EPSTEIN-BARR-VIRUS-ASSOCIATED DURAL LEIOMYOSARCOMA IN A MAN INFECTED WITH HUMAN-IMMUNODEFICIENCY-VIRUS - CASE-REPORT

A 35-year-old man infected with human immunodeficiency virus presented with cervical myelopathy of 2 months duration. Clinical and radiograp hic evaluation revealed a discrete, subdural mass at C-6. At surgery, the mass proved to have a dural attachment and thus clinically, radiog raphically, and grossly, it resembled meningioma. Histopathological an alysis revealed a leiomyosarcoma that stained diffusely for muscle spe cific actin. Electron microscopy revealed basal lamina surrounding the tumor cells and intracytoplasmic bundles of myofilaments. Epstein-Bar r virus (EBV) was demonstrated within tumor cell nuclei by in situ hyb ridization for EBER1 messenger RNA and immunohistochemical staining fo r EBNA2 protein. Epstein-Barr virus latent membrane protein (LMP1) was not detected. This is the first documentation of an EBV-associated sm ooth-muscle tumor of the dura, and the first demonstration that tumors in this location contain EBV in an unusual form of latency not seen i n lymphoid cell Lines. With increasing numbers of individuals being af flicted with long-term immunosuppression, EBV-associated dural leiomyo ma and leiomyosarcoma may be encountered more frequently in the future .