case_images: PMC10601747_01
case_images: a An overview of the clinical course. Immunosuppressants: tacrolimus (TL), prednisolone (PSL), and everolimus (EL). Hematoxylin-eosin staining (b), immunohistochemistry for CD8 (c) and CD4 (d), and in situ hybridization for Epstein-Barr virus-encoded small RNA (e) of the liver biopsy specimen after kidney transplantation conducted in 2015. CT (f) and Ga scintigraphy (g) images showing posttransplant hepatitis in 2015. CT images of the patient with EVB-SMT in 2018 (h, i), 2022 (j, k), and after dialysis (l, m).
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case_images: F1
case_images: A 20-year-old female patient who underwent kidney transplant surgery after she was diagnosed with focal segmental glomerulosclerosis in November 2015 experienced upper abdominal pain and was referred to our department in 2018 (Fig. 1). Her computed tomography (CT) scan revealed large liver tumors (>5 cm in diameter), multiple small lung tumors, and a left ovarian tumor (Fig. 1). The results of gallium scintigraphy performed in 2018 revealed the presence of gallium accumulation throughout the liver (Fig. 1). Subsequently, histopathological examination of a liver biopsy specimen revealed spindle cell proliferation with overlapping fascicles; therefore, the tumor was considered to be one of the types of sarcoma (Fig. 1, 2a, b). Accordingly, we added EL (2 mg/day), considering that EL could have both immunosuppressive and antitumor effects, and decreased a simple immunosuppressant, tacrolimus, from 5 mg/day to 3 mg/day (Fig. 1).
case_images: Pathological analyses of the liver tumor. a Hematoxylin-eosin staining (HE). b Elastica-Masson staining (EM). c Immunohistochemistry (IHC) with an anti-SMA antibody. d IHC with an anti-desmin antibody. e In situ hybridization (ISH) of Epstein-Barr virus-encoded small RNA (EBER). f IHC with an anti-Ki-67 antibody.
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case_images: F2
case_images: Subsequently, histopathological examination of a liver biopsy specimen revealed spindle cell proliferation with overlapping fascicles; therefore, the tumor was considered to be one of the types of sarcoma (Fig. 1, 2a, b). Further, we performed immunohistochemistry of the liver specimen, and the results were positive for markers such as smooth muscle actin and desmin (Fig. 2c, d). Moreover, the result of in situ hybridization for EBV-encoded small RNA was positive (Fig. 2e). The Ki-67 index was found to be low (2-5%) (Fig. 2f), and this tumor exhibited very low aggressive properties.
case_images: Changes in CT images of the EBV-SMTs in the lung and liver. a PET-CT image in July 2018. b CT images in July 2018. c CT images in January 2022.
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case_images: F3
case_images: Three months later, the liver and lung tumors had slightly diminished in size (Fig. 3).