ABSTRACT
Renal leiomyoma is a rare smooth muscle tumor of the kidney. An association between Epstein-Barr virus and smooth muscle tumors in immunocompromised patients recently has been recognized. We describe a pediatric renal transplant patient who developed an Epstein-Barr virus-associated renal leiomyoma in his transplant kidney 5 years posttransplantation. Possible factors involved in the tumor pathogenesis in our patient are discussed, including immunosuppression, growth hormone therapy, and Epstein-Barr virus induction.
Subject(s)
Epstein-Barr Virus Infections/transmission , Kidney Neoplasms/virology , Kidney Transplantation/adverse effects , Leiomyoma/virology , Postoperative Complications/virology , Transplantation, Homologous/adverse effects , Child, Preschool , Disease Transmission, Infectious , Female , Growth Disorders/etiology , Humans , Hydronephrosis/complications , Kidney/abnormalities , Kidney/chemistry , Kidney/pathology , Kidney/virology , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/surgery , Kidney Function Tests , Kidney Neoplasms/diagnostic imaging , Kidney Neoplasms/physiopathology , Leiomyoma/diagnostic imaging , Leiomyoma/physiopathology , Male , Middle Aged , Nephrectomy , Nephritis, Interstitial/etiology , Postoperative Complications/diagnostic imaging , Postoperative Complications/etiology , Postoperative Complications/physiopathology , RNA, Viral/analysis , Radiography , Recurrence , Renal Dialysis , Ultrasonography , Urethra/abnormalities , Urinary Tract Infections/etiologyABSTRACT
Isotretinoin can be teratogenic, affecting many tissues, including the ear. However, there are only two histopathologic studies of the temporal bone in affected humans, and neither describes the findings in early gestation. We had the opportunity to study both temporal bones in each of two fetuses (22 and 24 weeks) exposed to isotretinoin in early gestation. One of the fetuses had a dilated IVth ventricle and a hypoplastic cerebellar vermis, while no dysmorphic features were seen in the other. In both infants the external ears were not noticeably abnormal. Histologically, anomalies of the middle ear included medial deviation of the malleus, forward displacement of the incus, and a small tympanic cavity (4/4); unilateral absence of the stapes (1/4); single "columella" crus and hypoplastic footplate (3/4); and unilateral dehiscence of the facial canal in one infant. Autolysis limited the examination of the labyrinth, but there was reduction in the number of cochlear spirals, and dilatation of the saccule in both infants. Anomalies of the middle and inner ear can be present without anomalies of the external ear or the central nervous system, and may be found even after relatively short exposures. These anomalies are similar to those detected in experimental exposure to isotretinoin, and are consistent with altered expression of the goosecoid gene.
