Intralesional vinblastine therapy for Kaposi's sarcoma of the epiglottis

Kaposi Sarcoma of the Larynx: A Systematic Review

OBJECTIVE

Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes.

DATA SOURCES

PubMed, CINAHL, SCOPUS, and Cochrane Library.

REVIEW METHODS

A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow-up, and outcome were analyzed.

RESULTS

A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8-81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS-associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow-up was 20.4 months (range, 0.75-120). Most patients with AIDS-associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow-up (n = 13).

CONCLUSION

This review contains the largest pool of laryngeal KS cases to date. Long-term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis.

Unusual presentation of oropharyngeal Kaposi's sarcoma

BACKGROUND

The aim of this article is to focus ear, nose, and throat (ENT) practitioners on a pathology rarely seen within the head and neck mucosa.

METHODS

A 62-year-old black African man was referred to our ENT department for dysphagia and hoarseness. Physical ENT examination revealed a smooth normal mucosal mass on the left lateral pharyngeal wall, which masked the inlet of the larynx, and bilateral cervical lymph nodes but no other mucosal lesions. Anti-human immunodeficiency virus antibodies were found to be negative. Hemoglobin, hematocrit, white blood cell count, and platelet count were normal. Serum protein electrophoresis was also normal. A CT scan confirmed the lesion and lymph node involvement. Treatment consisted of a transoral endoscopic resection with ligature of the pedicle, with the patient under general anesthesia. The patient's improved medical condition permitted 11 cycles of bleomycin (15 mg/3 weeks).

RESULTS

A 5-month fibroscopic follow-up control showed no recurrence, and total clinical regression was observed after 1 year. Three years later, all ENT lesions had disappeared, with no adenopathy or mucosal lesions.

CONCLUSION

Kaposi's sarcoma is a pathology that the ENT practitioner must keep in mind when patients present with a laryngopharyngeal mass. The symptomatic cases were all surgically treated; however, death subsequently occurred.

Laryngeal pathology in the acquired immunodeficiency syndrome: diagnostic and therapeutic dilemmas

The acquired immunodeficiency syndrome has produced a growing population of patients who, because of their associated immune system compromise, are prone to opportunistic infections and neoplastic diseases. The larynx, with its relatively inaccessible yet critical anatomic location, is a site in which these processes can produce clinical dilemmas, with respect to diagnosis as well as to therapy. By presenting 4 cases involving unusual laryngeal problems in patients infected with the human immunodeficiency virus (HIV), we emphasize these inherent diagnostic and therapeutic problems. Otolaryngologists must be familiar with the many diagnostic possibilities and therapeutic alternatives when HIV-infected patients present with laryngeal complaints.

Kaposi's sarcoma of the larynx

Kaposi's sarcoma (KS) is a neoplastic vascular disorder, classically arising in the skin of the lower extremities. As a consequence of the acquired immunodeficiency syndrome (AIDS) epidemic, an increasing number of patients have been found to have KS. In AIDS patients, KS appears to exhibit a more diffuse nature and frequently affects the head and neck. Mucosal lesions are most often seen, commonly involving the oral cavity. Only rare cases of laryngeal involvement have been recorded in the literature. We report 2 cases of KS of the supraglottic larynx. Our first patient, an elderly man of Mediterranean descent, complained of voice change and throat discomfort. Endoscopy with biopsy for diagnosis allowed conservative treatment with chemotherapy. Our second patient was a younger man with AIDS who presented with symptoms of airway obstruction. Management with carbon dioxide laser epiglottectomy was successful in relieving that patient's symptoms. Although rare, KS may present in both healthy and immunocompromised patients, and must be considered in the differential diagnosis of all violaceous lesions of the larynx.