Non-AIDS Kaposi's sarcoma in the head and neck area

Kaposi Sarcoma Mimicking a Lingual Lesion in an HIV-Negative Patient: A Case Report

Tonsillar Kaposi sarcoma is rare, reported in patients with human immunodeficiency virus (HIV) infection. This case report of a tonsillar Kaposi sarcoma (KS) in an HIV-negative male patient, initially misinterpreted as a lingual lesion diagnosed with KS following tonsillectomy, highlights the value of a differential diagnosis in atypical presentations. The case report discusses the etiologic agent of KS, its detection and treatment, and a few case reports about tonsillar KS with no association with AIDS. The case underscores the diagnostic challenge of oropharyngeal lesions, particularly in patients with risk factors but negative HIV status.

Radiotherapy result of a case of Kaposi's sarcoma located on the vocal cord

Kaposi's sarcoma (KS) is an angiogenic tumor. KS lesions frequently develop in the skin and oral cavity mucosa in the head and neck regions, and pure laryngeal localization is extremely rare. We reported a 64-year-old male patient without HIV, HBV, and HCV positivity presented with a hemangiomatous lesion detected incidentally in the right vocal cord. Biopsy was taken for histopathological and immunohistochemical evaluation. Examination revealed that spindle cells were of vascular origin and expressed HHV-8, a specific marker associated with Kaposi's sarcoma-associated herpesvirus. Positron emission tomography-computed tomography (PET/CT) demonstrated an increased fluorodeoxyglucose (FDG) uptake in the vocal cord. The patient was treated with a 30 Gy volumetric arc plan. Disease-free follow-up continues in the first year after low-dose definitive RT. This is the first case report of KS in the vocal cord in which the most detailed data about RT were shared.

Isolated Kaposi sarcoma of the upper aerodigestive tract in immunocompetent individuals, an underrecognized entity with favorable prognosis

Kaposi sarcoma (KS) is a rare vascular neoplasm that most commonly arises in the setting of immunosuppression, in areas with high prevalence of Human Herpesvirus-8 infection, and when both situations coexist. Most cases affect the skin, isolated involvement of the upper respiratory tract without skin involvement is extremely rare with only a few cases reported in the literature. We present a case of isolated nasopharyngeal KS in an immunocompetent patient who achieved remission after multimodality therapy. Recent advances in KS-therapy are discussed.

Primary Kaposi's Sarcoma of the Nasal Cavity: Clinical Experience and Review of the Literature

Kaposi's sarcoma (KS) is a vascular sarcoma derived from vascular endothelial cells and presents with multiple lesions. It mainly appears on the skin and oral mucosa, usually in the face, oral mucosa, and genitals. Very few cases of primary lesions in the nasal cavity have been reported. It is often difficult to diagnose only by imaging examination. Here, we describe a case of KS in a patient who was human immunodeficiency virus (HIV)-negative, in which the primary sites were the nasal mucosa and nasal septum. A diagnosis was made according to the patient's clinical presentation, physical examination, laboratory examination, imaging examination, and histopathological results. We used surgical resection combined with chemotherapy, with 6 months' postoperative follow-up without recurrence. We reviewed the relevant literature to identify similar cases and summarize the findings reported on this rare manifestation of KS. We recommend that, where possible, antiviral therapy such as interferon, and regular review should continue, to improve the survival rate and patients' quality of life.

Recurrent Kaposi sarcoma of the ear in an HIV-negative patient: A case report with review of the literature. Is ear a predilection site for Kaposi sarcoma in HIV-negatives?

While Kaposi sarcoma (KS) of the head and neck is common in HIV-positives, it is a rare presentation in HIV-negatives. It is important to consider KS in the differential diagnosis of ear lesions in HIV-negative patients.

Kaposi's sarcoma of the larynx: an unusual location in an HIV-negative patient (a case report)

Head and neck involvement of Kaposi’s sarcoma is rarely encountered, especially for the Mediterranean classic subtype. Here we report a case of non-AIDS related laryngeal Kaposi’s sarcoma in a 77-year-old Tunisian man complaining of 4-month history of hoarseness and dysphagia. The patient underwent exclusive local radiotherapy with a prescription dose of 45 Gy delivered in 1.8 Gy daily fractions. He remained complaint-free for 3 months.

Quadruple Multiple Primary Malignancies: Early Detection of Second Primary Malignancy by Esophagogastroduodenoscopy/Colonoscopy Is Crucial for Patients with Classic Kaposi's Sarcoma

Currently, Kaposi's sarcoma (KS) is treated following the recommendations of international guidelines. These guidelines recommend esophagogastroduodenoscopy/colonoscopy for detecting multicentric KS of visceral lesions. Second primary malignancies (SPMs) are also a common KS complication; however, information on their detection and treatment is unfortunately not yet indicated in these guidelines. This paper reports on an 86-year-old man who suffered from quadruple primary malignancies: skin classic KS with colon adenocarcinoma, oral squamous cell carcinoma (maxilla), and well-differentiated stomach adenocarcinoma. Gastric cancer was incidentally detected during esophagogastroduodenoscopy, which was performed to detect visceral KS. We suggest that esophagogastroduodenoscopy/colonoscopy be routinely performed during the follow-up of patients with KS. As SPMs are crucial complications in patients with KS, these malignancies should be detected as early as possible.

Tonsillar Kaposi Sarcoma in an HIV-Negative Patient: A Case Report

Kaposi's sarcoma (KS) is a rare malignancy associated with AIDS and usually affects skin. The most common causative agent is the Human Herpes Virus Type 8 (HHV-8). In the literature, there are few case reports about KS with no association to AIDS. In this case report, we report a 72-year-old HIV (-) woman who presented to our clinic with a complaint of fast swelling in the right palatine tonsil and was histopathologically diagnosed as tonsillar KS.

Head and Neck Kaposi Sarcoma: Clinicopathological Analysis of 11 Cases

Kaposi sarcoma (KS) of the head and neck area is uncommon with limited published case series. Our routine and consultation files were reviewed for histologically and immunohistochemically proven KS affecting any cutaneous or mucosal head and neck site. Ten males and one female aged 42-78 years (median, 51 years; mean, 52 years) were retrieved. Eight patients were HIV-positive and three were HIV-negative. The affected sites were skin (n = 5), oral/oropharyngeal mucosa (n = 5), and lymph nodes (n = 3) in variable combination. The ear (pinna and external auditory canal) was affected in two cases; both were HIV-negative. Multifocal non-head and neck KS was reported in 50% of patients. At last follow-up (12-94 months; median, 46 months), most of patients were either KS-free (n = 8) or had ongoing remission under systemic maintenance therapy (n = 2). One patient was alive with KS (poor compliance). Histopathological evaluation showed classical features of KS. One case was predominantly sarcomatoid with prominent inflammation mimicking undifferentiated sarcoma. Immunohistochemistry showed consistent expression of CD31, CD34, ERG, D2-40 and HHV8 in all cases. This is one of the few series devoted to head and neck KS showing high prevalence of HIV-positivity, but also unusual presentations in HIV-negative patients with primary origin in the skin of the ear and the auditory canal. KS should be included in the differential diagnosis of difficult-to-classify spindle cell lesions at this uncommon location.

Oral Kaposi Sarcoma in HIV-seronegative Saudi patient: Literature review and case report

Kaposi Sarcoma (KS) is an intermediate neoplasm affecting the endothelial cells of mucous membranes and skin. It arises most commonly among HIV-infected individuals. We present an intra-oral KS in an 80-year-old Saudi male patient, who is HIV-seronegative, non-immunosuppressed, and with no history of organ transplantation. The patient was treated with fractionated radiation therapy, and had no recurrence in the 48 months of follow-up. The clinical disease, histologic features, and treatment modality used, as well as the relative literature are presented in this paper.

Pulmonary Kaposi's sarcoma in a female patient: Case report

Kaposi's sarcoma (KS) is a multicentric lymphoproliferative malignancy. Most of the time this tumor is confined to the skin and subcutaneous tissue, but it can present with widespread visceral involvement, such as in the lung. Pulmonary KS is the most frequent form in young adult males, in a ratio of 15:1. The disease usually affects individuals with low CD4 lymphocyte counts (<150-200 cells/mm3). We report a case of a female patient aged 35 years, with the presence of skin lesions, self-limiting episodes of diarrhea and weight loss of 15 kg for nearly 9 months, progressing to persistent fever. AIDS was diagnosed and biopsy of the lesions revealed Kaposi's sarcoma. Computed tomography of the chest showed peribronchovascular thickening, areas of ground glass opacity, condensations with air bronchograms surrounded by ground glass opacity (halo sign) and bilateral pleural effusion. The diagnosis of pulmonary KS is still a challenge, especially due to the occurrence of other opportunistic diseases that may also occur concurrently. Therefore, suspecting this diagnosis based on clinical and laboratory manifestations, and even more with CT findings, is fundamental, especially in patients who already have the cutaneous form of the disease.

Clinical value of diascopy and other non-invasive techniques on differential diagnosis algorithms of oral pigmentations: A systematic review

OBJECTIVES

To determine the diagnostic value of diascopy and other non-invasive clinical aids on recent differential diagnosis algorithms of oral mucosal pigmentations affecting subjects of any age.

MATERIAL AND METHODS

Data Sources: this systematic review was conducted by searching PubMed, Scopus, Dentistry & Oral Sciences Source and the Cochrane Library (2000-2015); Study Selection: two reviewers independently selected all types of English articles describing differential diagnosis algorithms of oral pigmentations and checked the references of finally included papers; Data Extraction: one reviewer performed the data extraction and quality assessment based on previously defined fields while the other reviewer checked their validity.

RESULTS

Data Synthesis: eight narrative reviews and one single case report met the inclusion criteria. Diascopy was used on six algorithms (66.67%) and X-ray was included once (11.11%; 44.44% with text mentions); these were considered helpful tools in the diagnosis of intravascular and exogenous pigmentations, respectively. Surface rubbing was described once in the text (11.11%).

CONCLUSIONS

Diascopy was the most applied method followed by X-ray and surface rubbing. The limited scope of these procedures only makes them useful when a positive result is obtained, turning biopsy into the most recommended technique when diagnosis cannot be established on clinical grounds alone. Key words:Algorithm, differential diagnosis, flow chart, oral mucosa, oral pigmentation, systematic review.

Puzzling and ambivalent roles of malarial infections in cancer development and progression

Scientific evidence strongly suggests that parasites are directly or indirectly associated with carcinogenesis in humans. However, studies have also indicated that parasites or their products might confer resistance to tumour growth.Plasmodiumprotozoa, the causative agents of malaria, exemplify the ambivalent link between parasites and cancer. Positive relationships between malaria and virus-associated cancers are relatively well-documented; for example, malaria can reactivate the Epstein-Barr Virus, which is the known cause of endemic Burkitt lymphoma. Nevertheless, possible anti-tumour properties of malaria have also been reported and, interestingly, this disease has long been thought to be beneficial to patients suffering from cancers. Current knowledge of the potential pro- and anti-cancer roles of malaria suggests that, contrary to other eukaryotic parasites affecting humans,Plasmodium-related cancers are principally lymphoproliferative disorders and attributable to virus reactivation, whereas, similar to other eukaryotic parasites, the anti-tumour effects of malaria are primarily associated with carcinomas and certain sarcomas. Moreover, malarial infection significantly suppresses murine cancer growth by inducing both innate and specific adaptive anti-tumour responses. This review aims to present an update regarding the ambivalent association between malaria and cancer, and further studies may open future pathways to develop novel strategies for anti-cancer therapies.

Head and neck sarcomas: clinical and histopathological presentation, treatment modalities, and outcomes

BACKGROUND

Sarcoma of the head and neck is a rare condition that poses significant challenges in management and often requires radical multimodality treatment.

OBJECTIVES

This study aimed to analyse current clinical presentation, evaluation, management dilemmas and oncological outcomes.

METHODS

Computer records and case notes were analysed, and 39 patients were identified. Variables were compared using Pearson's chi-square test and the log-rank test, while survival outcomes were calculated using the Kaplan-Meier method.

RESULTS

The histopathological diagnosis was Kaposi sarcoma in 20.5 per cent of cases, chondrosarcoma in 15.3 per cent and osteosarcoma in 10.2 per cent. A range of other sarcomas were diagnosed in the remaining patients. The site of disease was most commonly sinonasal, followed by the oral cavity and larynx.

CONCLUSION

Wide local excision with clear resection margins is essential to achieve local control and long-term survival. There is a need for cross-specialty collaboration in order to accrue the evidence which will be necessary to improve long-term outcomes.

Supraglottic Kaposi's Sarcoma in HIV-Negative Patients: Case Report and Literature Review

This paper presents a case report of an HIV-negative, supraglottic Kaposi's sarcoma patient. The 80-year-old male patient was admitted with complaints of hoarseness, difficulty in swallowing, and a stinging sensation in his throat for approximately six months. The endoscopic larynx examination revealed a lesion which had completely infiltrated the epiglottis, reached right aryepiglottic fold, was vegetating, pink and purple in color, multilobular, fragile, and shaped like a bunch of grapes, and partially blocked the bleeding airway passage. The case was discussed by the hospital's head-neck cancer committee and a surgery decision was made. A tracheotomy was performed under local anesthesia before the operation due to respiratory distress and endotracheal intubation difficulty. Direct laryngoscopy showed that the mass was limited in the supraglottic area, had invaded the entire left aryepiglottic fold and one-third of the front right aryepiglottic fold, and completely covered epiglottis. It should be remembered that although rare, Kaposi's sarcoma may be encountered in larynx malignancy cases. Disease-free survival may be achieved through local excision and postoperative radiotherapy.

Classic Mediterranean type of epiglottic Kaposi sarcoma

Kaposi sarcoma is a malignant, multifocal, vascular, and low-grade tumor that mostly occurs in mucocutaneous sites. Kaposi sarcoma is usually associated with acquired immunodeficiency syndrome and involves lymphatic nodes and visceral organs. In this report, an 81-year-old man with epiglottic Kaposi sarcoma who screened negative for human immunodeficiency virus is presented.

Mucosal Kaposi sarcoma, a Rare Cancer Network study

Kaposi's sarcoma (KS) most often affect the skin but occasionally affect the mucosa of different anatomic sites. The management of mucosal KS is seldom described in the literature. Data from 15 eligible patients with mucosal KS treated between 1994 and 2008 in five institutions within three countries of the Rare Cancer Network group were collected. The inclusion criteria were as follows: age >16 years, confirmed pathological diagnosis, mucosal stages I and II, and a minimum of 6 months' follow-up after treatment. Head and neck sites were the most common (66%). Eleven cases were HIV-positive. CD4 counts correlated with disease stage. Twelve patients had biopsy only while three patients underwent local resection. Radiotherapy (RT) was delivered whatever their CD4 status was. Median total radiation dose was 16.2 Gy (0–45) delivered in median 17 days (0–40) with four patients receiving no RT. Six patients underwent chemotherapy and received from 1 to 11 cycles of various regimens namely vinblastin, caelyx, bleomycine, or interferon, whatever their CD4 counts was. Five-year disease free survival were 81.6% and 75.0% in patients undergoing RT or not, respectively. Median survival was 66.9 months. Radiation-induced toxicity was at worse grade 1–2 and was manageable whatever patients' HIV status. This small series of mucosal KSs revealed that relatively low-dose RT is overall safe and efficient in HIV-positive and negative patients. Since there are distant relapses either in multicentric cutaneous or visceral forms in head and neck cases, the role of systemic treatments may be worth investigations in addition to RT of localized disease. Surgery may be used for symptomatic lesions, with caution given the risk of bleeding.

Sarcoma de Kaposi em membros inferiores: relato de caso

O sarcoma de Kaposi é uma neoplasia angioproliferativa maligna que na maioria das vezes se restringe à pele e ao tecido subcutâneo; porém, pode aparecer de forma mais agressiva, atingindo a cavidade oral, o trato gastrointestinal e os pulmões (sarcoma de Kaposi visceral). É classificado com quatro variantes clínco-epidemiológicas: clássica, endêmica, iatrogênica e epidêmica, todas associadas ao herpes vírus humano tipo 8. O objetivo desta publicação foi relatar um caso raro de sarcoma de Kaposi em paciente idosa imunossuprimida, não relacionado à síndrome da imunodeficiência adquirida, que evoluiu de forma desfavorável em um período de cinco meses a partir do aparecimento de lesões bolhosas hemáticas e necróticas que, posteriormente, progrediram com intensa exsudação local, desidratação, insuficiência renal e piora do estado geral, evoluindo então a óbito, tendo como causa mortis a falência de múltiplos órgãos.

Classic Kaposi's sarcoma in Han Chinese and useful tools for differential diagnosis

Kaposi's sarcoma (KS) is a common AIDS-related malignant neoplasm in the head and neck region, especially in the oral cavity, but is rarely described in the HIV-negative and non-immunosuppressed individual. Our case is of interest, because it is the first case in which manifestation of the KS occurred in the face and head areas in a patient with a Han ethnic background who had an adequate immune system. The lesions were diagnosed as angiosarcomas twice. The clinical presentation, therapeutic options, and tools for differentiating Kaposi sarcoma from other vascular and nonvascular spindle cell lesions are presented, and the relevant literature is reviewed.