Exclusive penile Kaposi's sarcoma: report of an HIV-negative man successfully treated with radiotherapy

Zebras in Foreskin Dermatopathology: A Review

OBJECTIVES

The aim of the study was to review uncommon foreskin dermatopathology conditions clinically and pathologically.

METHODS

A database search of PubMed and Google Scholar were extracted between March 1, 2009, and March 1, 2019, using the search terms "foreskin," "prepuce," "penis," "pathology," "dermatology," and "rare." The search was limited to "humans" and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. Patient details (diagnosis, dermatopathology, treatment, and follow-up if available) were extracted. We excluded articles written in the non-English language, unusual variants of common conditions, and cases of common dermatologic conditions.

RESULTS

A list of 369 articles was identified and another screening identified 30 articles for rare foreskin pathologies. Those are divided into categories based on the following etiologies: (a) benign, including congenital (e.g., aposthia), infectious (graft versus host disease and histoplasma), autoimmune (Crohn's disease and pyoderma gangrenosum), and benign neoplasms (neurofibroma, apocrine hidrocystoma, verruciform xanthoma, porokeratosis, penile cutaneous horn, localized amyloidosis) and (b) malignancies, including primary (myeloid sarcoma, basal cell carcinoma, Kaposi's sarcoma, mucosal-associated lymphoid tissue lymphoma), and metastasis.

CONCLUSIONS

We reviewed and discussed unusual benign and malignant dermatopathology conditions that can affect the foreskin.

Lesions and Neoplasms of the Penis: A Review

In addition to practitioners who care for male patients, with the increased use of high-resolution anoscopy, practitioners who care for women are seeing more men in their practices as well. Some diseases affecting the penis can impact on their sexual partners. Many of the lesions and neoplasms of the penis occur on the vulva as well. In addition, there are common and rare lesions unique to the penis. A review of the scope of penile lesions and neoplasms that may present in a primary care setting is presented to assist in developing a differential diagnosis if such a patient is encountered, as well as for practitioners who care for their sexual partners. A familiarity will assist with recognition, as well as when consultation is needed.

Classical Kaposi sarcoma: case reports with unusual presentation on the penis and scrotum

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.

Disseminated Kaposi's Sarcoma with the Involvement of Penis in the Setting of HIV Infection

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.

Isolated penile Kaposi's sarcoma in a HIV-positive patient stable on treatment for three years

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.

Isolated Kaposi Sarcoma in two HIV negative patients

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.

Kaposi Sarcoma of the Penis in an HIV-Negative Patient

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.

Primary Classic Kaposi's Sarcoma of the Penis in an HIV-Negative Patient

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.

Sarcoma de Kaposi primário do pênis

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.