: 05/18/2021] [Indexed: 10/21/2022]
Abstract
Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor that almost exclusively occurs in immunocompromised hosts. Here, we report a 75-year-old Taiwanese woman without definite immune-deficient history presenting with progressive occipital neuralgia, low cranial nerve deficits (CN9-12) and cervical (C1-C5) radiculopathy. Magnetic resonance imaging revealed a 4.5*4.0*6.7 cm infiltrating mass occupying posterior skull base and C1-C2 vertebra and C1-5 epidural extension with bone destruction and vertebral artery (VA) encasement. There was also a synchronous 2.7 cm tonsillar tumor. A two-stage operation for cranio-cervical tumor excision and stabilization was performed. Tumor was confirmed directly arising from VA intraoperatively. Pathology reported a spindle cell neoplasm and the diagnosis of EBV-SMT was confirmed by EBER (EBV-encoded small RNA) in situ hybridization. An immune survey and reconstruction should be conducted for patient with EBV-SMT. A near-total resection of tumor may be beneficial for local control, however, the role of surgical resection in treating CNS EBV-SMT remains to be determined.
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Affiliation(s)
- Ka-Wei Lau
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wei Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Ting Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mun Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Cheng-Chi Lee
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Ph.D. Program in Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Lau K, Hsu Y, Lin Y, Chen K. Role of surgery in treating epstein-barr virus-associated smooth muscle tumor (EBV-SMT) with central nervous system invasion: A systemic review from 1997 to 2019. Cancer Med 2021; 10:1473-1484. [PMID: 33576167 PMCID: PMC7940242 DOI: 10.1002/cam4.3770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 12/18/2022] Open
Abstract
Epstein-Barr virus-associated smooth muscle tumor (EBV-SMT) is a rare mesenchymal tumor occurred almost exclusively in immunocompromised hosts. This article provides a systematic review of literature under PRISMA guideline on clinical features, treatment modalities, roles of surgical intervention, and outcomes of all 65 reported EBV-SMTs with central nervous system (CNS) invasion. Over 95% of reported cases were immunocompromised, while human immunodeficiency virus infection and post-organ transplantation were the most commonly associated underlying causes (near 90%). Despite a heterogeneous follow-up period, a 1-year survival rate of 76.0% and 5-year survival rate of 59.6% may support the indolent and non-deadly nature of EBV-SMT even with CNS invasion. Immune survey and reconstruction should be conducted for every patient with CNS EBV-SMT. Surgical resection is mostly adopted as primary treatment to obtain diagnosis and relieve compressive effect. A total resection of tumor may be beneficial if tumor was symptomatic and had intracranial invasion.
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Affiliation(s)
- Ka‐Wei Lau
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yu‐Wei Hsu
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Yin‐Ting Lin
- College of MedicineChang Gung UniversityTaoyuanTaiwan
| | - Ko‐Ting Chen
- Department of NeurosurgeryChang Gung Memorial Hospital at LinkouTaoyuanTaiwan
- PhD. Program in Biomedical EngineeringChang Gung UniversityTaoyuanTaiwan
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