Epstein-Barr virus--associated smooth muscle tumor mimicking cutaneous angioleiomyoma

We present a case of a subcutaneous, unifocal, Epstein-Barr virus--associated smooth muscle tumor mimicking a cutaneous angioleiomyoma. The patient was immunocompromised due to a renal transplant. The tumor displayed diffuse and strong immunoreactivity for smooth muscle actin, H-caldesmon; focal positivity for desmin; and strong and diffuse positivity for Epstein--Barr virus RNA on in situ hybridization. This unique presentation emphasizes the importance of considering this pathologic entity when solitary smooth muscle tumors with the histological features of an angioleiomyoma are encountered in immunocompromised patients.