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Tammam A, Abdulrahman A, Ebrahim M, Mohammad B, Kanan A, Nada S, Abdulrahman A, Ahmad A. Penile Kaposi Sarcoma as an initial manifestation of HIV infection: A case report and literature review. IDCases 2022; 29:e01576. [PMID: 35912382 PMCID: PMC9334336 DOI: 10.1016/j.idcr.2022.e01576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/18/2022] [Indexed: 10/25/2022] Open
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2
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Anderson MA, Ying T, Wyburn K, Ferguson PM, Strach MC, Grimison P, Chadban S, Gracey DM. Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report. BMC Urol 2021; 21:87. [PMID: 34098936 PMCID: PMC8186205 DOI: 10.1186/s12894-021-00855-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Kaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable. Case presentation A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment. Conclusion This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.
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Affiliation(s)
- Matthew A Anderson
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.
| | - Tracey Ying
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Kate Wyburn
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Peter M Ferguson
- Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia
| | - Madeleine C Strach
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Peter Grimison
- Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Steve Chadban
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - David M Gracey
- Department of Renal Medicine and Renal Transplant, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Camperdown, NSW, Australia.,Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
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3
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Bhambhvani HP, Greenberg DR, Parham MJ, Eisenberg ML. A population-level analysis of nonsquamous penile cancer: The importance of histology. Urol Oncol 2020; 39:136.e1-136.e10. [PMID: 33257222 DOI: 10.1016/j.urolonc.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/07/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Nonsquamous penile cancers comprise 5% of penile malignancies, though their clinicopathologic features and prognostic significance remain unknown. We used a national cancer registry to detail clinical characteristics and compare cancer-specific mortality (CSM) of nonsquamous cancers with squamous cell carcinoma (SCC). METHODS The Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) was queried to identify adults with nonsquamous penile cancer and penile SCC. Multivariable Fine and Gray competing-risks regression, propensity score matching, and cumulative incidence plots were used. RESULTS 666 men with nonsquamous penile cancer and 5,894 men with penile SCC were identified. The most commonly represented nonsquamous histological subtypes were Kaposi sarcoma (n = 183, 27.5%), melanoma (n = 74, 11.1%), basal cell carcinoma (n = 65, 9.8%), and extramammary Paget disease (n = 42, 6.3%). Cumulative incidence plots revealed a 10-year CSM rate of 32.6% in the nonsquamous penile cancer group and 25.6% in the matched penile SCC group (P < 0.0001). Among Kaposi sarcoma patients and matched SCC patients, we found a 10-year CSM rate of 29.6% in the Kaposi sarcoma group and 15.3% in the penile SCC group (P = 0.002). Similarly, a comparison of penile melanoma patients with matched SCC patients revealed a 10-year CSM rate of 38.4% in the melanoma group and 16.6% in the SCC group (P = 0.002). There was no difference in CSM between patients with basal cell carcinoma and SCC. In a sensitivity analysis limiting year of diagnosis to 2000 and onward, we found no difference in CSM between the general nonsquamous cohort or the Kaposi sarcoma cohort and matched SCC patients, but contemporary melanoma patients maintained worse CSM with a 10-year rate of 38.4% vs. 15.8% in matched SCC patients (P = 0.045). CONCLUSIONS The most common nonsquamous penile cancers are Kaposi sarcoma, melanoma, and basal cell carcinoma. Overall, CSM is higher in nonsquamous penile cancers as compared to stage-matched SCC. Outcomes are similar in modern patients, likely due to improved control of systemic HIV in patients with Kaposi sarcoma. However, men with penile melanoma continue to experience a higher rate of CSM.
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Affiliation(s)
| | | | - Matthew J Parham
- Department of Urology, Stanford University Medical Center, Stanford, CA
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Brambilla L, Genovese G, Berti E, Peris K, Rongioletti F, Micali G, Ayala F, Della Bella S, Mancuso R, Calzavara Pinton P, Tourlaki A. Diagnosis and treatment of classic and iatrogenic Kaposi's sarcoma: Italian recommendations. Ital J Dermatol Venerol 2020; 156:356-365. [PMID: 33179877 DOI: 10.23736/s2784-8671.20.06703-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Kaposi's sarcoma (KS) is a lymphangioproliferative disorder associated with Human herpesvirus 8 (HHV8) infection. Four clinical subtypes are recognized: classic, endemic, epidemic (HIV-related) and iatrogenic. KS diagnosis is based on clinical features, histopathological assessment, and HHV8 serology. Classic KS is usually skin-limited and has a chronic course, while the iatrogenic variant may show mucosal, nodal or visceral involvement. Clinical staging is fundamental to guide the management. Localized disease may be treated with different local therapies, even if there are no randomized trials comparing these different modalities. Aggressive, disseminated KS and cases with visceral involvement usually require systemic chemotherapy, most commonly vinblastine, bleomycin or paclitaxel. Iatrogenic KS needs immunosuppression tapering/withdrawal and, if possible, switch to m-TOR inhibitors in post-transplant KS. The present work by a panel of Italian experts provides guidelines on KS diagnosis and management based on a critical review of the literature and a long and extensive personal experience.
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Affiliation(s)
- Lucia Brambilla
- Unit of Dermatology, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Unit of Dermatology, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical-Surgical Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Emilio Berti
- Unit of Dermatology, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical-Surgical Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ketty Peris
- Unit of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Unit of Dermatology, Sacred Heart Catholic University, Rome, Italy
| | - Franco Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Micali
- Clinic of Dermatology, University of Catania, Catania, Italy
| | - Fabio Ayala
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Silvia Della Bella
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy.,Department of Medical Biotechnologies and Translational Medicine, University of Milan, Milan, Italy
| | | | | | - Athanasia Tourlaki
- Unit of Dermatology, Maggiore Polyclinic Hospital, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy -
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5
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Tognetti L, Carraro A, Lamberti A, Cinotti E, Suppa M, Luc Perrot J, Rubegni P. Kaposi sarcoma of the glans: New findings by line field confocal optical coherence tomography examination. Skin Res Technol 2020; 27:285-287. [PMID: 32700774 DOI: 10.1111/srt.12938] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Andrea Carraro
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Arianna Lamberti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Mariano Suppa
- Department of Dermatology, Erasme Hospital, University of Brussels, Bruxelles, Belgium
| | - Jean Luc Perrot
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.,Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
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6
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Baazeem A. Solitary incidental primary Kaposi's sarcoma of the glans penis in a patient with no risk factors. Urol Ann 2020; 12:283-285. [PMID: 33100756 PMCID: PMC7546061 DOI: 10.4103/ua.ua_172_19] [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: 12/22/2019] [Accepted: 01/13/2020] [Indexed: 11/28/2022] Open
Abstract
Kaposi's sarcoma (KS) is an endothelial neoplasm, originally reported by Moritz Kaposi in 1872. It most commonly involves the lower extremities. Its clinical presentation and course can be quite variable. We present a rare case of solitary incidental primary KS of the glans penis in a circumcised, immunocompetent male who is human immunodeficiency virus seronegative. The lesion was discovered incidentally when the otherwise asymptomatic male presented to our outpatient department for an unrelated issue and was given a physical examination. To our knowledge, this is the first incidentally discovered case of primary penile KS.
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Affiliation(s)
- Abdulaziz Baazeem
- Department of Surgery, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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7
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Araghi F, Tabary M, Bidari-Zerehpoosh F, Asadi-Kani Z, Robati RM. Primary Kaposi sarcoma of the glans: A rare case in an HIV-negative patient. Clin Case Rep 2020; 8:1134-1137. [PMID: 32695343 PMCID: PMC7364109 DOI: 10.1002/ccr3.2838] [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: 02/20/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022] Open
Abstract
First presentation of the Kaposi sarcoma (KS) on the penis is not prevalent, and it was reported in 2%-3% of the cases that mostly occurred in the HIV-positive patients. Here, we report a case of primary KS on the glans penis in an HIV-negative patient.
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Affiliation(s)
- Farnaz Araghi
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | | | - Farahnaz Bidari-Zerehpoosh
- Department of Pathology Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Zahra Asadi-Kani
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Reza M Robati
- Skin Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
- Department of Dermatology Loghman Hakim Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
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8
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Alamri A, Adiga BK. Atypical presentation of classic Kaposi sarcoma in circumcised penis presenting as an ulcerative nodule with human herpesvirus 8 (HHV8) positivity and successfully treated with only local excision. Infect Agent Cancer 2019; 14:45. [PMID: 31827596 PMCID: PMC6889700 DOI: 10.1186/s13027-019-0261-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/20/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Although the Kaposi sarcoma (KS) is one of the AIDS defining entity and seen in almost one third of HIV infected patients with low CD4 cell counts, it is not uncommon in HIV seronegative persons, but genital KS is rare, particularly in people without risk factors for HIV infection. Isolated penile KS is an unusual manifestation, especially as solitary nodule with ulceration, in HIV seronegative patient. Case presentation We report such a case of Kaposi sarcoma showing HHV-8 positivity in an elderly male Arabian patient with a delay in prompt diagnosis, but treated successfully with 3 3 years follow-up after limited local surgical excision. Conclusion The general practitioners, venereologists and urologists should think of KS as a possibility in such lesion and consider early biopsy.
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Affiliation(s)
- Abdulaziz Alamri
- 1College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - B K Adiga
- 2Department of Pathology, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
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9
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Kuriyama Y, Shimizu A, Yamada K, Yasuda M, Amano H, Tamura A, Ishikawa O. Case of classic Kaposi sarcoma of the penis successfully treated with radiotherapy. J Dermatol 2018; 45:e175-e176. [PMID: 29341256 DOI: 10.1111/1346-8138.14220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yuko Kuriyama
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Shimizu
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuya Yamada
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroo Amano
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Department of Dermatology, Iwate Medical University, Morioka, Japan
| | | | - Osamu Ishikawa
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
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10
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Attwa E, Gharib K, Albalat W, Amer A. Classical Kaposi sarcoma: case reports with unusual presentation on the penis and scrotum. Int J Dermatol 2016; 55:e533-8. [PMID: 27231143 DOI: 10.1111/ijd.13319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 12/25/2015] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is the most common vascular neoplasm. Any skin area could be involved, including the genitalia. Traditionally, classic KS lesions have a general distribution, often involving skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. KS limited to the external genitalia is extremely rare in HIV seronegative individuals. METHODS We report six patients of classic KS with generalized dermal KS lesions. RESULTS Two of them presenting with unusual KS lesions on the penis and scrotum beside the other dermal lesions. Patients were HIV negative and human herpes virus eight positive. Histological examination showed classical KS. CONCLUSIONS Primary KS of the penis and scrotum is rare but could occur in HIV-negative patients.
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Affiliation(s)
- Enayat Attwa
- Dermatology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Khaled Gharib
- Dermatology Department, Faculty of Medicine, Zagazig University, Egypt.
| | - Waleed Albalat
- Dermatology Department, Faculty of Medicine, Zagazig University, Egypt
| | - Amin Amer
- Dermatology Department, Faculty of Medicine, Zagazig University, Egypt
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11
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Farshidpour M, Marjani M, Baghaei P, Tabarsi P, Masjedi H, Asadi Kani ZF, Nadji SA, Mansouri D. Disseminated Kaposi's Sarcoma with the Involvement of Penis in the Setting of HIV Infection. Indian J Dermatol 2015; 60:104. [PMID: 25657424 PMCID: PMC4318030 DOI: 10.4103/0019-5154.147852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Kaposi's sarcoma (KS) is a malignant proliferation of the endothelial cells. It typically presents with several vascular nodules on the skin and other organs. The penile localization of KS, particularly on the shaft area, is exceptional. We report an HIV-positive 34-year-old man who had multiple purplish-black plaques on his extremities and several small violaceous macules on the glans and shaft of the penis. Kaposi's sarcoma was diagnosed by histopathology.
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Affiliation(s)
- Maham Farshidpour
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Marjani
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Heidar Masjedi
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Seyed Alireza Nadji
- Virology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Mansouri
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12
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Lebari D, Gohil J, Patnaik L, Wasef W. Isolated penile Kaposi's sarcoma in a HIV-positive patient stable on treatment for three years. Int J STD AIDS 2014; 25:607-10. [PMID: 24492851 DOI: 10.1177/0956462413517494] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/14/2013] [Indexed: 11/15/2022]
Abstract
Kaposi's sarcoma (KS) is an AIDS-defining condition. Typically, KS affects the skin with or without visceral involvement. The extensive use of antiretroviral therapy (ART) has decreased the incidence of KS amongst the HIV-positive population. We report a case of a 40-year-old man with HIV-1 infection with CD4 count of 551 cells/mm(3)and an undetectable viral load who presented with two skin-coloured KS lesions on the prepuce of the penis. Diagnosis was confirmed by histopathology. He had been commenced on ART three years earlier with a nadir CD4 count of 255 cells/mm(3) He had achieved and maintained viral suppression since commencing ART. The patient was initially treated with cryotherapy and 5% imiquimod as the lesions were presumed to be warts. The lack of response to treatment prompted further investigation. We carried out a literature search of published cases of penile KS over the past 10 years. The majority of articles regarding penile KS were published in the pre-ART era and involved patients with AIDS. Over the past 10 years, published cases of penile KS have almost exclusively been in HIV-negative men. We found 10 published cases of penile KS in HIV-negative men and only one other published case of penile KS in a HIV-positive man, who had severe immune suppression with CD4 count below 200 cells/mm(3) This is the first case report to describe a HIV-positive patient stable on ART with a CD4 count above 200 cells/mm(3)and suppressed HIV-1 viral load, to develop two KS lesions on the penis. Clinicians have to remain suspicious of penile lesions and appreciate the crucial role a biopsy with histopathological analysis plays in confirming a diagnosis. In addition, this case illustrates that unusual presentations of KS can still occur in treated HIV-positive patients with sustained immune recovery.
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Affiliation(s)
- Dornubari Lebari
- Blackpool Sexual Health Services, Whitegate Health Centre, Blackpool, UK
| | - Jesal Gohil
- University of Liverpool Medical School, Liverpool, UK
| | - Lipsita Patnaik
- Department of Histopathology, Blackpool Victoria Teaching Hospital, Blackpool, UK
| | - Wafaa Wasef
- Blackpool Sexual Health Services, Whitegate Health Centre, Blackpool, UK
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13
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14
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Seleit I, Attia A, Maraee A, Samaka R, Bakry O, Eid E. Isolated Kaposi Sarcoma in two HIV negative patients. J Dermatol Case Rep 2011; 5:24-6. [PMID: 21894251 DOI: 10.3315/jdcr.2011.1067] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 03/28/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a neoplasm of the endothelial cells. It often manifests with multiple vascular nodules on the skin and other organs. It is a systemic, malignant and multifactorial disease and has a variable course. There are four types: classic, endemic, iatrogenic and HIV-associated. The primary presentation on the penis and face is uncommon and is mainly observed in HIV-positive patients. Multiple treatment modalities are used including surgery, cryotherapy, electrosurgery, laser and radiation therapy. MAIN OBSERVATION The authors present two cases of isolated Kaposi sarcoma in HIV negative, human herpes virus 8 (HHV-8) positive non immunocompromised patients. One case with facial KS and the other one with penile KS. Both were treated surgically with no recurrence in the following 6 months of the follow up period. CONCLUSIONS Kaposi sarcoma is rare in HIV negative patients and is associated with HHV-8 infection. Lesions are usually solitary and can be treated surgically. It should be included in the differential diagnoses of penile and facial lesions that are clinically suspecious and resistent to therapy.
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Affiliation(s)
- Iman Seleit
- Department of Dermatology, Andrology and S.T.Ds, Faculty of Medicine, Menoufiya University, Egypt
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15
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Cecchi R, Troiano M, Ghilardi M, Bartoli L. Kaposi Sarcoma of the Penis in an HIV-Negative Patient. J Cutan Med Surg 2011; 15:118-20. [DOI: 10.2310/7750.2011.10039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The penis is an unusual site of presentation for Kaposi sarcoma, especially in immunocompetent patients. Case Presentation: A 52-year-old human immunodeficiency virus (HIV)-seronegative man presented with a reddish, 8 mm in diameter nodule on the glans penis near the coronal sulcus. Histopathology after excision of the lesion was consistent with Kaposi sarcoma. No other cutaneous or mucosal manifestations were present. After a follow-up period of 2 years, no recurrence was observed. Conclusion: This unusual case suggests that Kaposi sarcoma should be considered in the differential diagnosis of macular, papular, and nodular lesions involving the penis.
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Affiliation(s)
- Roberto Cecchi
- From the Department of Dermatology, Pistoia Hospital, Pistoia, Italy
| | - Michela Troiano
- From the Department of Dermatology, Pistoia Hospital, Pistoia, Italy
| | - Maurizia Ghilardi
- From the Department of Dermatology, Pistoia Hospital, Pistoia, Italy
| | - Laura Bartoli
- From the Department of Dermatology, Pistoia Hospital, Pistoia, Italy
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16
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Kim KH, Choi JI, Ryu KH, Kang IH, Leng YH, Lee JW, Lee JW, Kim YJ, Lee JK. Primary Classic Kaposi's Sarcoma of the Penis in an HIV-Negative Patient. Korean J Urol 2010; 51:803-6. [PMID: 21165204 PMCID: PMC2991581 DOI: 10.4111/kju.2010.51.11.803] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/04/2010] [Indexed: 12/04/2022] Open
Abstract
Kaposi's sarcoma (KS) is a multifocal hemorrhagic sarcoma that occurs primarily on the extremities. KS limited to the penis is rare and a well-recognized manifestation of acquired immune deficiency syndrome (AIDS). However, KS confined to the penis is extraordinary in human immunodeficiency virus (HIV)-negative patients. We present the case of a 68-year-old man with a dark reddish ulcerated nodule on the penile skin, which was reported as a nodular stage of KS. We detected no evidence of immunosuppression or AIDS or systemic involvements in further evaluations. In his past medical history, the patient had undergone three transurethral resections of bladder tumors due to urothelial cell carcinoma since 2000 and total gastrectomy, splenectomy, and adjuvant fluorouracil/cisplatin chemotherapy for 7 months due to advanced gastric carcinoma in 2005. The patient was circumcised and has had no recurrence for 2 years.
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Affiliation(s)
- Kwang Ho Kim
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
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Mukai MM, Chaves T, Caldas L, Fillus Neto J, Santamaría JR. Sarcoma de Kaposi primário do pênis. An Bras Dermatol 2009; 84:524-6. [DOI: 10.1590/s0365-05962009000500013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 10/20/2008] [Indexed: 11/21/2022] Open
Abstract
Sarcoma de Kaposi é um tumor vascular que afeta a parede dos vasos linfáticos. Possui quatro formas: clássica, endêmica, iatrogênica e associada ao HIV. É uma doença sistêmica, maligna, multifatorial e de curso variável. A apresentação inicial no pênis é rara, e mais observada em pacientes HIV positivos. Em pacientes HIV negativos, os casos que ocorrem nesta região, apresentam-se com pápulas, nódulos, placas e lesões verruciformes, assintomáticas. Para o tratamento da forma clássica, dispõem-se de excisão cirúrgica, crioterapia, eletrocirurgia, laser e radioterapia. Neste trabalho, é relatado um caso raro de um paciente com a forma clássica, em região peniana tratado com sucesso com radioterapia.
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Hernández-Bel P, López J, Sánchez J, Vilata J, Alegre V. Sarcoma de Kaposi primario del pene en paciente VIH negativo. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s0001-7310(08)74769-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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CURATOLO PIETRO, MANCINI MONICA, RUGGIERO ARIANNA, CLERICO RITA, DI MARCO PIERO, CALVIERI STEFANO. Successful Treatment of Penile Kaposi's Sarcoma with Electrochemotherapy. Dermatol Surg 2008; 34:839-42; discussion 842-3. [DOI: 10.1111/j.1524-4725.2008.34157.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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COMMENTARY. Dermatol Surg 2008. [DOI: 10.1097/00042728-200806000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernández-Bel P, López J, Sánchez J, Vilata J, Alegre V. Primary Kaposi Sarcoma of the Penis in an HIV-Negative Patient. ACTAS DERMO-SIFILIOGRAFICAS 2008. [DOI: 10.1016/s1578-2190(08)70339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
A 65-year-old diabetic Saudi Arabian man taking glibenclamide for 9 years presented with painful reddish patches and plaques involving the palms and soles of 6 months' duration. These lesions started as small faint purple-red macules and gradually increased in number and size. The patient did not seek any medical advice other than for these painful lesions. His medical history was insignificant. On examination, the patient had multiple, discrete, dull red-to-violaceous and tender patches and plaques of variable sizes on both palms and soles (Figure 1 and Figure 2). His mucous membranes, scalp, and nails were normal. A systemic clinical examination was unremarkable other than an amputation of the distal phalanx of the left index. Result of routine laboratory investigations including complete blood cell count, liver and renal function tests, and chest x-ray were normal. An HIV test was negative. A punch skin biopsy taken from the left palm showed acanthosis and spongiosis in the epidermis. The dermis showed a large number of dilated, medium-sized capillaries with scanty extravasated red blood cells, marked infiltration of lymphocytes and histiocytes, and a few plasma cells (Figure 3 and Figure 4). Immunohistochemistry results were positive for CD34 and CD68. Polymerase chain reaction for human herpesvirus 8 was also positive. The treatment options, including cryotherapy and intralesional chemotherapy, were discussed with the patient but, unfortunately, he did not return for follow-up.
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Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer. J Am Acad Dermatol 2006; 54:369-91; quiz 391-4. [PMID: 16488287 DOI: 10.1016/j.jaad.2005.05.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 03/30/2005] [Accepted: 05/03/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED Penile cancer, while relatively rare in the western world, remains a disease with severe morbidity and mortality, not to mention significant psychological ramifications. Furthermore, the disease is observed with dramatically increased incidence in other parts of the world. A review of the literature has shown that the overwhelming majority of penile cancers are in situ or invasive squamous cell carcinomas, including a well-differentiated variant, verrucous carcinoma. Important predisposing factors are lack of circumcision, human papillomavirus infections, and penile lichen sclerosus, although other factors have occasionally been reported as well. Prevention, careful monitoring of patients at risk, and early diagnosis are essential to reduce the incidence of penile carcinoma and to provide a definitive cure. Public health measures, such as prophylactic use of circumcision, have proved successful but are controversial. Also, no standard therapeutic guidelines as to the best treatment strategy according to different stages, including efficacy of conservative nonsurgical modalities and indications for lymph nodal dissection, are available so far. It is common opinion that penile cancer is an emerging problem that deserves further investigations, and physicians, especially dermatologists, should be aware of this issue. LEARNING OBJECTIVE At the completion of this learning activity, participants should be familiar with penile carcinoma, its risk factors, its clinical and histologic presentation, and the treatments currently available for its management.
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Affiliation(s)
- Giuseppe Micali
- Department of Dermatology, University of Catania School of Medicine, Catania, Italy.
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25
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Zargari O. Exclusive penile Kaposi's sarcoma: report of an HIV-negative man successfully treated with radiotherapy. J Eur Acad Dermatol Venereol 2006; 20:318-20. [PMID: 16503896 DOI: 10.1111/j.1468-3083.2006.01423.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Kaposi's sarcoma (KS) is a rare neoplasm of endovascular cells with multifocal origin. The exact nature of the disease is not clear, but current data support the notion that KS is a vascular hyperplasia with a tight link to human herpesvirus 8 (HHV-8) infection. Classic KS occurs primarily on the lower extremities in elderly men living in the Mediterranean region. Penile involvement has rarely been reported in non-human immune deficiency virus (HIV) patients. Herein we present a 71-year-old HIV-negative man with isolated KS on the penis who was treated successfully with radiotherapy. A review of the literature is also presented.
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Affiliation(s)
- O Zargari
- Department of Dermatology, Guilan University of Medical Sciences, Rasht, Iran.
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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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Invasive Penile Carcinoma. Dermatol Surg 2004. [DOI: 10.1097/00042728-200402002-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Penile carcinoma is an invasive epithelial tumor that may arise from penile skin or mucosa. OBJECTIVE To review the pathogenesis and the clinical and histopathologic features of invasive penile carcinomas, with emphasis on current guidelines for their diagnosis and treatment. METHODS Information available from the authors' clinical experience, review articles, case reports, clinical trials, and in vitro research studies identified from a computerized literature search on MEDLINE database and from Meetings' Abstract Books, including those from non-English literature, was considered. RESULTS Penile cancer may develop de novo or in association with underlying factors. Conditions predisposing to the development of penile cancer are delineated. The diagnosis should be suspected by clinical findings and must be confirmed histologically. Imaging techniques may be useful for staging and planning therapy. Therapeutic options include excisional surgery, laser destruction, cryosurgery, radiotherapy, immunotherapy, and chemotherapy. CONCLUSIONS Although there are no current guidelines for the treatment of penile carcinoma, surgical ablation probably represents the best option, as conservative treatments still deserve cautious evaluation because of the relatively small number of treated patients and the lack of good-quality comparative data. Regarding indications for lymph nodal dissection in patients showing no inguinal node enlargement, sentinel node mapping with targeted lymph node dissection is recommended for those with deeply invasive, high-grade tumors, whereas a watchful waiting may be advised for those with superficially invasive, low-grade tumors.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania Dermatology Clinic, University La Sapienza of Rome Department of Dermatology, New Jersey Medical School, Newark, New Jersey, USA.
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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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