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Alfalahi A, Omar AI, Fox K, Spears J, Sharma M, Bharatha A, Munoz DG, Suthiphosuwan S. Epstein-Barr Virus-Associated Smooth-Muscle Tumor of the Brain. AJNR Am J Neuroradiol 2024; 45:850-854. [PMID: 38724198 PMCID: PMC11286019 DOI: 10.3174/ajnr.a8258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/14/2024] [Indexed: 07/10/2024]
Abstract
Epstein-Barr virus, a herpesvirus, has been associated with a variety of cancers, including Burkitt, Hodgkin, and non-Hodgkin lymphomas; posttransplant lymphoproliferative disorders; gastric carcinoma; and nasopharyngeal carcinoma, in both immunocompetent and immunocompromised individuals. Previous studies have established a connection between Epstein-Barr virus and the development of smooth-muscle tumors. Smooth-muscle tumors of the brain are very rare and are often misdiagnosed as meningiomas on imaging. To our knowledge, advanced imaging findings such as MR perfusion of smooth-muscle tumors of the brain have never been reported. We describe the radiologic and pathologic features of the Epstein-Barr virus-associated smooth-muscle tumors of the brain in a person with newly diagnosed advanced HIV.
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Affiliation(s)
- Afra Alfalahi
- From the Division of Diagnostic Neuroradiology (A.A., A.B., S.S.), St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Diagnostic Neuroradiology (A.A.), Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abdelsimar Il Omar
- Department of Medical Imaging, Division of Neurosurgery (A.I.O., K.F., J.S.), Department of Surgery, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Division of Neurosurgery (A.I.O.), Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Krystal Fox
- Department of Medical Imaging, Division of Neurosurgery (A.I.O., K.F., J.S.), Department of Surgery, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Julian Spears
- Department of Medical Imaging, Division of Neurosurgery (A.I.O., K.F., J.S.), Department of Surgery, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Malika Sharma
- Department of Infectious Diseases (M.S.), St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Aditya Bharatha
- From the Division of Diagnostic Neuroradiology (A.A., A.B., S.S.), St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David G Munoz
- Department of Laboratory Medicine (D.G.M.), St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Suradech Suthiphosuwan
- From the Division of Diagnostic Neuroradiology (A.A., A.B., S.S.), St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
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2
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Choi H, Bissell JNR, Edelbach BM, Paea J, Omosor E, Raghavan R, Gospodarev V, Lopez-Gonzalez MA. Giant primary intracranial multi-fossa leiomyosarcoma involving the frontal sinus, ethmoid air cells, anterior fossa, middle fossa, and intraventricular space: A case report and literature review. Surg Neurol Int 2023; 14:384. [PMID: 37941634 PMCID: PMC10629320 DOI: 10.25259/sni_647_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Background Leiomyosarcomas (LMSs) is a type of sarcoma that arises from smooth muscle and generally presents in the abdomen. Although intracranial LMS has been identified before, most reported presentations have been in immunocompromised patients. Here, we present an intracranial LMS in an immunocompetent patient. Case Description A 22-year-old male with a history of an atypical pineal parenchymal tumor of intermediate differentiation resected by suboccipital craniotomy at the age of 12 followed by adjuvant radiation therapy, presented with 3 weeks of decreased appetite, weight loss, and lethargy. He subsequently underwent transbasal approach skull base tumor resection. Histologic examination of the mass along with the patient's history of radiation was supportive of a low-grade, radiation-induced LMS arising from the anterior fossa of the skull or meninges and extends to the frontal sinus and ethmoid air cells. Conclusion Primary intracranial LMS is an extremely rare diagnosis and presenting symptoms vary with the location and size of the tumor. Due to the poor specificity of clinical symptoms, diagnosis is often based on histology. The most common treatment is surgical resection. Adjuvant chemotherapy with various agents has been found to be somewhat effective outside the central nervous system. When LMS does occur, a history of immunocompromised state or previous radiation exposure is often present. Pathological confirmation is required for an appropriate diagnosis.
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Affiliation(s)
- Hannah Choi
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Jorrdan N. R. Bissell
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Brandon Michael Edelbach
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Joel Paea
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Emmanuel Omosor
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Ravi Raghavan
- Department of Neurosurgery, Loma Linda University Medical School, Loma Linda, California, United States
| | - Vadim Gospodarev
- Department of Neurosurgery, Loma Linda University Medical Center, Loma Linda, California, United States
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Vij M, Sivasankaran M, Jayaraman D, Sankaranarayanan S, Kumar V, Munirathnam D, Scott J. CARMIL2 Immunodeficiency with Epstein Barr Virus Associated Smooth Muscle Tumor (EBV-SMT). Report of a Case with Comprehensive Review of Literature. Fetal Pediatr Pathol 2022; 41:1023-1034. [PMID: 34738861 DOI: 10.1080/15513815.2021.2000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Primary immunodeficiency (PID) having defects related to lymphocyte cytotoxic pathway or T-cell dysfunction are well known for developing opportunistic infections and Epstein-Barr virus (EBV)-associated diseases. CARMIL2 deficiency is a recently described combined immunodeficiency (CID) disorder characterized by defective CD28-mediated T cell co-stimulation, altered cytoskeletal dynamics, susceptibility to various infections and Epstein Barr Virus smooth muscle tumor (EBV-SMT). Case report: We report a homozygous CARMIL2 pathogenic variant presenting with recurrent infections and EBV associated smooth muscle tumor (SMT) in a child. Conclusion: The present study reports that EBV SMT may occur in a child with CARMIL2 deficiency.
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Affiliation(s)
- Mukul Vij
- Department of Pathology, Dr Rela Institute and Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Meena Sivasankaran
- Paediatric Hematology and Oncology, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India
| | - Dhaarani Jayaraman
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | | | - Vimal Kumar
- Department of Paediatric Haematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Deenadayalan Munirathnam
- Department of Paediatric Haematology & Oncology, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India
| | - Julius Scott
- Paediatric Hematology and Oncology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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4
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Jin J, Chen Z, Cao Z, Zhou S, Zhang X, Yao H. Epstein-Barr virus-associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature. Head Neck 2022; 44:2886-2903. [PMID: 36069494 PMCID: PMC9826281 DOI: 10.1002/hed.27184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/07/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023] Open
Abstract
We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein-Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.
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Affiliation(s)
- Jian‐Di Jin
- Department of Infection, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zhe Chen
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zai‐Zai Cao
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Shui‐Hong Zhou
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Xiu‐Ming Zhang
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Hong‐Tian Yao
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
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Li C, Yang X, Lu X, Wang W, Yang J. FDG PET/CT Demonstrated Epstein-Barr Virus-Associated Leiomyosarcoma in a Pediatric Patient With Wiskott-Aldrich Syndrome. Clin Nucl Med 2022; 47:190-191. [PMID: 35006111 DOI: 10.1097/rlu.0000000000004020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 7-year-old boy with Wiskott-Aldrich syndrome underwent FDG PET/CT to evaluate hepatic lesions revealed by an ultrasound. The images demonstrated multiple hypermetabolic lesions in the liver, lung, and lymph nodes. Biopsy of liver and lymph nodes demonstrated Epstein-Barr virus-associated leiomyosarcoma.
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Affiliation(s)
- Cuicui Li
- From the Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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6
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Surgical management and long-term outcomes of primary intracranial leiomyosarcoma: a case series and review of literature. Neurosurg Rev 2020; 44:2319-2328. [PMID: 33099713 DOI: 10.1007/s10143-020-01422-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023]
Abstract
Primary intracranial leiomyosarcomas (PILMSs) are extremely rare neoplasms, and their management remains unclear. The authors aimed to enunciate the radiological features and design a treatment protocol based on previously published cases combined with our series. Clinical data from all 12 cases of PILMS treated at their institute between 2008 and 2018 were reviewed. Meanwhile, they searched the Ovid MEDLINE, Embase, PubMed, Web of Science and Cochrane databases using the keywords "leiomyosarcoma" and "intracranial," "central nervous system," "cerebral," or "brain" Previously published data were processed and used according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors' cohort included 4 males (33.3%) and 8 females (66.7%) ranging in age from 13 to 67 years with a mean of 44.1 ± 5.0 years. Gross total resection (GTR), subtotal resection, and partial resection were achieved in 8 (66.7%), 3 (25%), and 1 (8.3%) patient, respectively, and only four patients (33.3%) received adjuvant therapy after surgery. After a mean follow-up of 30.5 ± 7.6 months, 6 patients (50%) experienced recurrences, and all of them died at the final. Twenty-seven patients (15 were male and 12 were female), in the literature cases, were identified between January 1980 and November 2019, presenting with PILMS. GTR and non-GTR were achieved in 21 (77.8%) and 6 (22.2%) patients, respectively. Postoperative radiotherapy was administrated in 17 patients (63.0%), and postoperative chemotherapy was administrated in 9 patients (33.3%), After a mean follow-up of 22.2 ± 4.1 months, recurrence and death occurred in 8 (36.4%) and 4 (14.8%) cases, respectively. In the pooled cases, the univariate analysis model revealed that only GTR was a significantly favorable factor for increased progression-free survival (hazard ratio 0.270, 95% confidence interval = 0.093-0.787, p = 0.016) and overall survival (hazard ratio 0.255, 95% confidence interval = 0.073-0.890, p = 0.032). GTR was recommended as an optimal treatment; meanwhile, postoperative radiation was also a choice to help increase the survival of patients of PILMS.
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Epstein Barr virus associated smooth muscle tumors in the central nervous system: a case report and systematic review of the literature. J Neurooncol 2020; 147:247-260. [PMID: 32140976 DOI: 10.1007/s11060-020-03426-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/05/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Epstein Barr virus (EBV)-associated smooth muscle tumors (SMT) in the central nervous system are rare tumors. EBV-associated SMT mainly occur in patient with compromised immune status. We report on a case of a HIV positive patient, who developed multiple EBV-SMTs, intracranially and in the spine. We systematically review the literature on the topic. CASE REPORT A 46 years old female with HIV was imaged for complaints of headaches for 2 years, when an intracranial lesion was found. The patient was followed with sequential MRI scans before an excision was performed 5 years later. Pathology revealed an EBV-associated SMT. Multiple other lesions appearing in the brain and in the spine over years were treated by stereotactic radiosurgery or by surgery. At the time of this report, the patient is alive under HARRT treatment without recurrence. METHODS A systematic PRISMA guided literature research was conducted on the topic reviewing multiple databases for EBV-associated SMT located in brain or spine. We identified 52 patients from the literature and performed a pooled analysis. RESULTS All patients in this cohort except one were immuno-suppressed from HIV, post-transplant therapy or because of CIS. Female predominance and a median age of 35 years was identified as was frequent multifocality. Therapeutic strategies varied but were mostly multidisciplinary with surgery. CONCLUSION Based on our results, EBV-associated SMT should be included in the differential diagnosis of intracranial lesions mimicking meningiomas in immuno-suppressed patients. Stereotactic radiosurgery can be offered as an alternate treatment option for suitable lesions. Long-term surveillance via MRI scanning is recommended for follow up.
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8
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Penney SW, Bishop BN, Howell DL. Treatment response with sirolimus for a pediatric patient with an EBV-associated smooth-muscle tumor after bone marrow transplantation. Pediatr Blood Cancer 2019; 66:e27585. [PMID: 30614215 DOI: 10.1002/pbc.27585] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/13/2018] [Accepted: 11/26/2018] [Indexed: 11/08/2022]
Abstract
Epstein-Barr virus-associated smooth-muscle tumors (EBV-SMTs) are unique and rare neoplasms described in immunocompromised patients. The case describes a nine-year-old female with a history of acute lymphoblastic leukemia with relapse and subsequent allogeneic bone marrow transplantation who presented with multiple EBV-SMTs of the liver. EBV utilizes the mammalian target of rapamycin (mTOR) pathway for tumor growth, and sirolimus, a mTOR inhibitor, has shown to result in a short-term response. We now report an extended treatment response with sirolimus in a pediatric patient with an EBV-SMT.
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Affiliation(s)
- Scott W Penney
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
| | - Bradie N Bishop
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
| | - Della L Howell
- San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio-Fort Sam, Houston, Texas
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9
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[A liver tumor in an immunodeficient patient]. Ann Pathol 2018; 39:54-56. [PMID: 30553638 DOI: 10.1016/j.annpat.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/18/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022]
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10
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Brown DA, Deep NL, Driscoll CL, Link MJ, Jentoft ME, Daniels DJ. Synchronous Epstein-Barr virus-associated skull base and adrenal smooth-muscle tumors in an 8-year-old girl with recent Epstein-Barr virus infection. J Neurosurg Pediatr 2018; 22:283-287. [PMID: 29905497 DOI: 10.3171/2018.3.peds17609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epstein-Barr virus-associated smooth-muscle tumors are rare tumors seen in immunocompromised patients. Most cases occur in the context of AIDS and organ transplantation, and very rarely in the setting of congenital immunodeficiency, with only 5 case reports of the latter published so far in the literature. The authors report the case of a previously healthy 8-year-old girl with headaches and precocious puberty who was found to have a large skull base lesion. There was a synchronous left adrenal lesion. She underwent resection of the skull base lesion and a left adrenalectomy. Thorough evaluation for immunodeficiency was negative for a known congenital immunodeficiency syndrome. She had a short course of intravenous immunoglobulin and has had no recurrence of disease or new lesions in the 17 months since presentation. Continued surveillance for the development of opportunistic infections and new or recurrent lesions is warranted in this case. Repeat surgery for surgically accessible tumors or chemoradiation would be recommended for any additional lesions.
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Affiliation(s)
| | | | | | | | - Mark E Jentoft
- 3Clinical and Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
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11
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Magg T, Schober T, Walz C, Ley-Zaporozhan J, Facchetti F, Klein C, Hauck F. Epstein-Barr Virus + Smooth Muscle Tumors as Manifestation of Primary Immunodeficiency Disorders. Front Immunol 2018. [PMID: 29535735 PMCID: PMC5835094 DOI: 10.3389/fimmu.2018.00368] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Epstein–Barr virus positive (EBV+) smooth muscle tumors (SMTs) constitute a very rare oncological entity. They usually develop in the context of secondary immunodeficiency caused by human immunodeficiency virus infection or immunosuppressive treatment after solid organ transplantation. However, in a small fraction of predominantly pediatric patients, EBV+ SMTs may occur in patients with primary immunodeficiency disorders (PIDs), such as GATA2 and CARMIL2 deficiency. In secondary immunodeficiencies and when the underlying condition can not be cured, the treatment of EBV+ SMTs is based on surgery in combination with antiretroviral and reduced or altered immunosuppressive pharmacotherapy, respectively. Importantly, without definitive reconstitution of cellular immunity, long-term survival is poor. This is particularly relevant for patients with EBV+ SMTs on the basis of PIDs. Recently, allogeneic hematopoietic stem cell transplantation resulted in cure of immunodeficiency and EBV+ SMTs in a GATA2-deficient patient. We propose that in the absence of secondary immunodeficiency disorders patients presenting with EBV+ SMTs should be thoroughly evaluated for PIDs. Allogeneic hematopoietic stem cell transplantation should be taken into consideration, ideally in the setting of a prospective clinical trial.
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Affiliation(s)
- Thomas Magg
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Tilmann Schober
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Walz
- Faculty of Medicine, Institute of Pathology, LMU Munich, Munich, Germany
| | | | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia School of Medicine, Spedali Civili Brescia, Brescia, Italy
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Hauck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
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12
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Kawabata Y, Aoki T, Yamamoto T, Yasui H, Sawai S, Fukuda S, Kawarazaki S, Tsukahara T. Pazopanib-mediated Long-term Disease Stabilization after Local Recurrence and Distant Metastasis of Primary Intracranial Leiomyosarcoma: A Case Report on the Efficacy of Pazopanib as a Salvage Therapy. NMC Case Rep J 2018; 5:1-7. [PMID: 29354331 PMCID: PMC5767479 DOI: 10.2176/nmccrj.cr.2017-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022] Open
Abstract
Primary intracranial leiomyosarcoma (LMS) is an extremely rare tumor of the central nervous system. Only sporadic case reports have been published, and therefore data regarding long-term prognosis remain scarce. A 76-year-old woman presented with a right parietal mass, which had grown rapidly in the month prior to admission. Neuroimaging showed a resemblance to intraosseous meningioma. Gross total resection of the tumor was achieved, and histological diagnosis confirmed LMS. Because positron emission tomography (PET) with fluorodeoxyglucose (FDG) just after the resection showed no abnormal uptake, we diagnosed the tumor as primary intracranial LMS. Follow-up PET at 16 months after treatment showed two foci of FDG uptake in the bilateral lungs. Histological diagnosis by surgical resection identified the lesions as lung metastases of LMS. In addition, follow-up head magnetic resonance imaging (MRI) at 31 months showed local recurrence, and we conducted salvage therapy using CyberKnife system (Accuray incorporated) and pazopanib. To date, for 15 months after local recurrence, she is alive with intracranial recurrent disease remained inactive.
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Affiliation(s)
- Yasuhiro Kawabata
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tomokazu Aoki
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tetsurou Yamamoto
- Department of Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Satoru Sawai
- Department of Chest Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Satoru Kawarazaki
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
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13
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Treatment of multifocal central nervous system AIDS-related Epstein Barr virus-associated malignant myopericytoma with bevacizumab. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jrid.2017.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Arva NC, Schafernak KT. Rare Presentations of Epstein-Barr Virus--Associated Smooth Muscle Tumor in Children. Pediatr Dev Pathol 2016; 19:132-8. [PMID: 26230054 DOI: 10.2350/15-05-1627-cr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epstein-Barr virus (EBV) has oncogenic potential and has been implicated in the etiology of a wide range of malignancies. Certain EBV-driven neoplasms, such as smooth muscle tumors (SMTs), manifest typically in immunocompromised patients. In children, these neoplasms have been encountered in the setting of primary immune disorders, specifically severe combined and common variable immunodeficiency syndromes. Human immunodeficiency virus infection and posttransplant immunosuppression, in particular liver and kidney transplantation, likewise increase the risk in the pediatric population. The location of these neoplasms appears related to the type of immunodeficiency: in acquired immunodeficiency syndrome they are frequently located intracranially or intraspinally, whereas after transplant they usually involve the liver or lung. We report 2 distinct cases of EBV-related SMT, unique through their coassociated immunosuppressive state or location: the 1st occurred in a patient with immunodeficiency secondary to NEMO gene mutation following hematopoietic stem cell transplantation; the 2nd developed in the orbit after heart transplant.
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Affiliation(s)
- Nicoleta C Arva
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Kristian T Schafernak
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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15
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Clinico-pathological characteristics of different types of immunodeficiency-associated smooth muscle tumours. Eur J Cancer 2014; 50:2417-24. [DOI: 10.1016/j.ejca.2014.06.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/22/2014] [Accepted: 06/09/2014] [Indexed: 12/17/2022]
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16
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Conrad A, Brunet AS, Hervieu V, Chauvet C, Buron F, Collardeau-Frachon S, Rivet C, Cassier P, Testelin S, Lachaux A, Morelon E, Thaunat O. Epstein-Barr virus-associated smooth muscle tumors in a composite tissue allograft and a pediatric liver transplant recipient. Transpl Infect Dis 2013; 15:E182-6. [PMID: 24034213 DOI: 10.1111/tid.12126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/03/2013] [Accepted: 04/21/2013] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV) is known to establish latent infections in B-lymphocytes that can cause lymphoproliferative disorders particularly in immunocompromised patients. More recently, the development of rare EBV-associated smooth muscle tumors has been reported in transplant recipients. We herein describe 2 new cases of EBV-associated post-transplant smooth muscle tumors (EBV-PTSMT), including the first in a facial composite tissue graft recipient. Among the striking features shared by these 2 patients were their young ages, the fact that they were naïve for EBV before the transplantation, that they developed a post-transplant lymphoproliferative disorder before the diagnosis of EBV-PTSMT, and that they responded favorably to reduction of immunosuppression. Radiological and histologic features of EBV-PTSMT are shown. Finally, pathophysiology and therapeutic management of EBV-PTSMT are discussed based on a comprehensive review of the literature.
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Affiliation(s)
- A Conrad
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
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Elawabdeh N, Cone BM, Abramowsky CR, Wrubel DM, Grossniklaus H, Walrath J, Bashir MZ, Shehata BM. Epstein-Barr virus associated smooth muscle tumors in post transplant pediatric patients two cases of rare locations, and review of the literature. Fetal Pediatr Pathol 2013; 32:184-91. [PMID: 23445451 DOI: 10.3109/15513815.2012.701265] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Epstein-Barr virus (EBV) may present few or no symptoms in immunocompetent individuals; however, in immunocompromised patients as in the case of AIDS and post-transplant patients, the virus occasionally stimulates neoplastic transformations. Epstein-Barr virus may play a role in the development of smooth muscle tumors (SMT). In the case of Epstein-Barr associated smooth muscle tumors (EBV+SMT), the virus is thought to be the leading factor to the tumorigenic pathway. We report two pediatric patients (6 and 13 years old) who underwent liver transplantation and developed EBV+SMT in the colon and orbit. These two cases represent rare locations for this kind of lesion.
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Affiliation(s)
- Nancy Elawabdeh
- Children's Healthcare of Atlanta, Pathology Laboratory, Atlanta, Georgia 30322, USA
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18
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Petersson F. Epstein-Barr virus–associated smooth muscle tumor—report of 3 tumors including 1 intracerebral case with a prominent intratumoral B-lymphocytic component and plasma cells. Ann Diagn Pathol 2013; 17:91-8. [DOI: 10.1016/j.anndiagpath.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/01/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
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19
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Zhang H, Dong L, Huang Y, Zhang B, Ma H, Zhou Y, Shu C, Cheng G. Primary intracranial leiomyosarcoma: review of the literature and presentation of a case. ACTA ACUST UNITED AC 2012; 35:609-16. [PMID: 23038237 DOI: 10.1159/000342676] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary intracranial leiomyosarcoma (LMS) is a rare tumor of the central nervous system and therefore has only been reported sporadically. METHODS The MEDLINE database was searched for relevant case reports and series published in English from 1969 to March 2012. These papers were reviewed to identify clinical and histopathological features, treatment modalities, and prognoses of patients with primary intracranial LMS. RESULTS We reviewed 37 patients, including our patient, with primary intracranial LMS. Of these cases, 16 (43.2%) involved immunosuppression, 4 (10.8%) involved radiation-induced LMS, 3 (8.1%) cases involved a potential leiomyosarcomatous transformation of a brain lesion, and 7 (18.9%) cases, including the presented case, had no specific medical history. The treatment for these cases included resection (33/37, 89.2%), postoperative radiotherapy (20/37, 54.1%), and chemotherapy (7/37, 18.9%). CONCLUSIONS The best method for the treatment of LMS could not be determined due to the limited number of cases that have been reported. However, optimized surgical resection, postoperative radiotherapy, and sarcoma-based chemotherapy may improve treatment outcomes.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese People's Liberation Army, Beijing, P. R. China
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20
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Abstract
Neoplasms of striated and smooth muscle in children are a diverse group of neoplasms that have some unique aspects in contrast to these tumors in adults. Rhabdomyosarcoma is the most common soft tissue sarcoma of infancy and childhood and is relatively common in adolescents. In contrast, smooth muscle tumors are relatively rare, and the various types of rhabdomyoma and smooth and skeletal muscle hamartomas are very uncommon. In recent years, the understanding of the pathologic and genetic aspects of rhabdomyosarcoma has been enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic analysis. The current classification of rhabdomyosarcoma emphasizes the histologic-prognostic correlations. This article reviews the clinicopathologic features of striated and smooth muscle tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents and the differential diagnosis.
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Affiliation(s)
- David M Parham
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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21
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Purgina B, Rao UNM, Miettinen M, Pantanowitz L. AIDS-Related EBV-Associated Smooth Muscle Tumors: A Review of 64 Published Cases. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:561548. [PMID: 21437186 PMCID: PMC3062098 DOI: 10.4061/2011/561548] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/01/2011] [Indexed: 11/20/2022]
Abstract
The number of reported cases of smooth muscle tumor (SMT) arising in patients with AIDS has been increasing since the mid-1990s. The aim of this study is to characterize the epidemiology, clinical manifestations, pathologic features, prognosis and, management of Epstein-Barr virus-related SMT (EBV-SMT) in patients with AIDS. An English language literature search identified 53 articles including 64 reported cases of EBV-SMT. The majority of these reports involved patients who were young, severely immunosuppressed, and had multifocal tumors. The central nervous system was the most common site to be involved. Histologically, tumors had smooth muscle features and were immunoreactive for muscle markers and all but two tumors demonstrated the presence of EBV by either immunohistochemistry, in situ hybridization, and/or PCR. While mitoses and/or necrosis were used to separate leiomyoma from leiomyosarcoma, these features did not correlate with clinical outcome. Treatment included primarily resection, and less often radiotherapy, chemotherapy and highly active antiretroviral therapy (HAART). Overall, EBV-SMTs appear to have variable aggressiveness and clinical outcome and may exhibit a more favorable prognosis compared to conventional leiomyosarcoma. Tumor-related death from EBV-SMT occurred in only 4 of 51 patients.
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Affiliation(s)
- Bibianna Purgina
- Department of Pathology, Presbyterian-Shadyside Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA 15232, USA
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22
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Abstract
A 17-year-old African American female with human immunodeficiency virus infection presented with an unresectable intracranial neoplasm with mass effect upon the brainstem. Stereotactic biopsy revealed an Epstein-Barr virus (EBV)-associated leiomyosarcoma. Radiation therapy and gemcitabine were used to shrink the mass with the aim to make it surgically resectable. Prolonged neutropenia and recurrent skin infections led to the discontinuation of gemcitabine. The mass stabilized after radiation therapy and has decreased in size in 15 months of follow-up. EBV has been demonstrated in most smooth muscle tumors associated with acquired immunodeficiency syndrome and other immunocompromised states. This is the first documented case of an EBV-positive intracranial leiomyosarcoma in a pediatric human immunodeficiency virus patient.
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23
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Morera Serna E, Pérez Fernández CA, de la Fuente Jambrina C, Razquin Muñoz J, Pérez Gil MÁ. Leiomiosarcoma laríngeo. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74964-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Chan ACL, Li CS, Cheuk W, Chan JKC. Epstein-Barr virus associated leiomyosarcoma in a patient with systemic lupus erythematosus. Pathology 2007; 39:358-61. [PMID: 17558866 DOI: 10.1080/00313020701329864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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25
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Atluri S, Neville K, Davis M, Robertson KA, Marshalleck FE, O'Malley DP, Buckley RH, Nelson RP. Epstein-Barr-associated leiomyomatosis and T-cell chimerism after haploidentical bone marrow transplantation for severe combined immunodeficiency disease. J Pediatr Hematol Oncol 2007; 29:166-72. [PMID: 17356396 DOI: 10.1097/mph.0b013e31803b95b3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The clinical course of Epstein-Barr virus (EBV)-associated smooth muscle tumors is variable and there are no reports in patients with mixed T-cell chimerism after bone marrow transplantation (BMT). OBSERVATIONS A child with X-linked severe combined immunodeficiency disease developed multiple renal and pulmonary leiomyomata 8 years after haploidentical BMT. Epstein-Barr viral DNA was detectable in the blood and in situ hybridization for EBV-encoded RNAs was positive in the tumor. The tumors have been radiographically stable, chimerism remains mixed, and plasma EBV DNA has been repeatedly negative for over 2 years after donor lymphocyte infusion. CONCLUSIONS EBV-associated smooth muscle tumors may occur in patients who are partially reconstituted after BMT for severe combined immunodeficiency and may not require surgery or chemotherapy.
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Affiliation(s)
- Srilatha Atluri
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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26
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Laryngeal Leiomyosarcoma. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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27
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Zevallos-Giampietri EA, Yañes HH, Orrego Puelles J, Barrionuevo C. Primary Meningeal Epstein-Barr Virus-related Leiomyosarcoma in a Man Infected With Human Immunodeficiency Virus. Appl Immunohistochem Mol Morphol 2004; 12:387-91. [PMID: 15536343 DOI: 10.1097/00129039-200412000-00018] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe the clinical, radiologic, surgical, and pathologic findings of a 29-year-old Peruvian human immunodeficiency virus-infected man with a primary parasellar meningeal leiomyosarcoma involving the left lesser esphenoidal wing and the cavernous sinus. Over a period of 13 months, he developed headache, vomiting, insomnia, and diplopia. Magnetic resonance imaging revealed a left parasellar extra-axial mass that was isointense in T1, hypointense in T2, and gadolinium-enhanced. The patient underwent subtotal resection of the tumor. The neoplasm was composed of spindle cells with smooth-muscle features. It showed moderate atypia, inconspicuous nucleoli, and scanty mitosis. No tumor necrosis was detected. The immunohistochemistry revealed strong positivity for vimentin, desmin, and smooth-muscle alpha-actin. A low-grade leiomyosarcoma was diagnosed. The in situ hybridization showed positive nuclear reactivity for Epstein-Barr virus-encoded RNA. The immunohistochemistry was negative for Epstein-Barr virus latent membrane protein 1. The main differential diagnosis of primary meningeal smooth-muscle tumors includes meningioma and peripheral nerve sheath tumors. Epstein-Barr virus has been demonstrated in most smooth-muscle tumors associated with acquired immune deficiency syndrome (AIDS). Primary meningeal smooth-muscle tumors, exceedingly rare neoplasms, remarkably affect young adults with AIDS. Comparatively, most AIDS-related visceral (nonmeningeal) smooth-muscle tumors have been reported in children. The permissiveness and tumorigenesis associated with Epstein-Barr virus may depend on the age of human immunodeficiency virus infection.
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28
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Cypriano MS, Jenkins JJ, Pappo AS, Rao BN, Daw NC. Pediatric gastrointestinal stromal tumors and leiomyosarcoma. Cancer 2004; 101:39-50. [PMID: 15221987 DOI: 10.1002/cncr.20352] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND With the introduction of molecularly targeted therapy for gastrointestinal stromal tumors (GISTs), it became important to distinguish GISTs from leiomyosarcomas (LMSs). The authors sought to characterize the clinicopathologic features of these tumors in pediatric patients. METHODS The authors reviewed the medical records of 11 patients for whom GIST or LMS was diagnosed between March 1962 and July 2002 at St. Jude Children's Research Hospital and reclassified the tumors according to current histologic and immunophenotypic criteria. The authors also reviewed the literature pertaining to pediatric GISTs and LMSs. RESULTS Seven patients had GISTs, and four had LMS. The median age of the patients at diagnosis was 11.5 years. At diagnosis, metastases were present in one patient with GISTs and in another with LMS. Unlike the focal distribution of CD117 (KIT) in LMS, diffuse and strong immunostaining was observed in GISTs. Only GISTs expressed CD34. Six patients underwent complete resection (four with GISTs and two with LMS), four patients underwent incomplete resection (three with GISTs and one with LMS), and one patient (with LMS) underwent a biopsy only. Radiotherapy or chemotherapy was used to treat one patient with GISTs and three patients with LMS. One patient with a high-risk GIST (largest dimension of 32 cm and high mitotic count) was treated with adjuvant imatinib mesylate outside the preferred setting of a clinical trial, due to concerns regarding the high risk of tumor recurrence. Four patients with GISTs and two with LMS survived median disease-free a median of 10.4 years and 4.3 years after diagnosis, respectively. Tumors in all but one survivor were completely resected. CONCLUSIONS KIT staining helped to distinguish GISTs from LMSs. Surgery was the treatment of choice for both entities, and tumor resectability was a key prognostic factor.
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Affiliation(s)
- Monica S Cypriano
- Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794, USA
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29
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Boudjemaa S, Boman F, Guigonis V, Boccon-Gibod L. Brain involvement in multicentric Epstein-Barr virus-associated smooth muscle tumours in a child after kidney transplantation. Virchows Arch 2004; 444:387-91. [PMID: 15143769 DOI: 10.1007/s00428-004-0975-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Epstein-Barr virus (EBV)-associated smooth muscle tumours (SMT) have been reported in young patients with induced immunosuppression associated with organ transplantation, acquired immunodeficiency syndrome or congenital immunodeficiencies. EBV-associated SMT are frequently multicentric or multifocal and often occur in unusual locations. We are reporting a case of EBV-associated multicentric SMT that occurred after kidney transplantation in a 2-year-old boy with a history of oligomeganephrony. Headaches and left VIth cranial nerve paralysis led to the discovery of a brain tumour 3 years after transplantation. There were multiple pulmonary, hepatic and splenic nodules and enlarged mesenteric lymph nodes. Histological examination revealed multicentric SMT of uncertain malignant potential. Further investigations using in situ hybridisation demonstrated EBV early RNAs in the nucleus of most tumour cells. The immunosuppressive therapy was reduced, and the child was treated with chemotherapy, but died 2 months later, due to neurological complications.
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Affiliation(s)
- Sabah Boudjemaa
- Department of Pathology, University School of Meidcine of Paris VI, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, France
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30
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Eckhardt BP, Brandner S, Zollikofer CL, Wentz KU. Primary cerebral leiomyosarcoma in a child. Pediatr Radiol 2004; 34:495-8. [PMID: 15057493 DOI: 10.1007/s00247-003-1123-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2003] [Accepted: 11/16/2003] [Indexed: 10/26/2022]
Abstract
We present a 13-year-old boy with a low-grade primary intra-axial cerebral leiomyosarcoma. MRI showed a contrast-enhancing intra-axial mass with features of a cell-rich tumour. The diagnosis was established after neurosurgery and exclusion of an extracerebral primary tumour. The resection of local recurrence 6 months later confirmed the diagnosis, but a higher grade of malignancy was established. The patient died 15 months after the onset of symptoms from general intracranial and intraspinal spread.
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Affiliation(s)
- Boris P Eckhardt
- Radiology Institute, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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31
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Monforte-Muñoz H, Kapoor N, Saavedra JA. Epstein-Barr virus-associated leiomyomatosis and posttransplant lymphoproliferative disorder in a child with severe combined immunodeficiency: case report and review of the literature. Pediatr Dev Pathol 2003; 6:449-57. [PMID: 14708738 DOI: 10.1007/s10024-003-8096-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The occurrence of smooth muscle neoplasms and lymphoproliferative disorders in immunocompromised patients is well recognized. We report the case of an 8-year-old girl with adenosine deaminase (ADA)-deficient severe combined immunodeficiency (SCID) status post-bone marrow transplant (BMT), in whom Epstein-Barr virus (EBV) was detected in innumerable leiomyomas involving the gallbladder (leiomyomatosis), and multifocal leiomyomas in liver, spleen, pancreas, intestinal tract, and lung. The leiomyomas of the gallbladder, liver, spleen, and lung were asymptomatic, while those located in the colon became clinically manifest by recurrent lower intestinal hemorrhage. The patient also developed extensive EBV-associated polymorphic lymphoproliferative disorder (PTLD) in nodal and extranodal sites. In addition, there were pulmonary and gastric adenovirus and small and large intestine cryptosporidum infections. Our case appears to be the first example of leiomyomatosis of the gallbladder coexisting with multifocal leiomyomas of the liver, spleen, pancreas, intestinal tract, and lung, as well as EBV-derived lymphoproliferative disorder in a young girl with ADA-deficient SCID. Awareness of the pattern of involvement and of the coexistence of benign leiomyomatous proliferations with lymphoproliferative disorder is of value when gallbladder, pancreatic, biliary tree, lung, and intestinal lesions become clinically manifest in these patients. The demonstration of EBV infection in both leiomyomata and the PTLD suggests a common pathogenesis that may have therapeutic and prognostic implications.
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Affiliation(s)
- Hector Monforte-Muñoz
- Department of Pathology-CHLA Box 43, Division of Anatomic Pathology, Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
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32
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Oliveira AM, Scheithauer BW, Salomao DR, Parisi JE, Burger PC, Nascimento AG. Primary sarcomas of the brain and spinal cord: a study of 18 cases. Am J Surg Pathol 2002; 26:1056-63. [PMID: 12170093 DOI: 10.1097/00000478-200208000-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Primary sarcomas of the central nervous system are exceedingly rare. We reviewed the clinicopathologic features of 18 primary central nervous system sarcomas diagnosed from 1959 through 1999. Median age at diagnosis of the nine female and nine male patients was 28 years (range 3-63 years). Median tumor size was 4 cm (range 1.3-8 cm). Fifteen tumors arose in the cerebrum (83%), two in the cerebellum, and one in the spinal cord. Histopathologically, the most common tumor types included fibrosarcoma (six), malignant fibrous histiocytoma (five), and undifferentiated sarcoma (three). Immunohistochemical and ultrastructural studies supported the histologic diagnosis in 17 and six cases, respectively. All patients had subtotal to gross total tumor resection; 16 also received radiotherapy and/or chemotherapy. Twelve tumors (67%) were high-grade. Follow-up was obtained in all instances (median 2.3 years). Nine patients died of the disease, eight with high-grade tumors. Survival at 5 years for patients with high-grade tumors was 28% compared with 83% for those with low-grade neoplasms (p = 0.03). Primary central nervous system sarcomas most often affect young and middle-aged adults. Most involve the cerebrum and show fibrous, "fibrohistiocytic," or no specific differentiation. The prognosis for high-grade sarcomas seems better than that for glioblastoma multiforme.
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Affiliation(s)
- Andre M Oliveira
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, U.S.A
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33
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Yeh DJ, Hessler RB, Lee MR. Leiomyosarcomatous transformation of unknown pediatric primary brainstem lesion following radiotherapy. Neurosurg Focus 2002; 12:ecp2. [PMID: 15926790 DOI: 10.3171/foc.2002.12.6.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary leiomyosarcoma of the central nervous system is rare and has been described both de novo and following temporally remote radiotherapy for a different unrelated malignancy. The authors report the case of a 42-year-old man in whom 60Co radiation treatment had been performed for an unknown primary mass in the brainstem 25 years previously. He presented with progressive neurological deterioration after undergoing many years of conservative therapy. A stereotactic biopsy sampling procedure was performed, and examination of the left cerebral pedunculopontine lesion revealed a spindle cell neoplasm. Histopathological and immunohistochemical examination of the tumor obtained from definitive resection suggested leiomyosarcomatous transformation of ganglioglioma.
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Affiliation(s)
- David John Yeh
- Department of Neurosurgery, Medical College of Georgia, Augusta, Georgia, USA.
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34
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Cheuk W, Li PCK, Chan JKC. Epstein-Barr virus-associated smooth muscle tumour: a distinctive mesenchymal tumour of immunocompromised individuals. Pathology 2002; 34:245-9. [PMID: 12109785 DOI: 10.1080/00313020220131309] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
immunosuppressed patients are predisposed to the development of smooth muscle tumours which show near consistent association with Epstein-Barr virus (EBV). This report describes a 37-year-old patient with acquired immunodeficiency syndrome who initially presented with two masses in the liver. Image-guided core biopsy revealed a spindle cell tumour with histological and immunological features of smooth muscle neoplasm which was shown by in situ hybridisation for EBV early RNAs to be EBV-associated. The literature on this uncommon entity is critically reviewed and the differential diagnosis is also discussed.
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Affiliation(s)
- W Cheuk
- Department of Pathology and Medicine, Queen Elizabeth Hospital, Kowloon, Hong Kong.
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35
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Abstract
The Epstein-Barr virus (EBV), one of eight known human herpesviruses, causes a wide spectrum of diseases under certain conditions. In particular, in the setting of immunodeficiency, which includes primary or secondary/acquired immunodeficiencies, they have been increasingly reported. The major clinical phenotype is the EBV genome-positive lymphoproliferative disorder, which ranges from benign lymphoproliferation to malignant lymphoma with cytogenetic alterations. Severe or fatal infectious mononucleosis may develop in some patients with immunodeficiencies such as X-linked lymphoproliferative disease.
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Affiliation(s)
- M Okano
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan.
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36
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Okano M, Gross TG. A Review of Epstein-Barr Virus Infection in Patients with Immunodeficiency Disorders. Am J Med Sci 2000. [DOI: 10.1016/s0002-9629(15)40780-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Ritter AM, Amaker BH, Graham RS, Broaddus WC, Ward JD. Central nervous system leiomyosarcoma in patients with acquired immunodeficiency syndrome. Report of two cases. J Neurosurg 2000; 92:688-92. [PMID: 10761660 DOI: 10.3171/jns.2000.92.4.0688] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Leiomyosarcomas (LMSs) of the central nervous system are extremely rare; however, they are becoming more prevalent in immunocompromised patients. The authors present the cases of two patients with acquired immunodeficiency syndrome: one with LMS of the thoracic vertebral body and the other with LMS originating from the region of the cavernous sinus. The epidemiological and histological characteristics of LMS and its association with latent Epstein-Barr virus are discussed, as well as the treatments for this neoplasm.
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Affiliation(s)
- A M Ritter
- Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA
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38
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Hsu JL, Glaser SL. Epstein-barr virus-associated malignancies: epidemiologic patterns and etiologic implications. Crit Rev Oncol Hematol 2000; 34:27-53. [PMID: 10781747 DOI: 10.1016/s1040-8428(00)00046-9] [Citation(s) in RCA: 190] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Epstein-Barr virus (EBV), a ubiquitous B-lymphotrophic herpesvirus, has been found in the tumor cells of a heterogeneous group of malignancies (Burkitt's lymphoma, lymphomas associated with immunosuppression, other non-Hodgkin's lymphomas, Hodgkin's disease, nasopharyngeal carcinoma, gastric adenocarcinoma, lymphoepithelioma-like carcinomas, and immunodeficiency-related leiomyosarcoma). As the epidemiologic characteristics of these cancers have not been considered together, this review seeks to relate their incidence patterns and risk factors to EBV biology and virus-host interaction in an attempt to help elucidate factors involved in EBV-related carcinogenesis. We include a brief review of EBV virology and primary infection to provide a biologic context for considering the epidemiology, summarize the most salient epidemiologic features of each malignancy, synthesize epidemiologic data by risk factor to uncover commonalities and informative contrasts across the diseases, and propose hypotheses regarding etiologic mechanisms, based on the possible effect of the risk factors at various stages in the viral life cycle.
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Affiliation(s)
- J L Hsu
- Northern California Cancer Center, 32960 Alvarado-Niles Road, Suite 600, Union City, CA 94587, USA
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