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Case Reports
. 2024 Nov 25;16(11):e74441.
doi: 10.7759/cureus.74441. eCollection 2024 Nov.

Epstein-Barr Virus-Associated Smooth Muscle Tumor in the Liver Post Kidney Transplant: A Case Report

Zeshan R Ali  1 , Burak Sevim  1 , Ramy Shoela  1
Affiliations
Case Reports

Epstein-Barr Virus-Associated Smooth Muscle Tumor in the Liver Post Kidney Transplant: A Case Report

Zeshan R Ali et al. Cureus. .

Abstract

Epstein-Barr virus (EBV) is one of the most common causes of infection from the herpes virus family which also possesses oncogenic potential. EBV-associated smooth muscle tumors (EBV-SMT) are often found in the CNS but here we present the case of a 50-year-old woman with EBV-SMT in the liver. This patient had a kidney transplant in 2009 and had been undergoing immunosuppressive therapy to support her transplant. Subsequent imaging found a liver mass which was not seen on previous imaging. The biopsy revealed an EBV-SMT. The exact pathophysiology of EBV-SMT is not clear though it is believed to involve the reactivation of latent infection through mTOR pathways. Treatment of such masses includes reducing immunomodulating pharmacotherapy though no established management guidelines exist.

Keywords: ebv-smt; immunosuppresion; large liver mass; rare tumors; smooth muscle tumor; transplant kidney.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CT abdomen oral and IV contrast axial with portal phase show well-defined, centrally hypodense peripherally enhancing heterogenous density lesion in segment 7 of the liver. Contrast seen in the stomach.
Figure 2
Figure 2. Coronal pane CT demonstrating a well-defined, centrally hypodense mass with peripheral enhancement in segment 7 of the liver.
Figure 3
Figure 3. Coronal plane MRI abdomen T2 demonstrating well-circumscribed heterogenous hyperintense mass in segment 7 of the liver.
Figure 4
Figure 4. Axial plane MRI abdomen T1 non-contrast study shows central hypointense lesion
Figure 5
Figure 5. Axial plane MRI abdomen T1 arterial phase shows peripheral enhancement of the segment 7 lesion
Figure 6
Figure 6. Axial plane MRI abdomen T1 with delayed phase demonstrates progressive enhancement in areas with increased T1 signal. There is no centripetal peripheral nodular enhancement.
Figure 7
Figure 7. MRI (axial plane) post-contrast hepatobiliary phase (20 minutes) with Eovist demonstrates decreased signal/nonenhancement of the lesion.
Figure 8
Figure 8. Cells positive for EBV in-situ hybridization and smooth muscle actin.
EBV: Epstein Barr virus
See this image and copyright information in PMC

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