A Rare Occurrence of Primary Hepatic Leiomyosarcoma Associated with Epstein Barr Virus Infection in an AIDs Patient

Primary hepatic leiomyosarcoma is exceedingly rare accounting for less than 1% of the hepatic tumors. Close to 45 cases have been reported in the English literature. Presentation is usually nonspecific and diagnosis is often delayed until tumors reach a large size. This leads to a dismal prognosis. The tumors are not yet fully understood, hence the standard of care is not well defined. Curative resection remains the mainstay of management. Close association of Epstein Barr virus (EBV) induced soft tissue sarcomas is proven, especially in the presence of immunosuppression encountered in HIV/AIDS patients and in posttransplant patients. We herein present a case report of a 54-year-old man diagnosed to have HIV/AIDS and EBV infection admitted to our hospital with complaints of intractable hiccups for more than a week. Extensive workup revealed primary leiomyosarcoma of the liver. 1. Introduction Sarcomas are rare mesenchymal tumors and account for 1% of all adult tumors, of which 5–10% are leiomyosarcomas. Hepatic leiomyosarcomas are unusual tumors. Most of them are metastatic leiomyosarcomas. Primary hepatic leiomyosarcoma is a very rare entity. Primary leiomyosarcomas are known to occur in uterus, retroperitoneum, genital organs, major blood vessels of the body, lungs, and liver [1]. They usually present with nonspecific symptoms and the diagnosis is often delayed resulting in poor prognosis. We herein present a case of a 54- year- old man with HIV/AIDS and EBV infection presenting with intractable hiccups and subsequent workup led to the diagnosis of primary hepatic leiomyosarcoma. 2. Case Report A 54- year- old African American man presented to our hospital with intractable hiccups that started about a week prior to admission. He also reported intermittent low grade fever with poor oral intake and weight loss of 9 kilograms for the last 3 months. He denied abdominal pain, nausea, vomiting, or irregular bowel habits. His comorbidities included HIV/AIDS, seizure disorder, and hypertension. His CD4 count was 24 at the time of admission. He had no history of liver disease or alcohol abuse. He never had any surgery. Family history was negative for any malignancies or liver disease. On physical examination he appeared cachectic. He had no palpable lymph nodes. Abdominal examination revealed minimal tenderness in the right upper quadrant and hepatomegaly of about 6？cm below the right costal margin. Laboratory analysis revealed alanine aminotransferase 81？IU/L (0–34？IU/L), aspartate aminotransferase 56？IU/L (0–40？IU/L), alkaline phosphatase 160？IU/L