The patient is a 32-year-old woman with a history of end stage kidney disease status post renal transplant. Her immediate post-transplant course was unremarkable; however, she later developed acute antibody rejection leading to high dose immunosuppressive therapy. Three years after her transplant, the patient was identified to have a multifocal spindle cell hepatic tumor with mild cellular atypia and scattered lymphocytes. Alpha-smooth muscle actin stain was positive while Keratin AE1/AE3, S-100, DOG1, CD117 and SOX10 stains were negative in tumor. Representative Hematoxylin and Eosin (H&E) and Desmin immunostain photomicrographs are provided.

What is your diagnosis?

A. Leiomyoma

B. Leiomyosarcoma

C. EBV-Associated Smooth Muscle Tumor

D. Fat-poor angiomyolipoma