Correspondence

Epstein–Barr Virus in Smooth-Muscle Tumors

N Engl J Med 1995; 332:1719June 22, 1995

Article

To the Editor:

Lee et al. (Jan. 5 issue)1 described three young liver-transplant recipients in whom smooth-muscle tumors containing the Epstein–Barr virus (EBV) genome developed. In the same issue of the Journal McClain et al. reported an association of EBV with leiomyosarcomas and leiomyomas in five children and one young man with AIDS.2 A causal relation between EBV infection and the subsequent proliferation of smooth-muscle cells was thought to be likely.3

In the Netherlands, 7000 kidney transplantations have been performed since 1967. Our National Registry for Malignancies after Kidney Transplantation documented the occurrence of leiomyosarcoma in only one patient. This patient, in whom renal insufficiency developed as a result of polycystic kidney disease, underwent transplantation in 1986. She received equine antithymocyte globulin as induction therapy and was treated with cyclosporine and prednisone thereafter. In 1991, the transition from cyclosporine therapy to treatment with azathioprine had to be stopped because of liver-enzyme abnormalities. In October 1993, a progressive skin defect developed on the left lower leg, which biopsies showed to be a leiomyosarcoma. The tumor was excised in toto, with confirmation of the diagnosis by electron microscopy. Radiotherapy (66 Gy) was given postoperatively. Currently, the patient is in good condition with no signs of tumor recurrence. Serologic analysis showed evidence of past infection with EBV; however, the results of in situ hybridization to detect the EBV genome were negative.

In this adult renal-transplant recipient with a leiomyosarcoma, no EBV genome could be demonstrated within the tumor, despite evidence of past infection with EBV. This case does not support a causal relation between EBV infection and leiomyosarcomas in adults.

T. van Gelder, M.D.
V.D. Vuzevski, M.D.
W. Weimar, M.D.
University Hospital Rotterdam, 3015 GD Rotterdam, the Netherlands

3 References

1. 1

   Lee ES, Locker J, Nalesnik M, et al. The association of Epstein-Barr virus with smooth-muscle tumors occurring after organ transplantation. N Engl J Med 1995;332:19-25
   Full Text | Web of Science | Medline

2. 2

   McClain KL, Leach CT, Jenson HB, et al. Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS. N Engl J Med 1995;332:12-18
   Full Text | Web of Science | Medline

3. 3

   Liebowitz D. Epstein-Barr virus -- an old dog with new tricks. N Engl J Med 1995;332:55-57
   Full Text | Web of Science | Medline

Citing Articles (9)

Citing Articles

1. 1

   Michael T. Tetzlaff, Carl Nosek, Carrie L. Kovarik. (2011) Epstein-Barr virus-associated leiomyosarcoma with cutaneous involvement in an African child with human immunodeficiency virus: a case report and review of the literature. Journal of Cutaneous Pathology 38:9, 731-739
   CrossRef

2. 2

   B. Sprangers, S. Smets, X. Sagaert, A. Wozniak, E. Wollants, M. Van Ranst, M. Debiec-Rychter, R. Sciot, Y. Vanrenterghem, D. R. Kuypers. (2008) Posttransplant Epstein-Barr Virus-Associated Myogenic Tumors: Case Report and Review of the Literature. American Journal of Transplantation 8:1, 253-258
   CrossRef

3. 3

   Srilatha Atluri, Kathleen Neville, Mary Davis, Kent A. Robertson, Francis E. Marshalleck, Dennis P. O??Malley, Rebecca H. Buckley, Robert P. Nelson. (2007) Epstein-Barr???associated Leiomyomatosis and T-cell Chimerism After Haploidentical Bone Marrow Transplantation for Severe Combined Immunodeficiency Disease. Journal of Pediatric Hematology/Oncology 29:3, 166-172
   CrossRef

4. 4

   Hal B. Jenson. 2006. Leiomyosarcoma. , 297-310.
   CrossRef

5. 5

   S. Ingen-housz-Oro, H. Bachelez, J. Mikol, M. Viguier, P. Marandas, L. Dubertret. (2002) Laryngeal leiomyosarcoma in a patient with Sezary syndrome. British Journal of Dermatology 147:4, 809-810
   CrossRef

6. 6

   Sylvie Euvrard, Jean Kanitakis, Alain Claudy. (2002) Neoplastic Skin Diseases in Organ Transplant Recipients. American Journal of Cancer 1:2, 109-120
   CrossRef

7. 7

   J. Kanitakis, E. Carbonnel, B. Chouvet, B. Labeille, A. Claudy. (2000) Cutaneous leiomyomas (piloleiomyomas) in adult patients with human immunodeficiency virus infection. British Journal of Dermatology 143:6, 1338-1340
   CrossRef

8. 8

   Joe L Hsu, Sally L Glaser. (2000) Epstein–Barr virus-associated malignancies: epidemiologic patterns and etiologic implications. Critical Reviews in Oncology/Hematology 34:1, 27-53
   CrossRef

9. 9

   Yoshito Sadahira, Takuya Moriya, Teruo Shirabe, Tsuyoshi Matsuno, Toshiaki Manabe. (1996) Epstein-Barr virus-associated post-transplant primary smooth muscle tumor of the liver: Report of an autopsy case. Pathology International 46:8, 601-604
   CrossRef