YO12 - Case report of Hepatic EBV-associated smooth muscle tumor in AIDS patient

Case summary

Case report : Hepatic EBV-associated Smooth Muscle Tumor (EBV-SMT)

A 51-year-old Thai man with history of HIV infection and chronic HBV hepatitis was sent to Vajira Hospital to evaluate liver lesions. He once had had pulmonary tuberculosis that was properly treated. Two years ago, the liver masses had been first identified on ultrasonography obtained routinely for HCC surveillance. At that moment, he was asymptomatic. His blood counts and blood chemistries including serum AFP were all unremarkable.

The triple-phase CT scan demonstrated two peripheral arterial enhancing masses with progressively enhanced on porto-venous and delayed phases, measured 5.7x4.7 cm and 4.2x3.4cm at segment IVa and IVb, respectively. Another enhancing nodule at porto-venous phase with decreased enhancement at delayed phase was found at segment V. Hepatic hemangioma had been considered and he had been advised to be closely observed, until three months ago, the repeated CT scan showed increasing size of the liver lesion at segment IVa to 6.0x4.7x5.1 cm, the rests were still stable in size.

At Vajira Hospital, he looked healthy. Physical examination was unrevealing. His blood count is normal. His blood chemistries were remarkable for mild elevation of ALT (194 U/L) (normal level, 46-116 U/L). His latest CD4 count and HIV viral load collected on 27/2/60 were 244/mm3 and less than 40 copies/mL, respectively. He was taking TDF/FTC/EFV.

MRI of upper abdomen revealed three progressively heterogeneously enhancing liver masses at segment at segment IVa, IVb, and V. The largest one was about 7.0x4.5x5.2 cm. The masses were in proximity of the left and middle hepatic veins. Percutaneous biopsy under CT guidance was done. It reported atypical spindle cell proliferation. IHC staining were positive for SMA and EBER, but negative for CD31, CD34, ERG, FLI-1, HHV-8, and Desmin. Thereby, EBV-SMT was diagnosed.

Clinical trial identification

Editorial acknowledgement