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Review
. 2023 Nov 24;15(23):5563.
doi: 10.3390/cancers15235563.

A Clinicopathology Review and Update of Epstein-Barr Virus-Associated Mesenchymal Tumors

Affiliations
Review

A Clinicopathology Review and Update of Epstein-Barr Virus-Associated Mesenchymal Tumors

Oswald Zhao Jian Lee et al. Cancers (Basel). .

Abstract

The Epstein-Barr virus (EBV) is associated with various tumor types, including nasopharyngeal carcinoma and lymphoproliferative disorders. While much is known about EBV-related epithelial and lymphoid tumors, there is a paucity of knowledge concerning EBV-associated mesenchymal tumors. This review aims to provide a comprehensive overview of EBV-associated mesenchymal tumors, encompassing their clinical features, pathological characteristics, pathophysiology, prognostic factors, and current treatment approaches. Through an extensive literature search using the PubMed database, we were able to identify three distinct EBV-associated mesenchymal tumors: EBV-associated smooth muscle tumors, inflammatory pseudotumor-like follicular dendritic cell sarcomas, and EBV-associated osteosarcomas. Although this review extensively explored the different aspects of these mesenchymal tumors, our comprehension of the underlying pathophysiology in this context is still incomplete. Therefore, we hope that this review paper will not only serve as a valuable repository of information but also serve as a catalyst for prospective in vitro and in vivo research studies to bridge the existing knowledge gap surrounding pathophysiology, ultimately making an important contribution to shaping future therapeutic approaches.

Keywords: Epstein–Barr virus (EBV); mesenchymal; sarcoma; smooth muscle.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Illustration of the life cycle of EBV and its associated latency programs, leading to the development of different types of tumors.
Figure 2
Figure 2
Hematoxylin and eosin stain. (A) A lymph node involved with a well-circumscribed EBV-SMT. (B) Two separate groups of tumor cells, with one resembling a typical leiomyoma, while the second group exhibits increased nuclear atypia with a higher nuclear atypia to the cytoplasmic (NC) ratio. (C) There is a focally increased number of mitotic figures, particularly within the group of tumor cells with a higher NC ratio (indicated by black arrows). (D) Increased vascularity is evident, characterized by the presence of delicate, thin-walled blood vessels within the tumor.
Figure 3
Figure 3
Immunohistochemistry. (A) Both tumor populations, exhibiting both higher and lower NC ratios, demonstrate diffuse SMA positivity. (B) Both tumor populations display patchy desmin positivity. (C) Patchy h-caldesmon positivity is observed within the tumor population with a higher NC ratio, whereas the tumor population with a lower NC ratio shows diffuse h-caldesmon positivity. (D) Both tumor populations display diffuse EBER-ish positivity.
Figure 4
Figure 4
Hematoxylin and eosin stain and immunohistochemistry. (A) A lymph node involved with a well-circumscribed IPT-FDCS comprising two distinct hypercellular and hypocellular areas. (B) Hypercellular areas comprising fascicles of spindle cells with admixed dense lymphocytic infiltrates. (C) The juxtaposition of hypercellular areas with hypocellular myxoid areas. (D,E) Neoplastic spindle cells from a different FDCS case displaying positive expression of CD21 and CD35, respectively.

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