Favourable outcome of AIDS-related multi-centric central nervous system Epstein–Barr virus-associated smooth muscle tumour with surgery and adjuvant radiation therapy: a case study and literature review
Restricted accessCase reportFirst published online May, 2019
Favourable outcome of AIDS-related multi-centric central nervous system Epstein–Barr virus-associated smooth muscle tumour with surgery and adjuvant radiation therapy: a case study and literature review
Epstein–Barr virus-associated smooth muscle tumour (EBV-SMT) is a unique condition which affects immunocompromised patients. We describe the favourable outcome of a patient with acquired immune deficiency syndrome (AIDS)-related multi-centric EBV-SMT involving the posterior fossa and spine treated with surgery and adjuvant volumetric modulated arc therapy comprising 50 Gy in 25 fractions to four sites initially to the brain and lumbar spine followed by sixth to ninth thoracic vertebrae (T6–T9) and sacrum a year later. Reported literature suggests that AIDS-related EBV-SMTs are more sensitive to radiotherapy. However, compliance to the highly active anti-retroviral therapy is paramount in preventing future recurrence. This case also emphasises the importance of multidisciplinary management in ensuring the best possible outcome.
MesriEAFeitelsonMAMungerK.Human viral oncogenesis: a cancer hallmarks analysis. Cell Host Microbe2014;
15: 266–282.
2.
McClainKLLeachCTJensonHBet al.
Association of Epstein–Barr virus with leiomyosarcomas in children with AIDS. N Engl J Med1995;
332: 12–18.
3.
LeeESLockerJNalesnikMet al.
The association of Epstein–Bar virus with smooth-muscle tumors occurring after organ transplantation. N Engl J Med1995;
332: 19–25.
4.
DeyrupAT.Epstein–Barr virus-associated epithelial and mesenchymal neoplasms. Hum Pathol2008;
39: 473–483.
5.
HusseinKRathBLudewigBet al.
Clinico-pathological characteristics of different types of immunodeficiency-associated smooth muscle tumours. Eur J Cancer2014;
50: 2417–2424.
6.
GallienSZuberBPolivkaMet al.
Multifocal Epstein–Barr virus-associated smooth muscle tumor in adults with AIDS: case report and review of the literature. Oncology2008;
74: 167–176.
7.
DeyrupATLeeVKHillCEet al.
Epstein–Barr virus-associated smooth muscle tumors are distinctive mesenchymal tumors reflecting multiple infection events: a clinicopathologic and molecular analysis of 29 tumors from 19 patients. Am J Surg Pathol2006;
30: 75–82.
8.
OngKWTeoMLeeVet al.
Expression of EBV latent antigens, mammalian target of rapamycin, and tumor suppression genes in EBV-positive smooth muscle tumors: clinical and therapeutic implications. Clin Cancer Res2009;
15: 5350–5358.
9.
ShenQFengWLongMSet al.
Multicentric hepatic EBV-associated smooth muscle tumors in AIDS patient: a case report, investigation of mTOR activation and review of the literature. Int J Clin Exp Pathol2011;
4: 421–429.
10.
IssarachaikulRShuangshotiSSuankratayC.Epstein–Barr virus-associated smooth muscle tumors in AIDS Patients: a largest case (Series). Intern Med2014;
53: 2391–2396.
11.
WongKHChanKCLeeSSet al.
Epstein–Barr virus-associated smooth muscle tumour in patients with acquired immunodeficiency syndrome. J Microbiol Immunol Infect2007;
40: 173–177.
12.
PurginaBRaoUNMMiettinenMet al.
AIDS-related EBV-associated smooth muscle tumors: a review of 64 published cases. Patholog Res Int2011;
2011: ▪.
13.
PiriouEJansenCAvan DortKet al.
Reconstitution of EBV latent but not lytic antigen-specific CD4+ and CD8+ T cells after HIV treatment with highly active antiretroviral therapy. J Immunol2005;
175: 2010–2017.
14.
CelaIShahNBBradlyDet al.
An Epstein–Barr virus-associated smooth muscle tumor successfully treated with surgical resection: a case report and literature review. Clin Adv Hematol Oncol2010;
8: 423–426.
15.
SuankratayCShuangshotiSMutiranguraAet al.
Epstein–Barr virus infection-associated smooth muscle tumors in patients with AIDS. Clin Infect Dis2005;
40: 1521–1528.
16.
SunYHuangYCXuQZet al.
HIV-1 Tat depresses DNA-PK (CS) expression and DNA repair, and sensitizes cells to ionizing radiation. Int J Radiat Oncol Biol Phys2006;
65: 842–850.
17.
FormentiSCChakLGillPet al.
Increased radiosensitivity of normal tissue fibroblasts in patients with acquired immunodeficiency syndrome (AIDS) and with Kaposi’s sarcoma. Int J Radiat Biol1995;
68: 411–412.
18.
PajonkFHimmelsbachJRiessKet al.
The human immunodeficiency virus (HIV)-1 protease inhibitor saquinavir inhibits proteasome function and causes apoptosis and radiosensitization in non-HIV-associated human cancer cells. Cancer Res2002;
62: 5230–5235.
19.
LiuRZhangLYangJet al.
HIV protease inhibitors sensitize human head and neck squamous carcinoma cells to radiation by activating endoplasmic reticulum stress. PLoS One2015;
10: e0125928.
20.
GuptaSHavensPLSouthernJFet al.
Epstein–Barr virus-associated intracranial leiomyosarcoma in an HIV-positive adolescent. J Pediatr Hematol Oncol2010;
32: e144–e147.
