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Lee DH, Park SY, Hong N, Kook HD, Jung HJ, Ahn J, Park MY. Very Early Patch Stage of AIDS-related Kaposi Sarcoma: A Case Report. Ann Dermatol 2023; 35:S310-S313. [PMID: 38061728 PMCID: PMC10727859 DOI: 10.5021/ad.22.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/03/2022] [Accepted: 01/12/2023] [Indexed: 12/20/2023] Open
Abstract
Kaposi sarcoma (KS) is a vascular and lymphatic neoplasm caused by human herpesvirus 8 (HHV-8). AIDS-related KS has variable clinical courses ranging from mild disease presenting as an incidental finding to severe disease presenting as an aggressively progressing neoplasm that can lead to poor prognosis or even death. Typical clinical manifestation of KS is known as multiple cutaneous lesions on the extremities, trunk, and face with mucosal involvement. A 46-year-old male with AIDS complained of an erythematous patch on the right forearm which appeared 5 months ago. For a year, he was treated with antiretroviral drugs for AIDS. Physical examination revealed a 2.5-cm solitary erythematous patch only on the right forearm. Laboratory data revealed human immunodeficiency virus (HIV)-1 RNA of less than 40 copies/ml and a CD4 cell count of 264 cells/mm3. Histological examination revealed numerous slit-like spaces and vascular proliferation with primitive blood vessels dissecting between the collagen bundles and the dermis. Immunohistochemical staining showed positive HHV-8 nuclear staining of spindle cells. The histological features and positive HHV-8 immunohistochemical stain were consistent with the diagnosis of early patch stage of AIDS-related KS. KS can readily be misdiagnosed in early patch stage even by experienced clinicians, which leads to requirement of pathologic determination. On close inspection, it can be distinguished from other mimickers by its distinctive histologic features and immunohistochemical staining for HHV-8. Therefore, in cases of HIV-positive patients with clinically or histologically vascular-appearing mucocutaneous lesions, KS should be considered as a possible differential diagnosis.
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Affiliation(s)
- Dong Heon Lee
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - So Yun Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Narang Hong
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hyung Don Kook
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jiyoung Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea.
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2
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Cantisani C, Baja AV, Gargano L, Rossi G, Ardigò M, Soda G, Boostani M, Kiss N, Pellacani G. Optical Coherence Tomography as a Valuable Tool for the Evaluation of Cutaneous Kaposi Sarcoma Treated with Imiquimod 5% Cream. Diagnostics (Basel) 2023; 13:2901. [PMID: 37761269 PMCID: PMC10529460 DOI: 10.3390/diagnostics13182901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Kaposi sarcoma (KS) is a rare disease that was not frequently identified before the widespread occurrence of AIDS. Even today, it remains a challenge for physicians to diagnose, particularly in its early stages, often requiring referral to specialists and further investigations. Dermoscopy, a non-invasive imaging technique, reveals a distinctive rainbow pattern that strongly indicates KS. Moreover, advanced imaging tools like optical coherence tomography (OCT) can provide additional information though specific disease-related patterns have not been fully established yet. These emerging techniques show promise in facilitating early diagnosis of skin-related KS and monitoring the effectiveness of treatments. However, biopsy remains the definitive method for confirming the disease. In this study, we present two cases of cutaneous Kaposi sarcoma, documented using OCT, both before and after treatment with imiquimod 5% cream. The study highlights the potential of OCT in evaluating disease progression and treatment response, as well as the usefulness of dermoscopy in detecting early indicators of KS. By integrating these advanced imaging techniques, the diagnosis and management of cutaneous KS could be improved, leading to timely interventions and better patient outcomes.
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Affiliation(s)
- Carmen Cantisani
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
| | - Alexandru-Vasile Baja
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
| | - Luca Gargano
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
| | - Giovanni Rossi
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
| | - Marco Ardigò
- Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute—IRCCS, 00144 Rome, Italy;
| | - Giuseppe Soda
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
| | - Mehdi Boostani
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (M.B.); (N.K.)
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, 1085 Budapest, Hungary; (M.B.); (N.K.)
| | - Giovanni Pellacani
- Dermatology Unit, Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (A.-V.B.); (L.G.); (G.R.); (G.S.); (G.P.)
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3
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Becker J, Wolde-Semait H, Wollstein R. Cutaneous Cryptococcus Infection and Suspected Kaposi Sarcoma of the Hand in an Immunocompromised Patient. J Hand Surg Asian Pac Vol 2023; 28:273-277. [PMID: 37120314 DOI: 10.1142/s2424835523720104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Cryptococcal infection is well-documented in immunocompromised individuals. Cutaneous manifestations are not as common and are often difficult to diagnose due to variable presentations. Furthermore, there have been reports of coexisting cutaneous Cryptococcus and malignancy. We describe a patient that presented with a fast-growing mass (suspected sarcoma) in the hand that was ultimately treated for a Cryptococcus skin infection. We believe familiarity with the possibility of coexistence of these two conditions in an immunocompromised host could have brought about earlier diagnosis and possibly more effective treatment. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Jacob Becker
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Henock Wolde-Semait
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
| | - Ronit Wollstein
- Department of Orthopedic Surgery, New York University School of Medicine, New York, NY, USA
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4
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Tourlaki A, Nazzaro G, Wei Y, Buffon S, Mattioli MA, Marzano AV, Brambilla L. Clinical, Dermoscopic, Ultrasonographic, and Histopathologic Correlations in Kaposi's Sarcoma Lesions and Their Differential Diagnoses: A Single-Center Prospective Study. J Clin Med 2022; 12:jcm12010278. [PMID: 36615078 PMCID: PMC9821103 DOI: 10.3390/jcm12010278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Kaposi's sarcoma (KS) is an angioproliferative neoplasm typically appearing as angiomatous patches, plaques, and/or nodules on the skin. Dermoscopy and ultrasonography have been suggested as an aid in the diagnosis of KS, but there is little evidence in the literature, especially regarding its possible differential diagnoses. Our aim is to describe and compare the clinical, dermoscopic, and ultrasonographic features of KS and KS-like lesions. (2) Methods: we conducted a prospective study on 25 consecutive patients who were first referred to our tertiary care center from January to May 2021 for a possible KS. (3) Results: 41 cutaneous lesions were examined by means of dermoscopy, Doppler ultrasonography, and pathology, 32 of which were KS-related, while the remaining 9 were lesions with clinical resemblance to KS. On dermoscopy, a purplish-red pigmentation, scaly surface, and the collarette sign were the most common features among KS lesions (81.3%, 46.9%, and 28.1%, respectively). On US, all 9 KS plaques and 21 KS nodules presented a hypoechoic image. Dermoscopic and Doppler ultrasonographic findings of KS-like lesions, such as cherry angioma, venous lake, glomus tumor, pyogenic granuloma, and angiosarcoma were also analyzed. (4) Conclusions: dermoscopy and Doppler ultrasonography can be useful to better assess the features of KS lesions and in diagnosing equivocal KS-like lesions.
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Affiliation(s)
- Athanasia Tourlaki
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Correspondence: ; Tel.: +39-0255035115
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Yiran Wei
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Stefano Buffon
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria A. Mattioli
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Angelo V. Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Lucia Brambilla
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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5
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Plaza JA, Sangueza OP, Giubellino A, Gru AA, Kaffenberger B, Wakely PE, Sangueza MJ. Angiosarcoma-like Kaposi Sarcoma: A Distinctive Histomorphologic Variant Representing an Important Diagnostic Pitfall. Am J Surg Pathol 2022; 46:1732-1738. [PMID: 35948518 DOI: 10.1097/pas.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kaposi sarcoma (KS) is a rare low-grade angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8) infection with multiple clinical subtypes and varying histopathologic patterns. Histologically, many different variants of KS have been reported, yet all can be difficult to recognize and must be differentiated from other vascular tumors. In this report, we studied fourteen cases of a newly described variant of KS reminiscent of a well-differentiated angiosarcoma (angiosarcoma-like KS). All cases showed a diffuse, ill-defined infiltrative dermal-based lesion composed of numerous anastomosing vascular channels of varying caliber lined by a single layer of endothelium with minimal pleomorphism. The vascular proliferation ramified through the dermis and dissected the collagen bundles along with infiltration into the subcutaneous fat and around skin appendages. All cases showed expression of vascular markers (CD31, CD34, and ERG) and were positive for HHV-8. None showed the classic histopathology associated with KS. Without clinical guidance these tumors can be difficult to recognize as KS, creating significant diagnostic challenges. Our study expands on a rare histologic variant of KS that ought to be considered in the differential diagnosis of any cutaneous well-differentiated angiosarcoma. Awareness of this variant of KS is of important for proper diagnosis and management of these patients; thus, careful attention to the histomorphology and clinical history can help lead the pathologist to the correct diagnosis.
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Affiliation(s)
- Jose A Plaza
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Benjamin Kaffenberger
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Paul E Wakely
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
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6
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Taskin S, Yasak T, Mentese ST, Yilmaz B, Çolak O. Kaposi's Sarcoma Management from a Plastic Surgery Perspective. J DERMATOL TREAT 2022; 33:2838-2843. [PMID: 35652782 DOI: 10.1080/09546634.2022.2083544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Kaposi's Sarcoma (KS) is a low-grade angioproliferative tumor arising from endothelial cells and associated with Human Herpes Virus 8 infection. Although KS cases are not rare and there are considerable number of patients referred for surgical excision, the plastic surgery literature on KS is exceptionally scarce. Thirty patients who were operated with the diagnosis of KS between March 2015 and January 2020 were included. Preoperative HIV tests and detailed whole-body examinations of the patients were performed. As a surgical method, for lesions with sizes ranging from 0.5 * 1 cm to 2 * 3 cm, excisions were made over the deep skin fascia by placing a margin between 0.5-1 cm, considering the anatomical location and elasticity of the skin. Primary repair was performed in 40 lesions and 12 lesions of 8 patients were repaired with a skin graft. In four patients the repair was performed with local skin flaps. Higher upper extremity involvement, less systemic involvement and less pronounced male predominance have been important results in our study that we have found different from the literature data. Compared to the therapies such as radiotherapy, laser, or chemotherapy which require several administrations; one-stage surgical excision of the lesions provides remarkable advantages.
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Affiliation(s)
- Selman Taskin
- Prof.Dr. Cemil Tascioglu City Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic
| | - Tugce Yasak
- Prof.Dr. Cemil Tascioglu City Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic
| | - S Tiber Mentese
- Prof.Dr. Cemil Tascioglu City Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic
| | - Burak Yilmaz
- Prof.Dr. Cemil Tascioglu City Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic
| | - Ozlem Çolak
- Prof.Dr. Cemil Tascioglu City Hospital, Plastic Reconstructive and Aesthetic Surgery Clinic
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7
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Daflaoui H, Saddouk H, Ouadi I, Zizi N, Dikhaye S. Iatrogenic Kaposi's sarcoma induced by rituximab and corticosteroid treatment for pemphigus vegetans in an HIV-negative patient. Indian J Dermatol Venereol Leprol 2022; 88:409-412. [PMID: 35434989 DOI: 10.25259/ijdvl_688_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/01/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Hanane Daflaoui
- Department of Dermatology, Mohammed VI University Hospital, Oujda, Morocco
| | - Hasna Saddouk
- Department of Dermatology, Mohammed VI University Hospital, Oujda, Morocco
| | - Imane Ouadi
- Department of Dermatology, Mohammed VI University Hospital, Oujda, Morocco
| | - Nada Zizi
- Department of Dermatology, Mohammed VI University Hospital, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Medical School of Oujda, Mohammed First University, Oujda, Morocco
| | - Siham Dikhaye
- Department of Dermatology, Mohammed VI University Hospital, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research and Public Health, Medical School of Oujda, Mohammed First University, Oujda, Morocco
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8
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Villani A, Fabbrocini G, Peduto T, Scalvenzi M. Reflectance confocal microscopy for Kaposi's sarcoma treatment monitoring after intralesional vincristine chemotherapy. Dermatol Ther 2022; 35:e15539. [PMID: 35489056 PMCID: PMC9539706 DOI: 10.1111/dth.15539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/04/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Kaposi's sarcoma (KS) is a multifocal systemic disease, originating from endothelial cells mainly affecting elderly men. Intralesional chemotherapy with vinblastine or vincristine is an effective and well‐tolerated treatment in patients presenting single nodules on the skin. Despite reflectance confocal microscopy represents a useful diagnostic method for many dermatological diseases, to date, there are few data regarding the use of RCM in mucocutaneous KS. Objective of this study was to evaluate the use of RCM for therapeutic follow‐up in KS patients treated with intralesional vincristine. An observational retrospective study involving patients with a histological diagnosis of classic KS was conducted. All patients were treated with intralesional vincristine; reflectance confocal microscopy images were taken for each patient at baseline (T0) and 1 month after vincristine injection. Four male patients with a median age of 76.8 years were included in the study and four nodules (one for each patient) were evaluated with RCM examination before and after vincristine injections. At 1 month from intralesional vincristine treatment, therapeutic response was confirmed at RCM examination; a reduction of inflammatory cell at the stratum spinosum level in all evaluated lesions was observed; at papillary dermis levels, black luminal structures were decreased in diameter and superficial linear canalicular structures were not represented. Aggregates of inflammatory cells and of hemosiderin deposition, at the dermal level, were reduced in number. Reflectance confocal microscopy showed to be a promising method to evaluate vincristine therapeutic response in patients with KS; further studies evaluating RCM use in KS patients in order to monitor treatment efficacy are still required.
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Affiliation(s)
- Alessia Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Tiziana Peduto
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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9
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Villani A, Scalvenzi M, Peduto T, Cinelli E, Fabbrocini G, Di Stefani A. Dermoscopy and reflectance confocal microscopy of Kaposi's sarcoma: an overview. J Eur Acad Dermatol Venereol 2021; 36:e272-e274. [PMID: 34817913 DOI: 10.1111/jdv.17831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - T Peduto
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - E Cinelli
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - A Di Stefani
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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10
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Yim KM, Liang T, Gnass E, DeClerck B. Epithelioid and clear-cell variant of Kaposi sarcoma: A rare histopathologic subtype. J Cutan Pathol 2021; 49:381-384. [PMID: 34773293 DOI: 10.1111/cup.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/05/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
Kaposi sarcoma is a malignant vascular tumor consisting of multiple clinical subtypes and varying histopathologic patterns. We report a case of a 53-year-old African-American male with HIV/AIDS who presented multiple times with skin nodules, pain, and edema in his lower extremities, secondary to recurrent Kaposi sarcoma. The patient was treated with two courses of liposomal doxorubicin with improvement, but his symptoms recurred a third time. A biopsy specimen of one of the nodules showed prominent neoplastic cells of epithelioid morphology, some with clear-cell change, appearing to form rudimentary vessels in the superficial dermis. Further inspection of the deeper dermis revealed more classic findings of Kaposi sarcoma, including admixed spindle cells, poorly defined vessels, scattered apoptotic bodies, entrapped collagen bundles, and extravasated erythrocytes. Both the epithelioid and classic portions of the neoplasm stained positive for CD31 and human herpesvirus 8, supporting a diagnosis of Kaposi sarcoma. Prior to this case, the epithelioid variant of Kaposi sarcoma has been reported only twice in the literature. Recognizing this rare histopathologic variant of Kaposi sarcoma among its other histopathologic patterns may assist in accurate and expedient diagnosis of this well-recognized disease.
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Affiliation(s)
- Kaitlyn M Yim
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Tom Liang
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Esteban Gnass
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Brittney DeClerck
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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Abstract
ABSTRACT Cutaneous Kaposi sarcoma (KS) covers a broad spectrum both clinically and pathologically. Some histological patterns of KS may be difficult to recognize and must be differentiated from other vascular neoplasms. We report on a 56-year-old Peruvian man who had been diagnosed with classical KS on the right foot 2 years before the present episode. He presented in our clinic with new lesions on the left foot. Histopathological findings included areas showing epithelioid cells with moderate pleomorphism, growing in solid sheets. Immunohistochemistry showed strong nuclear staining with a granular nuclear staining pattern for human herpesvirus 8 in the epithelioid cells. A diagnosis of epithelioid Kaposi sarcoma was made, which should be considered a new histological variant.
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12
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Mass migration and climate change: Dermatologic manifestations. Int J Womens Dermatol 2020; 7:98-106. [PMID: 33537399 PMCID: PMC7838242 DOI: 10.1016/j.ijwd.2020.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/20/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Major changes in climate resulting in mass migrations have unique dermatologic implications for global vulnerable populations. Dermatologic manifestations commonly accompany the infectious and communicable diseases that proliferate in the settings of confinement, crowding, and limited sanitation associated with mass migration. Ectoparasitic infestations abound in refugee camps, and poor nutrition, hygiene, and compromised immunity put refugees at an increased risk for more dangerous infectious diseases carried by these ectoparasites. Climate change also profoundly affects the worldwide distribution of various vector-borne illnesses, thereby leading to the emergence of various communicable diseases in previously nonendemic areas. Natural disasters not only disrupt important lifesaving treatments, but also challenge various infectious disease control measures that are critical in preventing rapid transmission of highly infectious diseases. This article reviews the infectious diseases commonly found in these scenarios and provides an in-depth discussion of important implications for the dermatologist.
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Epidemic, Endemic, or Stewart-Bluefarb? When Several Forms of Kaposi Seem to Dispute Paternity. Case Rep Dermatol Med 2020; 2020:6289285. [PMID: 32328314 PMCID: PMC7171606 DOI: 10.1155/2020/6289285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
Abstract
The role of human herpes virus 8 (HHV8) is demonstrated in the occurrence of Kaposi's disease, but the role of cofactors is still hardly known. We report a case of Kaposi's disease which occurred 10 years after a local trauma in an HIV-positive patient from Central Africa. A 38-year-old female, from and living in Central Africa, consulted for angiomatous papulo-nodules associated with purple-colored macules and painful lymphoedema of the right leg and foot that had been developing for 6 months. She reported a history of posttraumatic lymphoedema of the affected limb as a result of a road accident that occurred ten years earlier. The mucous were healthy. There was no sign of systemic lesions. The diagnosis of Kaposi's disease was evoked with, in differential, a Stewart–Bluefarb syndrome-type of pseudo-Kaposi and an epidemic Kaposi disease. Retroviral serology was positive to HIV1 with a CD4 count of 600 cells/mm3. Histopathology of the lesions and duplex ultrasonography could not be performed. The rest of the biological assessment was without particularity. The diagnosis of epidemic Kaposi's disease associated with cofactors involved in endemic Kaposi's disease and Stewart–Bluefarb syndrome was retained. An antiretroviral treatment (emtricitabine, tenofovir, and efavirenz) allowed to obtain after 6 months a noticeable improvement of the lesions and a disappearance of the pain with however the persistence of a residual lymphoedema. This is a special case of Kaposi's disease that seems to involve several factors. The role of cofactors in Kaposi's disease remains to be elucidated.
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14
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Huang AYY, Lin CL, Chen GS, Hu SCS. Clinical features of Kaposi's sarcoma: experience from a Taiwanese medical center. Int J Dermatol 2019; 58:1388-1397. [PMID: 31102268 DOI: 10.1111/ijd.14476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/10/2019] [Accepted: 04/11/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Most of the previous reports regarding the clinical features of Kaposi's sarcoma (KS) have been performed in Western and African countries. The clinical characteristics of KS have not been well defined in Han Chinese or Taiwanese patients. In this study, we analyzed the clinical features of KS patients in a Taiwanese medical center. METHODS Medical records from Kaohsiung Medical University Hospital over the past 20 years (1996-2016) were comprehensively reviewed. RESULTS There were 55 patients with KS (50 males and 5 females), including 37 patients (67%) with classic disease, 17 patients (31%) with AIDS-associated disease, and one patient (2%) with immunosuppressive medication-related disease. The average age was 58.7 years (range 20-87 years), and the average age was younger for AIDS patients (33.8 years) compared with non-AIDS patients (69.8 years). Among patients with classic KS, lesions were mostly localized to the lower extremities, whereas AIDS-associated KS patients were more likely to develop disseminated skin lesions, skin lesions on atypical sites (head and neck, trunk), and extracutaneous involvement (particularly oral cavity). The most common underlying diseases were diabetes mellitus (20% of patients) and hepatitis B (15% patients), and 38% of KS patients were smokers. Patients with AIDS-associated KS usually responded well to chemotherapy, whereas only 32% of patients with non-AIDS-associated KS showed complete response to radiotherapy. CONCLUSIONS The findings of the current study will serve as important references for clinicians in the diagnosis of KS and may form the basis for the implementation of KS clinical practice guidelines in Taiwan.
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Affiliation(s)
- Alice Ya-Yun Huang
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Ling Lin
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Gwo-Shing Chen
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Stephen Chu-Sung Hu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Baykal C, Atci T, Buyukbabani N, Kutlay A. The Spectrum of Underlying Causes of Iatrogenic Kaposi's Sarcoma in a Large Series: A Retrospective Study. Indian J Dermatol 2019; 64:392-399. [PMID: 31543535 PMCID: PMC6749761 DOI: 10.4103/ijd.ijd_217_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The frequency of clinicoepidemiological variants of Kaposi's sarcoma (KS) differs markedly throughout the world. The iatrogenic variant is mainly associated with the use of immunosuppressive therapy. Aims: We aimed to investigate the distribution of KS variants in our practice and elucidate the underlying causes of iatrogenic KS. Methods: Consecutive KS patients seen in a single tertiary center were grouped according to the tumor variants and iatrogenic KS patients were evaluated about associated conditions. Results: Among 137 patients, classic variant was the most frequent presentation (n = 88), followed by iatrogenic (n = 37) variant. Among the iatrogenic group, ten were transplant recipients. In 16 iatrogenic KS patients, systemic corticosteroid was used, in four for myasthenia gravis (MG) and in three for rheumatoid arthritis. In three patients, KS developed under topical corticosteroid (TC) treatment. Among iatrogenic KS patients, ten of them had a second primary neoplasm and one had congenital immunodeficiency syndrome. Conclusions: Our study revealed one of the highest rates for iatrogenic KS (27%) reported in the literature. Besides well-known causes, relatively frequent association with MG was remarkable. Usage of different forms of TCs was the cause of KS in a few cases.
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Affiliation(s)
- Can Baykal
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Tugba Atci
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Nesimi Buyukbabani
- Department of Pathology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Armagan Kutlay
- Department of Dermatology and Venereology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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16
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MDM2 gene polymorphisms and risk of classic Kaposi's sarcoma among Iranian patients. Med Microbiol Immunol 2017; 206:157-163. [PMID: 28083704 DOI: 10.1007/s00430-016-0491-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/27/2016] [Indexed: 12/30/2022]
Abstract
A single-nucleotide polymorphism (SNP) in the promoter region of MDM2 (SNP309T>G, rs2279744) has been shown to increase the expression of the MDM2 protein in various cancer types. However, only one study has analyzed the role of the MDM2 polymorphism in the development of Kaposi's sarcoma (KS). The association of MDM2 SNP309 with classic KS risk was evaluated in 79 Iranian patients with classic KS and 123 healthy controls. The MDM2 SNP309 was genotyped using PCR and restriction fragment length polymorphism methods. No significant correlation was found between the SNP309 polymorphism in MDM2 promoter and classic KS risk. There was no significant correlation between gender and disease stage. However, a significant association was found between SNP309 GG genotype and younger age (≤50 years) (odds ratio 9.5, 95% confidence intervals 1.5-60, p = 0.03). Our findings support no major role for the MDM2 SNP309 in KS development although it might influence the clinical outcome of KS in younger patients.
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17
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Varmazyar S, Shoja Z, Kakavand-Ghalehnoei R, Shahmahmoodi S, Marashi SM, Jalilvand S. Molecular typing of human herpesvirus 8 among HIV positive in comparison to HIV-negative individuals in Iran. J Med Virol 2016; 89:703-709. [PMID: 27463857 DOI: 10.1002/jmv.24644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2016] [Indexed: 01/19/2023]
Abstract
It is still unclear whether different HHV-8 genotypes may have different pathogenic and tumorigenic properties associated with a diverse rate of disease progression. In some areas where genotype C was found to be prominent among classic KS patients, genotype A was shown to be more frequent among AIDS-associated KS patients. Genotype C was previously reported to be widespread in Iran, with genotype A being less frequent among patients with classic KS although no data are available with regards to the HHV-8 genotyping among Iranian HIV-infected patients. In order to analyze HHV-8 genotypes (ORF K1), six HIV-infected patients (with or without KS), and 22 HIV-negative subjects (classic/iatrogenic KS patients and IVDUs) were investigated using nested PCR. Genotype A was detected more frequently among HIV-infected patients with or without KS (three out of six) whereas genotype C was found more common among HIV-negative subjects including classic/iatrogenic KS patients and IVDSs (21 out of 22), and this difference was statistically significant (P = 0.044). In conclusion, our data further support the dominancy of HHV-8 genotype C in Iranian general population. Moreover, genotype A was more common among HIV-infected patients with or without KS. J. Med. Virol. 89:703-709, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sajad Varmazyar
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Shohreh Shahmahmoodi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Mahdi Marashi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Jalilvand
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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18
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Identification of Human Herpesvirus 8 Sequences in Conjunctiva Intraepithelial Neoplasia and Squamous Cell Carcinoma of Ugandan Patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:801353. [PMID: 26509162 PMCID: PMC4609772 DOI: 10.1155/2015/801353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/18/2015] [Accepted: 06/28/2015] [Indexed: 12/20/2022]
Abstract
The incidence of squamous cell carcinoma of the conjunctiva is particularly high in sub-Saharan Africa with temporal trends similar to those of Kaposi sarcoma (KS). Human herpesvirus type 8 (HHV8), has not yet been investigated in conjunctiva tumors. In this study biopsies and PBMCs of conjunctiva neoplasia patients along with nonneoplastic conjunctiva tissues have been analyzed for HHV8 sequences by PCR targeting ORF26. All amplimers were subjected to nucleotide sequencing followed by phylogenetic analysis. HHV8 DNA has been identified in 12 out of 48 (25%) HIV-positive, and in 2 out of 24 (8.3%) HIV-negative conjunctiva neoplastic tissues and in 4 out of 33 (12.1%) PBMC samples from conjunctiva neoplasia diseased patients as well as in 4 out of 60 (6.7%) nontumor conjunctiva tissues. The viral load ranged from 1 to 400 copies/105 cells. Phylogenetic analysis showed that the majority of HHV8 ORF26 amplimers clustered with subtypes R (n = 11) and B2 (n = 6). This variant distribution is in agreement with that of HHV8 variants previously identified in Ugandan KS cases. The presence of HHV8 in conjunctiva tumors from HIV-positive patients warrants further studies to test whether HHV8 products released by infected cells may have paracrine effects on the growth of conjunctiva lesions.
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19
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Jalilvand S, Shoja Z, Marashi SM, Shahmahmoodi S, Safaie-Naraghi Z, Nourijelyani K, Nesheli AB, Mokhtari-Azad T. Mitochondrial haplogroups and control region polymorphisms in Kaposi's sarcoma patients. J Med Virol 2015; 87:1608-15. [DOI: 10.1002/jmv.24197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Somayeh Jalilvand
- Virology Department; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | | | - Sayed Mahdi Marashi
- Virology Department; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | - Shohreh Shahmahmoodi
- Virology Department; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | | | - Keramat Nourijelyani
- Biostatistics Department; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
| | | | - Talat Mokhtari-Azad
- Virology Department; School of Public Health; Tehran University of Medical Sciences; Tehran Iran
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20
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[Contribution of reflectance confocal microscopy in the diagnosis of Kaposi's disease]. Ann Dermatol Venereol 2015; 142:141-4. [PMID: 25662854 DOI: 10.1016/j.annder.2014.09.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/17/2014] [Accepted: 09/25/2014] [Indexed: 11/20/2022]
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21
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Electrochemotherapy as “new standard of care” treatment for cutaneous Kaposi's sarcoma. Eur J Surg Oncol 2014; 40:61-6. [PMID: 24075826 DOI: 10.1016/j.ejso.2013.09.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 07/25/2013] [Accepted: 09/01/2013] [Indexed: 11/23/2022] Open
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22
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Ruocco E, Ruocco V, Tornesello ML, Gambardella A, Wolf R, Buonaguro FM. Kaposi's sarcoma: etiology and pathogenesis, inducing factors, causal associations, and treatments: facts and controversies. Clin Dermatol 2013; 31:413-422. [PMID: 23806158 PMCID: PMC7173141 DOI: 10.1016/j.clindermatol.2013.01.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Kaposi's sarcoma (KS), an angioproliferative disorder, has a viral etiology and a multifactorial pathogenesis hinged on an immune dysfunction. The disease is multifocal, with a course ranging from indolent, with only skin manifestations to fulminant, with extensive visceral involvement. In the current view, all forms of KS have a common etiology in human herpesvirus (HHV)-8 infection, and the differences among them are due to the involvement of various cofactors. In fact, HHV-8 infection can be considered a necessary but not sufficient condition for the development of KS, because further factors (genetic, immunologic, and environmental) are required. The role of cofactors can be attributed to their ability to interact with HHV-8, to affect the immune system, or to act as vasoactive agents. In this contribution, a survey of the current state of knowledge on many and various factors involved in KS pathogenesis is carried out, in particular by highlighting the facts and controversies about the role of some drugs (quinine analogues and angiotensin-converting enzyme inhibitors) in the onset of the disease. Based on these assessments, it is possible to hypothesize that the role of cofactors in KS pathogenesis can move toward an effect either favoring or inhibiting the onset of the disease, depending on the presence of other agents modulating the pathogenesis itself, such as genetic predisposition, environmental factors, drug intake, or lymph flow disorders. It is possible that the same agents may act as either stimulating or inhibiting cofactors according to the patient’s genetic background and variable interactions. Treatment guidelines for each form of KS are outlined, because a unique standard therapy for all of them cannot be considered due to KS heterogeneity. In most cases, therapeutic options, both local and systemic, should be tailored to the patient’s peculiar clinical conditions.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
| | - Vincenzo Ruocco
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy.
| | - Maria Lina Tornesello
- Molecular Biology and Viral Oncology and AIDS Reference Centre, National Cancer Institute, "Fondazione Pascale," via M. Semmola - 80131 Naples, Italy
| | - Alessio Gambardella
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
| | - Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rehovot 76100 Israel; The School of Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Franco M Buonaguro
- Molecular Biology and Viral Oncology and AIDS Reference Centre, National Cancer Institute, "Fondazione Pascale," via M. Semmola - 80131 Naples, Italy
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23
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Buonaguro FM, Gueye SN, Wabinga HR, Ngoma TA, Vermorken JB, Mbulaiteye SM. Clinical oncology in resource-limited settings. Infect Agent Cancer 2013; 8:39. [PMID: 24099039 PMCID: PMC3852095 DOI: 10.1186/1750-9378-8-39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022] Open
Abstract
Infectious Agents and Cancer is introducing a new section of Clinical Oncology with the main objective of stimulating debate through articles published in the section. Infectious diseases have been the major causes of morbidity and mortality in human populations, and have dominated the medical approach to clinical and public health. Successful efforts to control mortality from acute infections have paved the way for chronic, mostly indolent, infections to become major causes of morbidity. Cancer, hitherto thought to be rare in resource-limited settings, is becoming a major contributor. The changes in mortality patterns are due, in part, to diseases linked to rapid changes in lifestyle, urbanization, and pollution. These diseases include many of the non-infection associated cancers. However, there is a dearth of information about the burden, pathogenesis, and therapeutic approaches about cancer in resource-limited countries. There are also substantial other challenges, including economic, infrastructure, technology, and personnel. The Journal advocates for interactive local-global (lo-bal) efforts to generate relevant knowledge about cancer burden, pathogenesis, and therapeutic approaches using a bottom-up approach to sharpen the focus on local and global relevance of research and clinical and public practice, particularly in resource-limited countries. The section on Clinical Oncology in Infectious Agents and Cancer will harness these "lo-bal" strategies to reduce substantially the time from concept, discovery, and development and implementation of locally and globally applicable diagnostic and therapeutic technologies.
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Affiliation(s)
- Franco M Buonaguro
- Division of Molecular Biology & Viral Oncology, Department of Experimental Oncology, Istituto Nazionale Tumori -IRCCS “Fond Pascale”, Naples, Italy
| | - Serigne N Gueye
- Division of Urology and Andrology, Grand Yoff General Hospital – Department of Surgery/Urology, University Cheikh Anta DIOP, Dakar, Senegal
| | - Henry R Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Sam M Mbulaiteye
- Infections and Immunoepidemiology Branch, Div of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, 9609 Medical Center Dr, Rm. 6E118 MSC 9704, Bethesda, MD 20892-9704, USA
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24
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Grazzini M, Stanganelli I, Rossari S, Gori A, Oranges T, Longo AS, Lotti T, Bencini PL, De Giorgi V. Dermoscopy, confocal laser microscopy, and hi-tech evaluation of vascular skin lesions: diagnostic and therapeutic perspectives. Dermatol Ther 2013; 25:297-303. [PMID: 22950556 DOI: 10.1111/j.1529-8019.2012.01547.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vascular skin lesions comprise a wide and heterogeneous group of malformations and tumors that can be correctly diagnosed based on natural history and physical examination. However, considering the high incidence of such lesions, a great number of them can be misdiagnosed. In addition, it is not so rare that an aggressive amelanotic melanoma can be misdiagnosed as a vascular lesion. In this regard, dermoscopy and confocal laser microscopy examination can play a central role in increasing the specificity of the diagnosis of such lesions. In fact, the superiority of these tools over clinical examination has encouraged dermatologists to adopt these devices for routine clinical practice, with a progressive spread of their use. In this review, we will go through the dermoscopic and the confocal laser microscopy of diagnosis of most frequent vascular lesions (i.e., hemangiomas angiokeratoma, pyogenic granuloma, angiosarcoma) taking into particular consideration the differential diagnosis with amelanotic melanoma.
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Affiliation(s)
- Marta Grazzini
- Department of Dermatology, University of Florence, Firenze, Italy
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25
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Koo E, Walsh A, Dickson H. Red flags and alarm bells: an atypical lesion masquerading as a diabetic foot ulcer. J Wound Care 2013; 21:550, 552. [PMID: 23413493 DOI: 10.12968/jowc.2012.21.11.550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 88-year-old male presented at a high-risk foot service with a non-healing, plantar wound on his right foot, which had the appearance of a neuropathic ulcer. On further examination, the lesion was confirmed asymmetrical in shape and atypical in appearance. It also presented with surrounding violaceous, pigmented nodules in the arch of the foot, and several small, similar nodules on the plantar surface of the contralateral foot, giving the appearance of an exophytic lesion and suggesting melanoma. Following biopsy, it was diagnosed as classic Kaposi sarcoma.
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Affiliation(s)
- E Koo
- Department of Podiatry, High Risk Foot Service, Liverpool Hospital, Liverpool, Australia.
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26
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Mudigonda T, Levender MM, O'Neill JL, West CE, Pearce DJ, Feldman SR. Incidence, risk factors, and preventative management of skin cancers in organ transplant recipients: a review of single- and multicenter retrospective studies from 2006 to 2010. Dermatol Surg 2012. [PMID: 23190408 DOI: 10.1111/dsu.12028] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Organ transplant recipients (OTRs) taking immunosuppressants are at high risk of skin cancer, which is the most common malignant condition in OTRs, so dermatologic surveillance is important for OTRs. OBJECTIVES To characterize the most common skin cancers arising from chronic immunosuppression in OTRs. METHODS A PubMed search for retrospective single- and multicenter studies reporting skin cancer incidence from 2006 to 2010 was undertaken. Data regarding each study's immunosuppressive regimen, affected skin cancer cohort, and associated risk factors were extracted. RESULTS Thirty-six articles that met our inclusion criteria reported incidences of nonmelanoma skin cancer (NMSC), Kaposi's sarcoma, melanoma, and Merkel cell carcinoma. NMSC was the most commonly reported cancer of all skin cancers after transplantation. Common risk factors were sex, age, sunlight exposure, and immunosuppressive agent-related (duration, type). CONCLUSION Sun education programs and frequent screenings in organ transplant clinics have provided the best preventative strategies after transplantation, although the characteristics of the immunosuppressive regimen also play an important role. Thus, the adjuvant strategy of modifying immunosuppression may be effective when confronting severe transplant-associated skin cancer. Although the decision-making process for curbing levels of immunosuppression is difficult, further long-term, randomized controlled studies should assess the effect of using less immunosuppressant medication while preserving graft function.
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Affiliation(s)
- Tejaswi Mudigonda
- Department of Dermatology, Center for Dermatology Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
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27
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Everly D, Sharma-Walia N, Sadagopan S, Chandran B. Herpesviruses and Cancer. CANCER ASSOCIATED VIRUSES 2012:133-167. [DOI: 10.1007/978-1-4614-0016-5_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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28
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Jalilvand S, Tornesello ML, Buonaguro FM, Buonaguro L, Naraghi ZS, Shoja Z, Ziaee AA, Hamkar R, Shahmahmoodi S, Nategh R, Mokhtari-Azad T. Molecular epidemiology of human herpesvirus 8 variants in Kaposi's sarcoma from Iranian patients. Virus Res 2011; 163:644-9. [PMID: 21963664 DOI: 10.1016/j.virusres.2011.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/16/2011] [Accepted: 09/16/2011] [Indexed: 11/19/2022]
Abstract
Kaposi's sarcoma (KS) is a rare cancer in Iran and there is no epidemiological and molecular information about HHV-8 variants circulating among the Iranian population. In this study HHV-8 sequences have been analyzed in 43 cutaneous KS biopsies from Iranian patients mainly affected by classic KS. DNA samples were subjected to PCR amplification of HHV-8 ORF26, T0.7 and K1 followed by direct nucleotide sequencing and phylogenetic analysis. The analysis of ORF26 showed that 30 (69.8%) and 13 (30.2%) samples belonged to subtypes A/C and K, respectively. In general, the clustering of HHV-8 T0.7 variants paralleled that of ORF26. Genotyping of K1 sequences showed that the majority of samples (39 out of 41) fall into the large C clade with only 2 belonging to the A clade. In conclusion, HHV-8 variants identified among classic Iranian KS are largely related to Eurasian genotypes previously identified in KS from Mediterranean, Middle East, and East Asian regions.
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Affiliation(s)
- Somayeh Jalilvand
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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29
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Jalilvand S, Shoja Z, Mokhtari-Azad T, Nategh R, Gharehbaghian A. Seroprevalence of Human herpesvirus 8 (HHV-8) and incidence of Kaposi's sarcoma in Iran. Infect Agent Cancer 2011; 6:5. [PMID: 21527020 PMCID: PMC3108908 DOI: 10.1186/1750-9378-6-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/28/2011] [Indexed: 01/21/2023] Open
Abstract
Seroepidemiological surveys show that the prevalence of human herpesvirus 8 (HHV-8) infection mostly varies in various geographical areas and reflects the local incidence of classic and endemic KS, being widespread in sub-Saharan Africa and Mediterranean countries and uncommon in the USA and Northern Europe. In the Middle East only few populations, such as Ashkenazi and Sephardic groups in Israel, have been adequately evaluated for HHV-8 seroprevalence. Among Iranian population a striking higher seroprevalence of HHV8 has been reported among haemodialysis (16.9%), renal transplant recipients (25%) and HIV (45.7%) patients compared to blood donors (2%). Kaposi's sarcoma (KS) is the rarest cancer in Iran, with an annual age-standardized incidence varying from 0.10 to 0.17 per 100,000 in males and from 0.06 to 0.08 per 100,000 in females. KS, however, is one of the most important malignancies in Iranian renal transplanted patients affecting up to 2.4% of organ recipients. The epidemiology of HHV8 and KS in Iran needs further evaluation. While the high prevalence of HHV-8 antibodies in HIV positive and haemodialysis individuals may be attributed to high-risk sexual behavior and polytransfusions, respectively, unknown determinants may be responsible for high seroprevalence of HHV8 and high incidence of KS in solid organ recipients. A global survey on HHV8 seroprevalence in Iran is mandatory to define co-factors associated with HHV8 infection and KS risk in the general Iranian population and in specific patient groups.
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Affiliation(s)
- Somayeh Jalilvand
- Research Center of Iranian Blood Transfusion Organization, Tehran, Iran.
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30
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Ruocco V, Ruocco E, Schwartz RA, Janniger CK. Kaposi sarcoma and quinine: a potentially overlooked triggering factor in millions of Africans. J Am Acad Dermatol 2011; 64:434-6. [PMID: 21238829 DOI: 10.1016/j.jaad.2009.12.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/11/2009] [Accepted: 12/02/2009] [Indexed: 11/15/2022]
Abstract
Kaposi sarcoma (KS)-associated herpesvirus, also known as human herpesvirus 8, is necessary but not sufficient for the development of KS. Lytic reactivation of human herpesvirus 8 may be important in KS pathogenesis. KS and its causative agent, KS-associated herpesvirus, have distinctive largely unexplained geographic distributions. We note the recent "oncoweed" hypothesis of biologic plants in the environment accounting for this reactivation. We believe that quinine and its derivatives might better explain the epidemiology of KS than oncoweeds. Indeed, we propose an "oncodrug" hypothesis, specifically with regard to quinine and its derivatives, a linkage first advanced by one of us (V. R.) and associates in 1984.
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Affiliation(s)
- Vincenzo Ruocco
- Dermatology, Seconda Università degli Studi di Napoli, Naples, Italy
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31
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Tornesello ML, Buonaguro L, Cristillo M, Biryahwaho B, Downing R, Hatzakis A, Alessi E, Cusini M, Ruocco V, Viviano E, Romano N, Katongole-Mbidde E, Buonaguro FM. MDM2 and CDKN1A gene polymorphisms and risk of Kaposi's sarcoma in African and Caucasian patients. Biomarkers 2010; 16:42-50. [PMID: 20979563 DOI: 10.3109/1354750x.2010.525664] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A single-nucleotide polymorphism in the MDM2 promoter (SNP309; rs2279744) causes elevated transcription of this major negative regulator of p53 in several cancer types. We investigated MDM2 SNP309 and CDKN1A (p21/Waf1/Cip1) codon 31 (rs1801270) polymorphisms in 86 cases of cutaneous Kaposi's sarcoma (KS) from African and Caucasian patients, and 210 healthy controls. A significant increase of the MDM2 SNP309 T/G genotype was observed among classic KS cases (odds ratio 2.38, 95% confidence interval 1.0-5.5). Frequencies of CDKN1A codon 31 genotypes were not significantly different between cases and controls. The results suggest that the MDM2 SNP309 G allele may act as a susceptibility gene for the development of classic KS in Caucasian patients.
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Affiliation(s)
- Maria Lina Tornesello
- Molecular Biology and Viral Oncology and AIDS Reference Centre, National Cancer Institute, 'Fondazione Pascale', Naples, Italy
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Kaposi’s sarcoma of the head and neck: A review. Oral Oncol 2010; 46:135-45. [DOI: 10.1016/j.oraloncology.2009.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 12/15/2022]
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Tornesello ML, Biryahwaho B, Downing R, Hatzakis A, Alessi E, Cusini M, Ruocco V, Katongole-Mbidde E, Loquercio G, Buonaguro L, Buonaguro FM. Human herpesvirus type 8 variants circulating in Europe, Africa and North America in classic, endemic and epidemic Kaposi's sarcoma lesions during pre-AIDS and AIDS era. Virology 2010; 398:280-9. [PMID: 20079510 DOI: 10.1016/j.virol.2009.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 10/30/2009] [Accepted: 12/02/2009] [Indexed: 12/27/2022]
Abstract
Human herpesvirus-8 (HHV-8) variants have been found heterogeneously distributed among human populations living in diverse geographic regions, but their differential pathogenicity in Kaposi's sarcoma development remains controversial. In the present study, HHV-8 variant distribution has been analyzed in classic, iatrogenic, endemic as well as epidemic Kaposi's sarcoma (KS) during pre-AIDS and AIDS period (1971-2008) in countries with different KS incidence rate. DNA samples from cutaneous KS lesions of 68 patients living in Africa (n=23, Cameroon, Kenya and Uganda), Europe (n=34, Greece and Italy) and North America (n=11) have been subjected to PCR amplification of HHV-8 ORF 26, T0.7, K1 and K14.1/15, followed by direct nucleotide sequencing and phylogenetic analysis. Among the 23 African samples, the majority of HHV-8 ORF 26 variants clustered with the subtype R (n=12) and B (n=5). Conversely, the viral sequences obtained from 45 European and North European tumors belonged mainly to subtype A/C (n=36). In general, HHV-8 and K1 variant clustering paralleled that of ORF 26 and T0.7. Genotyping of the K14.1/15 loci revealed a large predominance of P subtype in all tumors. In conclusion, comparison of the HHV-8 sequences from classic or endemic versus AIDS-associated KS showed a strong linkage of the HHV-8 variants with specific populations, which has not changed during AIDS epidemic.
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Affiliation(s)
- Maria Lina Tornesello
- Molecular Biology and Viral Oncology and AIDS Reference Centre, National Cancer Institute "Fondazione Pascale", Cappella Cangiani, 80131 Naples, Italy
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Hu SCS, Ke CLK, Lee CH, Wu CS, Chen GS, Cheng ST. Dermoscopy of Kaposi's sarcoma: Areas exhibiting the multicoloured ‘rainbow pattern’. J Eur Acad Dermatol Venereol 2009; 23:1128-32. [DOI: 10.1111/j.1468-3083.2009.03239.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Serdaroglu S, Antonov M, Demirkesen C, Tuzun Y. Iatrogenic Kaposi’s sarcoma in a patient with pemphigus vulgaris. Clin Exp Dermatol 2009; 34:839-40. [DOI: 10.1111/j.1365-2230.2008.03035.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cheng ST, Ke CL, Lee CH, Wu CS, Chen GS, Hu SS. Rainbow pattern in Kaposi’s sarcoma under polarized dermoscopy: a dermoscopic pathological study. Br J Dermatol 2009; 160:801-9. [DOI: 10.1111/j.1365-2133.2008.08940.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rubegni P, Sbano P, De Aloe G, Flori ML, Fimiani M. Thalidomide in the treatment of Kaposi's sarcoma. Dermatology 2007; 215:240-4. [PMID: 17823523 DOI: 10.1159/000106583] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Accepted: 01/15/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a lymphangioproliferative tumour. Therapy of KS depends on the characteristics of the disease, especially area and growth rate of lesions, and patient condition. Currently symptomatic resectable lesions are excised, whereas more advanced disease and unresectable lesions are treated with radiotherapy. If a large area or internal organs are affected or other treatments fail, chemotherapy is used. Recently some authors have reported their encouraging experience in the use of thalidomide in patients with AIDS-related KS. OBJECTIVE To evaluate the efficacy of thalidomide in 3 patients with non-AIDS-related KS. METHODS Two patients with classic widespread cutaneous and 1 with iatrogenic cutaneous and visceral KS were treated with thalidomide (100 mg/day) for 12 months. RESULTS In all 3 patients partial remission was evident after 4 months of thalidomide therapy; in 2 out of 3 complete remission was achieved after 12 months of treatment. CONCLUSIONS Our results seem to confirm the utility of thalidomide in the treatment of non-AIDS-related KS.
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Affiliation(s)
- Pietro Rubegni
- Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy.
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Rossiello L, Ruocco E, Signoriello G, Micheli P, Rienzo M, Napoli C, Rossiello R. Evidence of COX-1 and COX-2 expression in Kaposi's sarcoma tissues. Eur J Cancer 2007; 43:1232-41. [PMID: 17467980 DOI: 10.1016/j.ejca.2007.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Revised: 03/14/2007] [Accepted: 03/15/2007] [Indexed: 12/27/2022]
Abstract
Cyclooxygenases (COXs) are enzymes catalysing prostaglandin synthesis and are implicated in the carcinogenesis of some cancer types. In addition, an important role of these enzymes in herpesvirus infections was demonstrated and it has recently been proposed that COX-2 may participate in herpesvirus-induced neoplasia such as Kaposi's sarcoma (KS). To date no immunohistochemical study has been performed to determine the identification of COX-1 and COX-2 in KS. We have investigated 35 cases of classic KS and 27 cases of epidemic KS form in order to study the distribution and localisation of COXs. We have examined by immunohistochemistry the expression of COX-1 and COX-2 in classic and epidemic forms of KS also in relationship to the characteristic morphological phases (patch, plaque and nodular stage) of KS and cell localisation by double immunostaining. Moreover, we have obtained COX-1 and COX-2 expression by Western blot analysis. Our results establish that (a) COX-1 and COX-2 are overexpressed significantly in classic and epidemic KS compared with control skin tissues (P<0.01 and P>0.03, respectively, for COX-1; P<0.01 and P>0.03, respectively, for COX-2); (b) the extent and intensity staining for both COXs were higher in classic than in epidemic form of KS. Our data support the hypothesis that both COXs may be involved in the pathogenesis of KS.
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Affiliation(s)
- Luigi Rossiello
- Department of Dermatology, II University of Naples, Naples 80131, Italy.
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González-Sixto B, Conde A, Mayo E, Pardavila R, de la Torre C, Cruces M. Kaposi Sarcoma Associated With Systemic Corticosteroid Therapy. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70512-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Paradela S, del Pozo J, Almagro M, Martínez W, Fernández JL, Yebra-Pimentel T, Fonseca E. Purple nodules and a palatal plaque. Am J Med 2006; 119:1036-8. [PMID: 17145245 DOI: 10.1016/j.amjmed.2006.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 10/10/2006] [Accepted: 10/10/2006] [Indexed: 10/23/2022]
Affiliation(s)
- Sabela Paradela
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain
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Brambilla L, Tourlaki A, Ferrucci S, Brambati M, Boneschi V. Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings. J Dermatol 2006; 33:451-6. [PMID: 16848816 DOI: 10.1111/j.1346-8138.2006.00108.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Lymphedema of the lower extremities is a frequent complication of Kaposi's sarcoma (KS). Compressive therapy is the basis of treatment for lymphatic disorders, but to the authors' knowledge, there are no controlled trials to evaluate its effectiveness in KS-related lymphedema. Sixty-five patients with classic KS-associated lymphedema limited to below the knee were studied. Fifty patients received below-knee elastic stockings, whereas the remaining 15 did not use any compressive device. Among treated patients, 60% (30/50) experienced a limb volume reduction, while 40% (20/50) had an increase of limb volume. In contrast, all patients (15/15) of the untreated group had an increase of limb volume. No correlation between lymphedema reduction and systemic or local chemotherapy was observed, supporting compressive therapy as the major strategy for the treatment of this condition. Our results suggest that elastic stockings may be important tools for the management of lymphedema associated to classic KS.
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Affiliation(s)
- Lucia Brambilla
- Institute of Dermatological Sciences, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy
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Serrano C, Sánchez G, del Mar Serrano M, Linares J, Dulanto C, Naranjo R. [Nodules and violaceous plaques on the scrotum and thigh]. ACTAS DERMO-SIFILIOGRAFICAS 2006; 96:127-9. [PMID: 16476352 DOI: 10.1016/s0001-7310(05)73053-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cristina Serrano
- Servicio de Dermatología, Hospital Clínico Universitario San Cecilio, Facultad de Medicina, Avda. Madrid 9, 18012 Granada, Spain.
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Gönen M, Cenker A, Kiyici H, Kalkan M. Penile Kaposi's sarcomas in a circumcised and HIV-seronegative patient. Int J Urol 2006; 13:318-20. [PMID: 16643638 DOI: 10.1111/j.1442-2042.2006.01282.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kaposi's sarcoma (KS) limited to penis is rare and usually observed in AIDS patients. However, in circumcised and HIV-seronegative patients, KS confined to the penis is extremely rare. We present the case of an HIV-seronegative and circumcised 55-year-old man, who presented with two reddish papules, one 5 mm in diameter on the coronal sulcus near the frenulum, and the other 2 mm in diameter on the glans penis, which were reported as a Kaposi's sarcoma after excision of the lesion.
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Ares C, Allal AS. Long-term complete remission of laryngeal Kaposi's sarcoma after palliative radiotherapy. ACTA ACUST UNITED AC 2005; 2:473-7; quiz 1 p following 477. [PMID: 16265016 DOI: 10.1038/ncponc0294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 07/12/2005] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 43-year-old Caucasian man presented with enlarged right laterocervical lymph nodes, and a 6-month history of diarrhea and 9 kg weight loss. His previous medical history was unremarkable. Physical examination and a cervical CT scan showed several indistinct necrotic right laterocervical lymph nodes of 4 cm maximal diameter, but with no lesions of the respiratory or digestive tracts. INVESTIGATIONS Physical examination, cervical CT scan, laterocervical lymph node biopsy, laboratory tests, and endoscopy. DIAGNOSIS Clinical stage 4 AIDS with stage T0 I1 S1 epidemic AIDS-related Kaposi's sarcoma of the laterocervical lymph nodes and, subsequently, the larynx. MANAGEMENT Highly active antiretroviral treatment (stavudine, didanosine, and nelfinavir), tracheotomy, and palliative radiotherapy.
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Affiliation(s)
- Carmen Ares
- Division of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland.
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Mohanna S, Ferrufino JC, Sanchez J, Bravo F, Gotuzzo E. Epidemiological and clinical characteristics of classic Kaposi's sarcoma in Peru. J Am Acad Dermatol 2005; 53:435-41. [PMID: 16112349 DOI: 10.1016/j.jaad.2005.05.041] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 05/17/2005] [Accepted: 05/23/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Classic Kaposi sarcoma (KS) occurs predominantly among the elderly, with predominance among Jews, Italians, and Greeks. Classic KS has been seen relatively frequently in Peru. OBJECTIVE Our purpose was to outline the epidemiological and clinical profile of classic KS in Peru. METHODS Epidemiological and clinical features of all classic KS cases diagnosed between 1969 and 2003 at Hospital Nacional Cayetano Heredia (HNCH) and between 1946 and 2004 at Instituto Nacional de Enfermedades Neoplasicas (INEN) were reviewed and studied retrospectively. RESULTS An overall incidence of 2.54 per 10,000 attended patients was obtained at the INEN during the 48-year period (mean, 2.39; standard deviation: 1.99; 95% confidence interval, 2.92-1.86). Twenty-one cases were discovered at HNCH and 106 cases at INEN. A male/female ratio of 2.62:1 was found. Mean age at diagnosis was 68.5 years. Lower limbs were involved in 109 patients (85.8%); the trunk was involved in 11 patients (8.6%). Nodules were the most common type of lesion (85.8%); less commonly found were plaques (27.5%), macules (12.5%), papules (12.5%), and ulcers (8.6%). Sixty-two patients had no symptoms (48.8%). Pain was the most common symptom (26.7%), followed by edema (21.2%), bleeding (14.9%), and pruritus (3.9%). A second primary malignancy was found in 11 patients (8.6%). LIMITATIONS These results were obtained from patients with classic KS in Peru and may not be applicable to other populations. CONCLUSION Classic KS is quite common in Peru with sporadic cases found throughout the country and some clustering in the coastal region. Classic KS in Peru has a clinical presentation that is very similar, but not identical, to the classic KS described in the Mediterranean region, exhibiting some special clinical and epidemiological characteristics with a nodular, nonsymmetric presentation that usually affects the lower extremities.
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Affiliation(s)
- Salim Mohanna
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Abstract
While there have been many important advances in the study of Kaposi's sarcoma (KS), it remains both a challenge and an enigma in many ways. Kaposi's original description of "multiple idiopathic hemorrhagic sarcoma[s]" in patients who died within 2-3 years resembles KS in AIDS more than classic KS in elderly men of Italian, Jewish, or Mediterranean lineage, in whom the disease is usually benign. KS had been evident in about one-third of those with early AIDS, often as its presenting sign, a pattern markedly reduced in recent times since the introduction of highly active anti-retroviral therapy (HAART). The most important advance has been the convincing etiologic linkage of KS with human herpesvirus 8 (HHV-8), which is necessary but not sufficient. It has a low prevalence in the general population of the USA and UK, with an intermediate rate in Italy and Greece, and a high one in Uganda. KS risk may be significantly lower in AIDS patients with a history of anti-herpes therapy. Many aspects of HHV-8, including its transmission pattern and different genospecies, are being scrutinized. The diagnosis of KS may be difficult. One should be aware of KS clinical variants, including telangiectatic, eccymotic, and keloidal KS. One must consider a number of other disorders, including bacillary angiomatosis. HHV-8 DNA sequences in dermatofibromas and other tumors should probably not be viewed as representing a marker for KS. Therapeutic options vary for KS. Intralesional and low-dose outpatient intravenous vinblastine may be valuable, as immunosuppression with KS is not a good idea if it can be avoided. Anti-herpes virus therapy may have potential for wide use, especially in preventing the development of KS in at risk populations, such as HHV-8 seropositive individuals undergoing transplantation surgery.
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Affiliation(s)
- Robert A Schwartz
- Dermatology, New Jersey Medical School, Newark, New Jersey 07103, USA.
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