Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Jan 7;17(1):3.
doi: 10.1186/s13000-021-01180-6.

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

Mohammad Hossein Anbardar  1   2 , Neda Soleimani  3   4 , Dornaz Safavi  1 , Ahad Eshraghian  5 , Abbas Ayoub  5
Affiliations
Case Reports

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

Mohammad Hossein Anbardar et al. Diagn Pathol. .

Abstract

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.

Keywords: CMV; EBER; EBV; Post-transplant smooth muscle tumor; Smooth muscle tumor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Spiral CT scan showed well-defined solid lesions in the liver (vertical arrow) and spleen (horizontal arrow)
Fig. 2
Fig. 2
Colonoscopy showed multiple submucosal polypoid lesions
Fig. 3
Fig. 3
Microscopic view of colon polyps, (A)(H&E × 100), (B)(H&E × 400), and the liver mass (C)(H&E × 40) show intersecting fascicles of spindle cells with elongated nuclei, eosinophilic cytoplasms, mild atypia, and low mitotic activity. There is a thin rim of non-neoplastic liver tissue (white arrow). D The neoplastic cells are reactive for SMA and desmin
Fig. 4
Fig. 4
Epstein–Barr virus (EBV)-encoded RNA (EBER) positivity of tumor cells by chromogenic in-situ hybridization (CISH) study
See this image and copyright information in PMC

References

    1. Lee ES, Locker J, Nalesnik M, Reyes J, Jaffe R, Alashari M, Nour B, Tzakis A, Dickman PS. The association of Epstein-Barr virus with smooth-muscle tumors occurring after organ transplantation. N Engl J Med. 1995;332(1):19–25. doi: 10.1056/NEJM199501053320104. - DOI - PubMed
    1. Salamanca J, Massa DS. EBV-associated hepatic smooth muscle tumor after lung transplantation: report of a case and review of the literature. J Heart Lung Transplant. 2009;28(11):1217–1220. doi: 10.1016/j.healun.2009.07.007. - DOI - PubMed
    1. Miettinen M. Smooth muscle tumors of soft tissue and non-uterine viscera: biology and prognosis. Mod Pathol. 2014;27(S1):S17–S29. doi: 10.1038/modpathol.2013.178. - DOI - PMC - PubMed
    1. Purgina B, Rao UN, Miettinen M, et al. AIDS- related EBV-associated smooth muscle tumors: a review of 64 published cases. Pathol Res Int. 2011;2011:561548–561510. doi: 10.4061/2011/561548. - DOI - PMC - PubMed
    1. Cerilli LA. Multiple hepatic masses in a 38-year-old male 10 years after renal transplantation. Nephrol Dial Transplant. 2005;20(8):1756–1758. doi: 10.1093/ndt/gfh795. - DOI - PubMed

Publication types

MeSH terms