A case is presented of a 36-year-old Chinese woman with a renal transplant for end-stage renal failure due to Goodpasture's syndrome. She presented with a year's history of throat discomfort and acid regurgitation into her throat. Videolaryngoscopy revealed bilateral vocal process granuloma, presumed to be due to gastroesophageal reflux. A four-week course of high dose omeprazole was prescribed. On follow up a month later, the granulomas had enlarged, and laser excision was undertaken. Histological and immunohistochemical staining was consistent with Epstein–Barr virus-associated smooth muscle tumour. This is believed to be the first reported case in the English literature of such a tumour affecting the vocal process. The aim of this paper is to present the pathogenesis, clinical behaviour and treatment of Epstein–Barr virus-associated smooth muscle tumour, and to review the literature concerning the differential diagnosis of polypoid vocal process lesions.

Head and neck cancers have been described in patients with human immunodeficiency virus-1 (HIV-1) infection. However the incidence, aetiology and clinical features of the disease remain unclear.

Patients with head and neck cancer and HIV were identified from a large HIV centre. The incidence and clinical features were recorded, and the tumours were stained for Epstein-Barr virus (EBV).

Head and neckcancer occurred more frequently than in an age-matched control group (1.66 vs 0.55/10,000 patient years respectively p < 0.05). Highly active anti-retroviral therapy has not significantly altered the incidence of the disease. All of the tumours tested were positive for EBV. Patients were moderately immunosuppressed at diagnosis and had aggressive tumours. All but one of the patients died of cancer with a median survival of 28 months.

Head and neck cancer occurs more frequently in HIV. It is an aggressive disease and EBV may play a role in its pathogenesis.