General Spine

Douglas W Brandt, MD,
Jonathan M Morris, MD, ASSR Member

Excerpta Extraordinaire

Mentor Award: No

Institution where work was conducted

Mayo Clinic-Rochester

Affiliation and Department

Department of Radiology

Address

200 First St. SW
Rochester, Minnesota
55905
Phone: 507-284-0440, Fax: 507-293-3680
Email: brandt.douglas@mayo.edu

Purpose

To present a case report and demonstrate the imaging characteristics of a rare tumor seen in immunocompromised patients that can mimic a schwannoma.

Methods & Materials

Retrospective review of the clinical and imaging findings in an immunosuppressed renal transplant patient with an Epstein – Barr virus (EBV) associated smooth muscle tumor.

Results

A 66 year old woman with a past medical history significant for immunosuppression following a kidney/pancreas transplant in 2005 presented to Mayo Clinic with low back and buttock pain which radiated down the posterior aspect of her left thigh in a S1 distribution. An MRI scan of the lumbar-spine demonstrated a 2.2×0.9×1.2cm, mildly expansile, dumbbell-shaped mass within the left S1-S2 neural foramen which was hypointense on T1 and iso-hypointense T2 weighted images. IV contrast was not given secondary to the patient’s elevated creatinine. This mass was new when compared to images from 10 years prior. The imaging findings of this new mass were thought to be consistent with the interval development of a moderate-sized schwannoma. Given the patients concordant pain she was taken to surgery for decompressive laminectomy and removal of the mass.

Pathologic evaluation demonstrated ovoid tumor cells arranged in fascicles and mixed with lymphoid infiltrates. The tumor cells stained positive for actin and desmin and showed diffuse nuclear positivity for EBV on in-situ hybridization study. Final diagnosis was EBV-associated smooth muscle tumor.

Conclusion

Since EBV was discovered in Burkitt Lymphoma in 1964 it has been shown to play a role in the pathogenesis of many tumors including nasopharyngeal carcinoma, non-Hodgkin’s lymphoma, oral hairy leukoplakia, T-cell lymphoma, Gastric Carcinoma and Hodgkin’s disease. In 1995 a causative link between EBV and smooth muscle tumors in immunocompromised patients was established. EBV-associated smooth muscle tumors have been reported to occur in a wide variety of locations including the basal ganglia, bronchus, kidney, liver, mediastinum, lung and vulva. They are frequently multifocal, and definite metastasis has not been reported. Surgery remains the first line treatment. EBV-associated smooth muscle tumors can also occur in the spine. Due to the rarity of the tumor and its imaging characteristics, EBV-associated smooth muscle tumors can be mistaken for more common neoplasms such as schwannomas. Our goal in presenting this case is to familiarize neuroradiologists with this entity for inclusion in a differential diagnosis when evaluating immunocompromised patients.

References

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