Abstract
Primary intracranial smooth muscle tumors are rare. Most cases are related to Epstein-Barr virus proliferation in immunocompromised patients such as organ solid recipients. Only a few cases have been reported in pediatric patients. The clinical features are very variable depending mainly on the location and size of the smooth muscle tumor (SMT) and the pathogenesis is poorly understood. We describe two cases of intracranial SMT localized in the temporal lobe and associated with EBV in immunosuppressed children. A review of the literature associated with intracranial leiomyomas was also done.
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Magg T, Schober T, Walz C, Ley-Zaporozhan J, Facchetti F, Klein C, Hauck F (2018) Epstein-Barr virus+ smooth muscle tumors as manifestation of primary immunodeficiency disorders. Front Immunol 9:368. https://doi.org/10.3389/fimmu.2018.00368
Balarezo FS, Joshi VV (2002) Proliferative and neoplastic disorders in children with acquired immunodeficiency syndrome. Adv Anat Pathol 9:360–370. https://doi.org/10.1097/00125480-200211000-00005
McClain KL, Leach CT, Jenson HB et al (1995) Association of Epstein-Barr virus with leiomyosarcomas in young people with AIDS. N Engl J Med 332:12–18
Taylor GS, Long HM, Brooks JM, Rickinson AB, Hislop AD (2015) The immunology of Epstein-Barr virus–induced disease. Annu Rev Immunol 33:787–821. https://doi.org/10.1146/annurev-immunol-032414-112326
Lee ES, Locker J, Nalesnik M et al (1995) The association of Epstein–Barr virus with smooth-muscle tumors occurring after organ transplantation. N Engl J Med 332:19–25
Jha HC, Pei Y, Robertson ES (2016) Epstein-Barr virus: diseases linked to infection and transformation. Front Microbiol 7:1602. https://doi.org/10.3389/fmicb.2016.01602
Jonigk D, Laenger F, Maegel L, Izykowski N, Rische J, Tiede C, Klein C, Maecker-Kolhoff B, Kreipe H, Hussein K (2012) Molecular and clinicopathological analysis of Epstein-Barr virus-associated posttransplant smooth muscle tumors. Am J Transplant 12:1908–1917. https://doi.org/10.1111/j.1600-6143.2012.04011.x
Kroe DJ, Hudgins WR, Simmons JC, Blackwell CF (1968) Primary intrasellar leiomyoma. Case report. J Neurosurg 29:189–191. https://doi.org/10.3171/jns.1968.29.2.0189
Thierauf P, Weiland H (1978) Intracranial Leiomyoma. Die Medizinische Welt 29:1280–1212
Asai A, Yamada H, Murata S, Matsuno A, Tsutsumi K, Takemura T, Matsutani M, Takakura K (1988) Primary leiomyosarcoma of the dura mater. Case report. J Neurosurg 68:308–311. https://doi.org/10.3171/jns.1988.68.2.0308
Anderson WR, Cameron JD, Tsai SH (1980) Primary intracranial leiomyosarcoma. Case report with ultrastructural study. J Neurosurg 53:401–405. https://doi.org/10.3171/jns.1980.53.3.0401
Louis DN, Richardson EP, Dickersin GR, Petrucci DA, Rosenberg AE, Ojemann RG (1989) Primary intracranial leiomyosarcoma. Case report. J Neurosurg 71:279–282. https://doi.org/10.3171/jns.1989.71.2.0279
Kazumoto K, Kogure S, Matzumoto M (1992) Primary intracranial leiomyoma: report of a case. Brain Tumor Pathol 9:87–89
Skullerud K, Stenwig AE, Brandtzaeg P, Nesland JM, Kerty E, Langmoen I, Saeter G (1995) Intracranial primary leiomyosarcoma arising in a teratoma of the pineal area. Clin Neuropathol 14:245–248
Niwa J, Hashi K, Minase T (1996) Radiation induced intracranial leiomyosarcoma: its histopathological features. Acta Neurochir 138:1470–1471. https://doi.org/10.1007/BF01411129
Lin SL, Wang JS, Huang CS, Tseng HH (1996) Primary intracerebral leiomyoma: a case with eosinophilic inclusions of actin filaments. Histopathology 28:365–369. https://doi.org/10.1046/j.1365-2559.1996.d01-440.x
Murakami N, Morioka T, Nishio S, Matsukado K, Inamura T, Fukui M, Kouno S (1997) Radiation-induced leiomyosarcoma of the dura mater: a case report. No Shinkei Geka 25:1049–1053
Wang KC, Kim CJ, Cho BK, Kim IO, Lee HJ, Chi JG (1997) Cerebral leiomyoma in a child. J Korean Med Sci 12:378–382. https://doi.org/10.3346/jkms.1997.12.4.378
Lai PH, Yang CF, Huang CH, Yeh LR, Lin SL, Pan HB (1998) Primary intracranial leiomyoma: case report. Neuroradiology 40:238–241. https://doi.org/10.1007/s002340050574
Kleinschmidt-Demasters BK, Mierau GW, Sze CI, Breeze RE, Greffe B, Lillehei KO, Stephens JK (1998) Unusual dural and skull-based mesenchymal neoplasms: a report of four cases. Hum Pathol 29:240–245. https://doi.org/10.1016/S0046-8177(98)90042-9
Litofsky NS, Pihan G, Corvi F, Smith TW (1998) Intracranial leiomyosarcoma: a neuro-oncological consequence of acquired immunodeficiency syndrome. J Neuro-Oncol 40:179–183. https://doi.org/10.1023/A:1006167629968
Karpinski NC, Yaghmai R, Barba D, Hansen LA (1999) Case of the month: March 1999 - a 26 year old HIV positive male with dura based masses. Brain Pathol 9:609–610. https://doi.org/10.1111/j.1750-3639.1999.tb00609.x
Bargiela A, Rey JL, Díaz JL, Martínez A (1999) Meningeal leiomyoma in an adult with AIDS: CT and MRI with pathological correlation. Neuroradiology 41:696–698. https://doi.org/10.1007/s002340050826
Blumenthal DT, Raizer JJ, Rosenblum MK, Bilsky MH, Hariharan S, Abrey LE (1999) Primary intracranial neoplasms in patients with HIV. Neurology 52:1648–1651. https://doi.org/10.1212/wnl.52.8.1648
Bejjani GK, Stopak B, Schwartz A, Santi R (1999) Primary dural leiomyosarcoma in a patient infected with human immunodeficiency virus: case report. Neurosurgery 44:199–202. https://doi.org/10.1097/00006123-199901000-00119
Brown HG, Burger PC, Olivi A, Sills AK, Barditch-Crovo PA, Lee RR (1999) Intracranial leiomyosarcoma in a patient with AIDS. Neuroradiology 41:35–39. https://doi.org/10.1007/s002340050701
Kim SH, Youm JY, Song SH, Kim Y, Song KS (1999) Primary intracranial leiomyoma. J Neurosurg 90:171. https://doi.org/10.3171/jns.1999.90.1.0171
Citow JS, Kranzler L (2000) Multicentric intracranial smooth-muscle tumor in a woman with human immunodeficiency virus. Case report. J Neurosurg 93:701–703. https://doi.org/10.3171/jns.2000.93.4.0701
Lerdlum S, Lalitanantpong S, Numkarunarunrote N, Chaowanapanja P, Suankratay C, Shuangshoti S (2004) MR Imaging of CNS leiomyosarcoma in AIDS patients. J Med Assoc Thail 87:152
Kumar S, Santi M, Vezina G, Rosser T, Chandra RS, Keating R (2004) Epstein-Barr virus-associated smooth muscle tumor of the basal ganglia in an HIV+ child: case report and review of the literature. Pediatr Dev Pathol 7:198–203
Suankratay C, Shuangshoti S, Mutirangura A, Prasanthai V, Lerdlum S, Shuangshoti S, Pintong J, Wilde H (2005) Epstein-Barr virus infection-associated smooth-muscle tumors in patients with AIDS. Clin Infect Dis 40:1521–1528. https://doi.org/10.1086/429830
Hussain S, Nanda A, Fowler M, Ampil FL, Burton GV (2006) Primary intracranial leiomyosarcoma: report of a case and review of the literature. Sarcoma 2006:1–3
Ali AE, Fazl M, Bilbao JM (2006) Primary intracranial leiomyoma: a case report and literature review. Virchows Arch 449:382–384
Mathieson CS, St George EJ, Stewart W, Sastry J, Jamal S (2009) Primary intracranial leiomyosarcoma: a case report and review of the literature. Childs Nerv Syst 25:1013–1017. https://doi.org/10.1007/s00381-009-0845-3
Zevgaridis D, Tsonidis C, Kapranos N, Venizelos I, Tsitsopoulos P, Tsitsopoulos P (2009) Epstein-Barr virus associated primary intracranial leiomyoma in organ transplant recipient: case report and review of the literature. Acta Neurochir 151:1705–1709. https://doi.org/10.1007/s00701-009-0307-4
Hua W, Xu F, Mao Y, Zhang JW, Wang Y, Mao RL, Zhou LF (2009) Primary intracranial leiomyomas: report of two cases and review of the literature. Clin Neurol Neurosurg 111:907–912. https://doi.org/10.1016/j.clineuro.2009.08.016
Gupta S, Havens PL, Southern JF, Firat SY, Jogal SS (2010) Epstein-Barr virus-associated intracranial leiomyosarcoma in an HIV-positive adolescent. J Pediatr Hematol Oncol 32:e144–e147. https://doi.org/10.1097/MPH.0b013e3181c80bf3
Dorwal P, Kaul S, Arora D, Prasad R (2010) Intracranial leiomyoma in a male patient. Indian J Pathol Microbiol 53:837–839. https://doi.org/10.4103/0377-4929.72074
Sivendran S, Vidal CI, Barginear MF (2011) Primary intracranial leiomyosarcoma in an HIV-infected patient. Int J Clin Oncol 16:63–66. https://doi.org/10.1007/s10147-010-0110-5
Ibebuike KE, Pather S, Emereole O, Ndolo P, Kajee A, Gopal R, Naidoo S (2012) Epstein-Barr virus-associated smooth muscle tumour presenting as a parasagittal brain tumour. J Clin Neurosci 19:1589–1591. https://doi.org/10.1016/j.jocn.2011.09.037
Lohan R, Bathla G, Gupta S, Hegde AN (2013) Epstein-Barr virus (EBV)-related smooth muscle tumors of central nervous system-a report of two cases and review of literature. Clin Imaging 37:564–568. https://doi.org/10.1016/j.clinimag.2012.09.019
Ko A, Su DK, Born D, DeSantis A, Alan Failor R, Ferreira M Jr (2013) Two patients with primary sellar leiomyomas, a rare entity. J Clin Neurosci 20:897–901. https://doi.org/10.1016/j.jocn.2012.07.001
Fornoff L, Nelson KS, McComb RD (2013) Primary intracranial leiomyoma in immunocompetent patients: case report, review of literature, and treatment recommendations. J Neurol Disord 1:102
Garces J, Mathkour M, Valle-Giler E et al (2016) Primary intraventricular leiomyoma in an immunocompetent patient: first case report and review of the literature. World Neurosurg 90:698.e13–698.E18. https://doi.org/10.1016/j.wneu.2016.01.088
Patel U, Patel N (2017) Primary intracranial leiomyoma in renal transplant recipient. Saudi J Kidney Dis Transpl 28:921–924
Derakhshan F, Taraboanta C, Yip S (2017) Epstein-Barr virus associated primary intracranial leiomyoma in a patient with human immunodeficiency virus. Clin Neuropathol 36:151–153
Hussein K, Maecker-Kolhoff B, Donnerstag F, Laenger F, Kreipe H, Jonigk D (2013) Epstein-Barr virus-associated smooth muscle tumours after transplantation, infection with human immunodeficiency virus and congenital immunodeficiency syndromes. Pathobiology 80:297–301. https://doi.org/10.1159/000351326
Jehendran MV, Monish V, Aswathappa S, Ramprakash HV (2019) Primary intracranial leiomyoma-a case report and literature review. Indian J Radiol Imaging 29:72–76
Kelley TW, Borden EC, Goldblum JR (2004) Estrogen and progesterone receptor expression in uterine and extrauterine leiomyosarcomas: an immunohistochemical study. Appl Immunohistochem Mol Morphol 12:338–341. https://doi.org/10.1097/00129039-200412000-00008
Gargett CE, Bucak K, Zaitseva M, Chu S, Taylor N, Fuller PJ, Rogers PA (2002) Estrogen receptor-alpha and -beta expression in microvascular endothelial cells and smooth muscle cells of myometrium and leiomyoma. Mol Hum Reprod 8:770–775. https://doi.org/10.1093/MOLEHR/8.8.770
Kim JJ, Sefton EC (2012) The role of progesterone signaling in the pathogenesis of uterine leiomyoma. Mol Cell Endocrinol 358:223–231
Raheja A, Sowder A, Palmer C, Rodriguez FJ, Couldwell WT (2017) Epstein-Barr virus - associated smooth muscle tumor of the cavernous sinus: a delayed complication of allogenic peripheral blood stem cell transplantation: case report. J Neurosurg 126:1479–1483. https://doi.org/10.3171/2016.4.JNS16290
Ong KW, Teo M, Lee V, Ong D, Lee A, Tan CS, Vathsala A, Toh HC (2009) 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 Res 15:5350–5358. https://doi.org/10.1158/1078-0432.CCR-08-2979
Fingar DC, Blenis J (2004) Target of rapamycin (TOR): an integrator of nutrient and growth factor signals and coordinator of cell growth and cell cycle progression. Oncogene 23:3151–3171
Shen Q, Feng W, Long MS, Duan X, Jaijakul S, Arias CA, Brown RE, Zhao B (2011) Multicentric hepatic EBV-associated smooth muscle tumors in an AIDS patient: a case report, investigation of mTOR activation and review of the literature. Int J Clin Exp Pathol 4:421–429
Setsu N, Yamamoto H, Kohashi K, Endo M, Matsuda S, Yokoyama R, Nishiyama K, Iwamoto Y, Dobashi Y, Oda Y (2012) The Akt/mammalian target of rapamycin pathway is activated and associated with adverse prognosis in soft tissue leiomyosarcomas. Cancer 118:1637–1648. https://doi.org/10.1002/cncr.26448
Chaves NJ, Kotsimbos TC, Warren MA, McLean CA, Spelman DW, Williams TJ, Snell GI, Westall GP (2007) Cranial leiomyosarcoma in an Epstein-Barr virus (EBV)-mismatched lung transplant recipient. J Heart Lung Transplant 26:753–755. https://doi.org/10.1016/j.healun.2007.05.007
Young LS, Rickinson AB (2004) Epstein-Barr virus: 40 years on. Nat Rev Cancer 4:757–768
Shaw RK, Issekutz AC, Fraser R, Schmit P, Morash B, Monaco-Shawver L, Orange JS, Fernandez CV (2012) Bilateral adrenal EBV-associated smooth muscle tumors in a child with a natural killer cell deficiency. Blood 119:4009–4012. https://doi.org/10.1182/blood-2011-10-385377
Schober T, Magg T, Laschinger M et al (2017) A human immunodeficiency syndrome caused by mutations in CARMIL2. Nat Commun:8. https://doi.org/10.1038/ncomms14209
Jossen J, Chu J, Hotchkiss H, Wistinghausen B, Iyer K, Magid M, Kamath A, Roayaie S, Arnon R (2015) Epstein-Barr virus-associated smooth muscle tumors in children following solid organ transplantation: a review. Pediatr Transplant 19:235–243
Toh HC, Teo M, Ong KW, Lee V, Chan E, Lee ASG, Vathsala A (2006) Use of sirolimus for Epstein-Barr virus-positive smooth-muscle tumour. Lancet Oncol 7:955–957. https://doi.org/10.1016/S1470-2045(06)70943-3
Dancey J (2010) MTOR signaling and drug development in cancer. Nat Rev Clin Oncol 7:209–219
Blagosklonny MV (2013) Immunosuppressants in cancer prevention and therapy. OncoImmunology 2:1–8
Gallien S, Zuber B, Polivka M, Lagrange-Xelot M, Thiebault JB, Bertheau P, Gray F, Molina JM (2008) Multifocal Epstein-Barr virus-associated smooth muscle tumor in adults with AIDS: case report and review of the literature. Oncology 74:167–176
Belingheri M, Comoli P, Locatelli F, Baldanti F, Martina V, Giani M, Ferraresso M, Cro L, Edefonti A, Ghio L (2010) Successful medical treatment of EBV smooth muscle tumor in a renal transplant recipient. Pediatr Transplant 14:E101–E104. https://doi.org/10.1111/j.1399-3046.2009.01213.x
Purgina B, Rao UNM, Miettinen M, Pantanowitz L (2011) AIDS-related EBV-associated smooth muscle tumors: a review of 64 published cases. Pathol Res Int 2011:1–10. https://doi.org/10.4061/2011/561548
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The authors would like to acknowledge Dr. Juan Jose Marengo for playing a key role in the approach and treatment of the reported cases.
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Paez-Nova, M., Andaur, K., García-Ballestas, E. et al. Primary intracranial smooth muscle tumor associated with Epstein-Barr virus in immunosuppressed children: two cases report and review of literature. Childs Nerv Syst 37, 3923–3932 (2021). https://doi.org/10.1007/s00381-021-05173-0
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DOI: https://doi.org/10.1007/s00381-021-05173-0