Multifocal Hepatic Epstein-Barr Virus-Associated Smooth Muscle Tumor Mimicking Posttransplant Lymphoproliferative Disorder in a Renal Allograft Recipient.

Srinivasan, Prashanth; Kumar, Srinivas Ananth; Goyal, Harish; Halanaik, Dhanapathi · Clin Nucl Med · 2026

case_report · Level V

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Abstract

Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) are rare neoplasms seen in immunocompromised patients and may mimic posttransplant lymphoproliferative disorder (PTLD). We report a 19-year-old renal transplant recipient presenting with abdominal symptoms and suspected PTLD. 18 F-FDG PET/CT demonstrated multiple hypermetabolic liver lesions. Histopathology confirmed EBV-SMT. Follow-up PET/CT after immunosuppression with mTOR inhibition demonstrated partial metabolic response. This case highlights the role of 18 F-FDG PET/CT in detecting multifocal disease, guiding biopsy, differentiating from PTLD, and assessing treatment response in EBV-SMT.

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