Epstein-Barr virus infection-associated smooth-muscle tumors in patients with AIDS.
BACKGROUND
The aim of our study is to describe the unusual clinical manifestations of smooth-muscle tumors (SMTs) in patients with acquired immunodeficiency virus (AIDS) and to demonstrate the association between Epstein-Barr virus (EBV) infection and SMTs.


METHODS
Nine patients with AIDS and SMTs were characterized at Chulalongkorn Hospital (Bangkok, Thailand) from 2001 through 2003. Tumor tissues suitable for immunohistochemical analysis and in situ hybridization were assayed for SMTs and EBV, respectively. Plasma and serum samples were tested for EBV by real-time quantitative polymerase chain reaction and serologic analysis.


RESULTS
The study included 8 adults and 1 child (3 males and 6 females). All patients had CD4 cell counts of <200 cells/microL. By the end of the study, 3 patients had died, and 6 patients had survived. The sites of SMTs were the epidura (5 intracranial and 4 intraspinal SMTs), vocal cords (2), adrenal glands (2), abdominal wall (2), iris (1), liver (1), lung (1), orbit (1), and thigh (1). Seven patients had multicentric SMTs involving intracranial sites only (4 SMTs), extra- and intracranial sites (3), or extracranial sites only (2), which occurred either concurrently or sequentially. We found evidence of EBV infection, as determined by in situ hybridization, in all SMTs. Furthermore, EBV DNA was detectable in plasma samples from 2 patients. The results of serologic analysis were consistent with past EBV infection.


CONCLUSIONS
SMTs in patients with AIDS typically arise in multiple and very unusual sites that are not often observed in SMTs among immunocompetent individuals. Our series also suggests association between EBV infection and SMTs in patients with AIDS. The exact role of EBV in smooth-muscle oncogenesis awaits further study.
Suankratay
Chusana
C
Division of Infectious Diseases, Department of Medicine, Chulalongkorn University, Bangkok, Thailand. schusana@hotmail.com
Shuangshoti
Shanop
S
Mutirangura
Apiwat
A
Prasanthai
Vichit
V
Lerdlum
Sukalya
S
Shuangshoti
Somruetai
S
Pintong
Jarupan
J
Wilde
Henry
H
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications* / Q000453:epidemiology / Q000601:surgery / Q000821:virology*; D008297:Male; D008875:Middle Aged; D013785:Thailand / Q000453:epidemiology