Epstein-Barr virus associated hepatic smooth muscle tumor in a patient with acquired immunodeficiency syndrome

Abstract

Introduction: Epstein-Barr virus (EBV) associated smooth muscle tumors (SMTs) usually present under the condition of immunosuppression, including congenital immunodeficiency syndrome-SMT, post-transplantation-SMT and HIV-SMT. HIV-SMTs are most likely to invade the central nervous system, followed by the liver, lungs, and other locations. [ 1 ] Many laboratory techniques, including serological techniques, polymerase chain reaction and immunohistochemistry (IHC), are employed to determine the aetiologies of these tumours. With respect to therapy, surgical resection is the main treatment. In patients with immunodeficiency, improving immune status is significant for defending against other viruses. We describe a case of the primary focus of SMT in the liver of HIV-positive patient without any metastasis. Patient concerns: A young male HIV-positive patient complained of fever and abdominal pain for 2 months. Diagnosis: IHC of liver tissue confirmed the finding: EBV-related smooth muscle tumor. Interventions: Given the patient's general condition, he was not a suitable candidate for surgical resection. He was given antibiotics, antifungal agents and EBV-directed agents to control infection as well as highly active antiretroviral therapy to enhance the immunity. Outcomes: The patient's symptoms improved. He was discharged. Conclusions: In conclusion, EBV-related HIV-SMTs is a rare neoplasm found in the liver among immunodeficient patients. This case highlights that a variety of examinations such as IHC for smooth muscle markers (smooth muscle actin and desmin) and EBER, as well as polymerase chain reaction for EBV DNA should be done when diagnoses are ambiguous.

Intracranial Epstein-Barr virus-associated smooth muscle tumor with superimposed cryptococcal infection

“…In as many as 90% of patients with EBV-SMT, death is secondary to opportunistic infections rather than tumor burden [4,6] . There are few reports of disseminated cryptococcal infection or cryptococcal meningitis occurring concomitantly in a patient with EBV-SMT(s) of the CNS [7–9] . To our knowledge, there has not been any previously described cases of EBV-SMT with infectious organisms present within the tumor matrix, such as seen in this case.…”

Epstein-Barr Virus-Associated Smooth Muscle Tumor and Its Correlation With CD4 Levels in a Patient With HIV Infection

“…The gold standard for diagnosing EBV-SMT is EBV-encoded small RNA in situ hybridization because immunohistochemistry alone has a rather low sensitivity ( Magg et al., 2018 ). It is particularly important to establish an algorithm for the pathological diagnosis of spindle cell tumors in HIV patients, as other differential diagnoses include Kaposi sarcoma, myopericytoma, gastrointestinal stromal tumor, and mycobacterial spindle cell pseudotumor ( Zhou et al., 2020 ).…”

Antiretroviral therapy achieved metabolic complete remission of hepatic AIDS related Epstein-Barr virus-associated smooth muscle tumor

“…While some cases reported that combination with surgical resection and ART achieved complete remission in AIDS related EBV-SMTs [4,5], case reports of ART alone were extremely rare. Previous case reports of ART alone for AIDS related EBV-SMTs are summarized in Table 1 [12][13][14]. Unfortunately, it is difficult to evaluate the effectiveness of ART alone for AIDS related EBV-SMTs from these cases.…”