PMC6669837_01
(A and B) Computed tomography (CT) before treatment for posttransplantation lymphoproliferative disorder. Large tumors are present in the left lung (arrow) and left lobe of the liver (arrowhead). (C and D) CT before segmentectomy of the liver. Due to administration of several chemotherapy agents, the left lung tumor was reduced in size. In contrast, the size of the tumor in the left lobe of the liver increased (arrowhead).
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Multiple lung and liver tumors were detected 1.5 years after transplantation (Figure 1A and B), and a biopsy revealed PTLD (diffuse large B-cell lymphoma). A liver biopsy was performed because the hepatic lesion continued to progress while the pulmonary lesion decreased in size (Figure 1C and D); however, only necrotic tissue was detected.
Magnetic resonance imaging before liver segmentectomy: (A) sagittal plane and (B) coronal plane. A spinal tumor was detected at the level of C2 (arrow).
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At this time, neck pain appeared, and a spinal tumor was detected on magnetic resonance imaging (Figure 2).
The histopathology of the tumor. Hematoxylin-eosin (HE) staining (A) x20, (B) x200 and immunohistochemical staining, (C) alpha-SMA, and (D) EBER. (A) The cellularity of the tumor tissue is very high. Tumor cells spread into the normal tissue around the tumor. (B) The tumor cells were spindle type. Numerous mitotic figures were detected. (C and D) The tumor was positive for alpha-SMA and EBER. alpha-SMA indicates alpha-smooth muscle actin; EBER, Epstein-Barr virus-encoded small RNA.
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Several mitotic figures were detected (Figure 3A and B). Immunohistochemical staining was positive for alpha-smooth muscle actin (alpha-SMA) and negative for CD20, CD34, S100, and c-kit (Figure 3C). Finally, the tumor was diagnosed as EBV-associated leiomyosarcoma based on the detection of EBER in the spindle cells (Figure 3D).