Supplementary Material for: Clinical course of a rare Epstein–Barr virus-associated smooth muscle tumor and its genomic analysis

Epstein–Barr virus (EBV) can rarely induce smooth muscle tumors (SMTs). A 20-year-old female patient underwent kidney transplantation for renal failure. Since then, she has been treated with immunosuppressants, including a calcineurin inhibitor, tacrolimus, and prednisolone, owing to the immunological rejection. Three years later, she developed large liver tumors (diameter > 5 cm) and multiple small lung tumors that were identified as EBV-SMTs based on the results of liver biopsy/histopathology. No intervention was performed, except for the addition of an mTOR inhibitor, everolimus, which inhibits both immune reaction and SMT growth. Finally, after 8 years, the transplanted kidney became nonfunctional and immunosuppressant administration became unnecessary as urinary dialysis was started. Under these circumstances, SMT growth was observed despite the absence of immunosuppressant administration. Three months after the cessation of the immunosuppressants, EBV-SMTs in the liver and lungs shrank slightly. To the best of our knowledge, this is the first report on the genomic profile of this rare tumor. The clinical course of our patient indicates that EBV can induce SMTs, and immunological suppression of EBV may inhibit the activity of these tumors.爱泼斯坦-巴尔病毒（Epstein–Barr virus，EBV）极少诱发平滑肌肿瘤（smooth muscle tumors，SMTs）。本病例中，一名20岁女性患者因肾衰竭接受肾移植术，术后因免疫排斥反应，接受了包括钙调磷酸酶抑制剂他克莫司（tacrolimus）及泼尼松龙（prednisolone）在内的免疫抑制治疗。术后3年，患者出现直径＞5cm的巨大肝脏肿瘤及多发肺部小结节，经肝脏活检/组织病理学检查确诊为EBV相关平滑肌肿瘤（EBV-SMTs）。除加用同时抑制免疫反应与平滑肌肿瘤生长的哺乳动物雷帕霉素靶蛋白抑制剂（mTOR inhibitor）依维莫司（everolimus）外，未采取其他干预措施。术后8年，移植肾丧失功能，患者启动透析治疗，无需再服用免疫抑制剂。在此临床背景下，尽管未使用免疫抑制剂，仍观察到平滑肌肿瘤生长。停止免疫抑制剂治疗3个月后，患者肝脏与肺部的EBV-SMTs略有缩小。据我们所知，本研究为首例针对该罕见肿瘤基因组特征的报道。本病例的临床病程提示，EBV可诱发平滑肌肿瘤，而针对EBV的免疫抑制或许可抑制此类肿瘤的增殖活性。