Sir,
I thank the author for the interest shown in our published article and appreciate the new information reported.[1]
In fact, the number of reported cases of smooth muscle tumor (SMT) arising in the setting of human immunodeficiency virus (HIV) infection has been increasing for the last three decades. Coinfection with Epstein-Barr virus (EBV) appears to be a necessary cofactor for the development of these tumors.[2,3] These EBV-related SMT also were reported in posttransplant immunosuppressed patients and individuals with autoimmune disease or iatrogenic immunosuppression.[4] None of these conditions, including HIV infection, was present in the patient of our case report. Detection of EBV was performed in the tumor tissue with negative results.
Although EBV-SMT affects especially patients who are young, severely immunosuppressed and have multifocal tumors, it is true that EBV-SMT should be included in the differential diagnosis of any SMT occurring in uncommon sites (e.g., conjunctiva).[2] These tumors appear to have a more favorable prognosis than conventional leiomyosarcoma.
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Conflicts of interest
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References
- 1.Montes TL, Agra MV, Alonso MS, Lorenzo AO. Conjunctival leiomyosarcoma: A case report and review of literature. Indian J Ophthalmol. 2017;65:406–8. doi: 10.4103/ijo.IJO_656_16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Moore Dalal K, Antonescu CR, Dematteo RP, Maki RG. EBV-associated smooth muscle neoplasms: Solid tumors arising in the presence of immunosuppression and autoimmune diseases. Sarcoma. 2008;2008:859407. doi: 10.1155/2008/859407. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Issarachaikul R, Shuangshoti S, Suankratay C. Epstein-Barr virus-associated smooth muscle tumors in AIDS patients: A largest case (series) Intern Med. 2014;53:2391–6. doi: 10.2169/internalmedicine.53.2674. [DOI] [PubMed] [Google Scholar]
- 4.Purgina B, Rao UN, Miettinen M, Pantanowitz L. AIDS-related EBV-associated smooth muscle tumors: A Review of 64 published cases. Patholog Res Int. 2011;2011:561548. doi: 10.4061/2011/561548. [DOI] [PMC free article] [PubMed] [Google Scholar]