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Saberian C, Lurain K, Hill LK, Marshall V, Cornejo Castro EM, Labo N, Miley W, Moore K, Roshan R, Ruggerio M, Ryan K, Widell A, Ekwede I, Mangusan R, Rupert A, Barochia A, Whitby D, Yarchoan R, Ramaswami R. Kaposi sarcoma herpesvirus viral load in bronchoalveolar lavage as a diagnostic marker for pulmonary Kaposi sarcoma. AIDS 2024; 38:1172-1180. [PMID: 38564482 PMCID: PMC11141217 DOI: 10.1097/qad.0000000000003897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Kaposi sarcoma is a vascular tumor that affects the pulmonary system. However, the diagnosis of airway lesions suggestive of pulmonary Kaposi sarcoma (pKS) is reliant on bronchoscopic visualization. We evaluated the role of Kaposi sarcoma herpesvirus (KSHV) viral load in bronchoalveolar lavage (BAL) as a diagnostic biomarker in patients with bronchoscopic evidence of pKS and evaluated inflammatory cytokine profiles in BAL and blood samples. DESIGN In this retrospective study, we evaluated KSHV viral load and cytokine profiles within BAL and blood samples in patients who underwent bronchoscopy for suspected pKS between 2016 and 2021. METHODS KSHV viral load and cytokine profiles were obtained from both the circulation and BAL samples collected at the time of bronchoscopy to evaluate compartment-specific characteristics. BAL was centrifuged and stored as cell pellets and KSHV viral load was measured using primers for the KSHV K6 gene regions. RESULTS We evaluated 38 BAL samples from 32 patients (30 with HIV co-infection) of whom 23 had pKS. In patients with airway lesions suggestive of pKS, there was higher KSHV viral load (median 3188 vs. 0 copies/10 6 cell equivalent; P = 0.0047). A BAL KSHV viral load cutoff of 526 copies/10 6 cells had a sensitivity of 72% and specificity of 89% in determining lesions consistent with pKS. Those with pKS also had higher IL-1β and IL-8 levels in BAL. The 3-year survival rate for pKS patients was 55%. CONCLUSION KSHV viral load in BAL shows potential for aiding in pKS diagnosis. Patients with pKS also have evidence of cytokine dysregulation in BAL.
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Affiliation(s)
- Chantal Saberian
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Kathryn Lurain
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Lindsay K Hill
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Vickie Marshall
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Elena M. Cornejo Castro
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Nazzarena Labo
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Wendell Miley
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Kyle Moore
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Romin Roshan
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Margie Ruggerio
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Kerry Ryan
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Anaida Widell
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Irene Ekwede
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ralph Mangusan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Adam Rupert
- AIDS Monitoring Laboratory, Leidos Biomedical Research, Frederick, MD
| | - Amisha Barochia
- Critical Care Medicine and Pulmonary Branch, National Heart Lung and Blood Institute, Bethesda, MD
| | - Denise Whitby
- Viral Oncology Section, AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Robert Yarchoan
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
| | - Ramya Ramaswami
- HIV & AIDS Malignancy Branch, Center for Cancer Research, NCI, Bethesda, MD
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Cobanoglu HB, Koprucu ER. Non-squamous Cancers of the Larynx. Curr Oncol Rep 2024; 26:625-632. [PMID: 38668924 PMCID: PMC11168984 DOI: 10.1007/s11912-024-01535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE OF REVIEW Although non-squamous tumors of the larynx are really rare, they may not always be viewed from the same perspective in the multidisciplinary treatment approach once the diagnosis is made. In this review, non-squamous tumors of the larynx and current approaches in treatment will be discussed. RECENT FINDINGS When the studies and meta-analyses presented in the last 5 years are evaluated, it is seen that these tumors usually show non-specific symptoms. Due to their submucosal location, the stage of the disease at the time of diagnosis is often advanced. In the literature, treatment may vary in these particular cases. The majority of non-squamous tumors of the larynx includes minor salivary gland tumors, neuroendocrine carcinomas, sarcomas, cartilage tumors, and malignant melanomas. Once treating a patient with these diagnoses, it should be kept in mind that the histopathological subtype is almost as important as the stage of the tumor.
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Affiliation(s)
- H Bengu Cobanoglu
- Faculty of Medicine, Department of Otorhinolaryngology Head & Neck Surgery, Karadeniz Technical University, Trabzon, Turkey.
| | - Erdal Rahman Koprucu
- Faculty of Medicine, Department of Otorhinolaryngology Head & Neck Surgery, Karadeniz Technical University, Trabzon, Turkey
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Donuru A, Torigian DA, Knollmann F. Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features. Tomography 2024; 10:574-608. [PMID: 38668402 PMCID: PMC11054070 DOI: 10.3390/tomography10040045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.
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Affiliation(s)
- Achala Donuru
- Division of Cardiothoracic Imaging, Department of Radiology, Hospitals of University of Pennsylvania, Philadelphia, PA 19104, USA; (D.A.T.); (F.K.)
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Umehana M, Hosono M, Hijikata Y, Takahashi M, Kanagaki M. Pembrolizumab-Associated Pneumonitis Resembling Lymphangitic Carcinomatosis in a Melanoma Patient. Clin Nucl Med 2023; 48:e529-e531. [PMID: 37793162 DOI: 10.1097/rlu.0000000000004845] [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: 10/06/2023]
Abstract
ABSTRACT In recent years, many articles have described the adverse events associated with immune checkpoint inhibitors. We report the case of a 63-year-old woman with bilateral lung shadows after 1-year pembrolizumab immunotherapy following surgery for the right-foot melanoma because of positive sentinel lymph nodes. Follow-up 18 F-FDG PET/CT demonstrated bilateral diffuse mass-like peribronchovascular opacities with marked FDG uptake. Clinically, melanoma metastases with lymphangitic spread were suspected, and bronchoscopy was performed, although no evidence of malignancy was found. The lung shadow was mostly resolved after steroid treatment. Pembrolizumab-induced pneumonitis can be a mimicker of melanoma metastasis with lymphangitic spread.
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Affiliation(s)
- Masaki Umehana
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Makoto Hosono
- Department of Radiology, Kindai University Faculty of Medicine, Osaka
| | - Yoichiro Hijikata
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
| | - Mina Takahashi
- Department of Plastic and Reconstructive Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Mitsunori Kanagaki
- From the Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo
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5
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Sidorov IV, Abramov DS, Strumila NA, Shelihova LN, Viktorova EA, Konovalov DM. Kaposi's Sarcoma in Children After Hematopoietic Stem Cell Transplantation: Two Cases of Rare Primary Tumor Localizations in the Lungs and Lymph Node. J Pediatr Hematol Oncol 2023; 45:e972-e975. [PMID: 37669118 DOI: 10.1097/mph.0000000000002745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 07/10/2023] [Indexed: 09/07/2023]
Abstract
Kaposi's sarcoma (KS) is a vascular / mesenchymal tumor with an indefinite degree of malignancy, caused by complex etiopathogenetic factors including Human Herpes Virus-8 infection of immunocompromised patients. For example, KS is more common in adult men with HIV. We describe 2 very rare cases of iatrogenic KS in children after hematopoietic stem cell transplant with isolated organ damage (case 1: lung; case 2: inguinal lymph node). KS is a potential complication of bone marrow transplant in pediatric patients and can occur in different age groups and at atypical sites.
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Affiliation(s)
| | | | | | | | | | - Dmitry Mikhailovich Konovalov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology
- Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation Moscow, Russia
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6
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Saberian C, Campbell BR. Rapidly Disseminated Kaposi's Sarcoma Despite Initiation of Antiretroviral Therapy. Cureus 2023; 15:e39627. [PMID: 37256167 PMCID: PMC10226159 DOI: 10.7759/cureus.39627] [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] [Accepted: 05/29/2023] [Indexed: 06/01/2023] Open
Abstract
Kaposi's sarcoma (KS) is the most common malignancy in people living with HIV. The reported incidence of AIDS-related KS has been dramatically decreased with the introduction of antiretroviral therapy (ART). Systemic treatment with ART is indicated for patients with AIDS-related KS; however, some patients may develop KS-related immune reconstitution inflammatory syndrome characterized by sudden rapid progression of new or pre-existing KS within the initiation of ART. Here, we present a case of rapidly disseminated KS with widespread visceral involvement despite ART initiation in a 27-year-old African American man with advanced HIV/AIDS.
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Affiliation(s)
| | - Breanna R Campbell
- Department of Infectious Diseases, Baton Rouge General, Baton Rouge, USA
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Motamedi M, Ferrara G, Yacyshyn E, Osman M, Abril A, Rahman S, Netchiporouk E, Gniadecki R. Skin disorders and interstitial lung disease: Part I-Screening, diagnosis, and therapeutic principles. J Am Acad Dermatol 2023; 88:751-764. [PMID: 36228941 DOI: 10.1016/j.jaad.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/26/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022]
Abstract
Numerous inflammatory, neoplastic, and genetic skin disorders are associated with interstitial lung disease (ILD), the fibrosing inflammation of lung parenchyma that has significant morbidity and mortality. Therefore, the dermatologist plays a major role in the early detection and appropriate referral of patients at risk for ILD. Part 1 of this 2-part CME outlines the pathophysiology of ILD and focuses on clinical screening and therapeutic principles applicable to dermatological patients who are at risk for ILD. Patients with clinical symptoms of ILD should be screened with pulmonary function tests and high-resolution chest computed tomography. Screening for pulmonary hypertension should be considered in high-risk patients. Early identification and elimination of pulmonary risk factors, including smoking and gastroesophageal reflux disease, are essential in improving respiratory outcomes. First-line treatment interventions for ILD in a dermatological setting include mycophenolate mofetil, but the choice of therapeutic agents depends on the nature of the primary disease, the severity of ILD, and comorbidities and should be the result of a multidisciplinary assessment. Better awareness of ILD among medical dermatologists and close interdisciplinary collaborations are likely to prevent treatment delays improving long-term outcomes.
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Affiliation(s)
- Melika Motamedi
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Elaine Yacyshyn
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammed Osman
- Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada
| | - Andy Abril
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida
| | - Samia Rahman
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Robert Gniadecki
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada.
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Barron K, Omiunu A, Celidonio J, Cruz-Mullane A, Din-Lovinescu C, Chemas-Velez MM, Baredes S, Eloy JA, Fang CH. Kaposi Sarcoma of the Larynx: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:269-281. [PMID: 35671149 DOI: 10.1177/01945998221105059] [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: 04/08/2022] [Accepted: 05/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Kaposi sarcoma (KS) of the larynx is a rare disease with few cases reported in the literature. This study aims to provide a comprehensive review of laryngeal KS, including patient characteristics, treatment, and clinical outcomes. DATA SOURCES PubMed, CINAHL, SCOPUS, and Cochrane Library. REVIEW METHODS A systematic review of the published English literature was conducted. An electronic search and bibliographic examination of articles pertaining to laryngeal KS were performed. Demographic data, tumor site, treatment strategies, follow-up, and outcome were analyzed. RESULTS A total 77 cases from 50 articles were included in the review. The mean age was 47.6 years (range, 8-81). There was an 8.6:1 male:female ratio. The most common presenting symptoms were dyspnea (n = 35) and hoarseness (n = 25). Laryngeal KS arose most frequently in the supraglottic region (n = 16). Chemotherapy alone (n = 27) was the most common treatment modality in patients with AIDS-associated KS, and surgical excision alone (n = 7) was most common in patients with other subtypes of KS (eg, classic, transplant associated). Average follow-up was 20.4 months (range, 0.75-120). Most patients with AIDS-associated KS died of other causes (n = 25), but most patients with other subtypes of KS were alive with no evidence of disease at follow-up (n = 13). CONCLUSION This review contains the largest pool of laryngeal KS cases to date. Long-term outcomes were generally unfavorable, often due to advanced HIV disease at the time of diagnosis.
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Affiliation(s)
- Kendyl Barron
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ariel Omiunu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Joseph Celidonio
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alexandra Cruz-Mullane
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Corina Din-Lovinescu
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Maria Manuela Chemas-Velez
- Department of Otolaryngology and Maxillofacial Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA
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Soliman M, Guys N, Liu P, Moshiri M, Menias CO, Mellnick VM, Savas H, Badawy M, Elsayes KM, Gaballah AH. Multimodality imaging findings of infection-induced tumors. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3930-3953. [PMID: 36069914 DOI: 10.1007/s00261-022-03651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 01/18/2023]
Abstract
Several infections can predispose to certain malignancies in different body parts. These infections include viral, bacterial, and fungal pathogens. Imaging plays a vital role in the diagnosis, staging, and management of these neoplastic conditions. Furthermore, it can help in differentiating infection-related non-neoplastic processes that can mimic malignancies. Both radiologists and clinicians should be familiar with these conditions. This review discusses the epidemiology, pathogenesis, and imaging features of infection-related tumors.
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Affiliation(s)
- Moataz Soliman
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas Guys
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter Liu
- Department of Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Mariam Moshiri
- Department of Diagnostic Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hatice Savas
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Ayman H Gaballah
- Department of Diagnostic Radiology, University of Missouri, Columbia, MO, USA.
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Franquet T, Franks TJ, Lee KS, Marchiori E, Mazzini S, Giménez A, Johkoh T, Cho J, Galvin JR. Human Oncoviruses and Thoracic Tumors: Understanding the Imaging Findings. Radiographics 2022; 42:644-660. [PMID: 35363552 DOI: 10.1148/rg.210157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Approximately 1.4 million virus-induced cancers occur annually, representing roughly 10% of the cancer burden worldwide. Seven oncogenic DNA and RNA viruses (ie, oncoviruses) are implicated in approximately 12%-25% of all human cancers owing to a variety of mechanisms as uncommon consequences of the normal viral life cycle. These seven well-recognized human oncoviruses are Epstein-Barr virus (EBV), human T-lymphotropic virus 1, hepatitis B virus, hepatitis C virus, HIV, human papilloma virus (HPV), and human herpesvirus 8 (HHV-8). Several viruses-namely, EBV, HPV, and Kaposi sarcoma herpesvirus or HHV-8-are increasingly being recognized as being related to HIV and/or AIDS, the growing number of transplant cases, and the use of immunosuppressive therapies. Infectious and inflammatory processes, and the accompanying lymphadenopathy, are great mimickers of human oncovirus-related tumors. Although it is often difficult to differentiate these entities, the associated clinical setting and radiologic findings may provide clues for an accurate diagnosis and appropriate management. Malignant lymphoid lesions are best evaluated with multidetector chest CT. The radiologic findings of these lesions are often nonspecific and are best interpreted in correlation with clinical data and histopathologic findings. ©RSNA, 2022.
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Affiliation(s)
- Tomás Franquet
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Teri J Franks
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Kyung Soo Lee
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Edson Marchiori
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Sandra Mazzini
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Ana Giménez
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Takeshi Johkoh
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Junhun Cho
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
| | - Jeffrey R Galvin
- From the Department of Diagnostic Radiology, Hospital de Sant Pau, Universidad Autónoma de Barcelona, C/ Sant Quintí 89, 08041, Barcelona, Spain (T.F., S.M., A.G.); Department of Pulmonary and Mediastinal Pathology, Department of Defense, the Joint Pathology Center, Silver Spring, Md, and Department of Chest Imaging, American Institute for Radiologic Pathology, Silver Spring, Md (T.J.F.); Department of Radiology, Samsung ChangWon Hospital, Sungkyunkwan University School of Medicine (SKKU-SOM), ChangWon, Gyeongsangnam-Do, Korea (K.S.L.); Department of Radiology, Hospital Universitário Clementino Fraga Filho-Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil (E.M.); Department of Radiology, Kansai Rosai Hospital, Amagasaki, Japan (T.J.); Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (J.C.); and Departments of Diagnostic Radiology and Internal Medicine, University of Maryland School of Medicine, Baltimore, Md (J.R.G.)
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11
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Munro M, Voight DM, Bryson BA, Bogart KR. Enacted Stigma Experiences and Identity Noticeability of LGBQ+ Women with Rare Diseases. JOURNAL OF HOMOSEXUALITY 2022:1-26. [PMID: 35452381 DOI: 10.1080/00918369.2022.2059971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lesbian, gay, bisexual, and queer (LGBQ+) people and those with rare diseases (RDs) experience considerable enacted stigma due to their sexual identity and disability/RD status. The frequency, severity, and type of enacted stigma is often influenced by identity noticeability. Although research has shown the challenging impacts of compounded oppression on multiply marginalized individuals, there has been no empirical research to date on the experiences of LGBQ+ women with RDs. This mixed methods study used survey and interview methods to explore enacted stigma experiences and identity noticeability of 29 LGBQ+ women with RDs. We found that RD visibility had a significant positive correlation to RD stigma. Additionally, age had a significant negative correlation to RD stigma and RD visibility. Common concerns for participants included healthcare stigma, sexual identity erasure, RD and/or LGBQ+ community exclusion, and heteropatriarchal expectations and norms. Increased research and support are needed for LGBQ+ women with RDs.
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Affiliation(s)
- Marla Munro
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, Texas, USA
| | - Danica M Voight
- School of Psychological Science, College of Liberal Arts, Oregon State University, Corvallis, Oregon, USA
| | - Brooke A Bryson
- School of Psychological Science, College of Liberal Arts, Oregon State University, Corvallis, Oregon, USA
| | - Kathleen R Bogart
- School of Psychological Science, College of Liberal Arts, Oregon State University, Corvallis, Oregon, USA
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12
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Micali C, Russotto Y, Facciolà A, Marino A, Celesia BM, Pistarà E, Caci G, Nunnari G, Pellicanò GF, Venanzi Rullo E. Pulmonary Kaposi Sarcoma without Respiratory Symptoms and Skin Lesions in an HIV-Naïve Patient: A Case Report and Literature Review. Infect Dis Rep 2022; 14:228-242. [PMID: 35447880 PMCID: PMC9025598 DOI: 10.3390/idr14020028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
Kaposi sarcoma (KS) is a multifocal lympho-angioproliferative, mesenchymal low-grade tumor associated with a γ2-herpesvirus, named Kaposi sarcoma-associated virus or human herpesvirus (KSHV/HHV8). The lung is considered a usual anatomical location of KS, despite being infrequent, often in association with extensive mucocutaneous lesions and very uncommonly as an isolated event. We report a case of a pulmonary KS (pKS) in a human immunodeficiency virus (HIV) naïve patient, which was atypical due to a lack of cutaneous involvement and an absence of respiratory symptoms. The pKS was initially identified as a tumoral suspected nodular lesion and only after immunohistochemical analysis was it characterized as KS. Furthermore, the diagnosis of pKS led to the discovery of the HIV-seropositive status of the patient, previously unknown. Our report underlines the importance of considering pKS even without skin lesions and as a first manifestation of HIV infection. We also reviewed literature on the current knowledge about pKS in people living with HIV (PLWH) to underline how one of the most common HIV/acquired immunodeficiency syndrome (AIDS) associated tumors can have a challenging localization and be difficult to recognize.
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Affiliation(s)
- Cristina Micali
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (C.M.); (G.C.); (G.N.); (E.V.R.)
| | - Ylenia Russotto
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (C.M.); (G.C.); (G.N.); (E.V.R.)
| | - Alessio Facciolà
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, 98100 Messina, Italy;
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (A.M.); (B.M.C.); (E.P.)
| | - Benedetto Maurizio Celesia
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (A.M.); (B.M.C.); (E.P.)
| | - Eugenia Pistarà
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Catania, 95131 Catania, Italy; (A.M.); (B.M.C.); (E.P.)
| | - Grazia Caci
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (C.M.); (G.C.); (G.N.); (E.V.R.)
| | - Giuseppe Nunnari
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (C.M.); (G.C.); (G.N.); (E.V.R.)
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Adult and Childhood Human Pathology “Gaetano Barresi”, University of Messina, 98124 Messina, Italy;
| | - Emmanuele Venanzi Rullo
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy; (C.M.); (G.C.); (G.N.); (E.V.R.)
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13
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Flores-Gonzalez J, Ramon-Luing LA, Ocaña-Guzman R, Buendia-Roldan I, Islas-Muñoz B, Volkow-Fernández P, Chavez-Galan L. Valganciclovir as Add-On Therapy Modifies the Frequency of NK and NKT Cell Subpopulations in Disseminated Kaposi Sarcoma Patients. Cancers (Basel) 2022; 14:cancers14020412. [PMID: 35053573 PMCID: PMC8773484 DOI: 10.3390/cancers14020412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/29/2021] [Accepted: 01/14/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Kaposi sarcoma is one disease that develops in people living with HIV with severe immunosuppression and impacts morbidity and associated mortality. This disease is currently treated with antiretroviral therapy and chemotherapy agents that can further contribute to immunosuppression in patients. Thus, searching for new therapies to induce a robust immune system activation in these patients is necessary. Herein, the frequency and phenotype of natural killer subpopulation cells in people living with HIV with Kaposi sarcoma were evaluated. After KS diagnosis, patients started antiretroviral therapy or valganciclovir plus antiretroviral therapy. Results showed that in patients treated with valganciclovir plus antiretroviral therapy, the expression of CD57 and CD27 proteins on natural killer cells was regulated, enhancing the immune response of the study cohort. This finding contributes to understanding more about the immune response of people living with HIV with Kaposi sarcoma. Abstract Human herpesvirus-8 infection (HHV-8) is the causative agent of Kaposi sarcoma (KS) and is highly prevalent among people living with HIV (KS/HIV). It has been reported that valganciclovir (VGC) reduces HHV-8 replication in KS/HIV patients. However, currently it is unclear if VGC modifies the frequency and induces changes in markers of immune regulation of immune cells necessary to eliminate HHV8-infected cells, such as Natural Killer (NK) and NK T cells (NKT). This study evaluated the effect of VGC used as antiviral HHV8 therapy in KS patients on the frequency of NK and NKT subpopulations based on the CD27 and CD57 expression, and the immunosenescence markers, PD-1 and KLRG1. Twenty KS/HIV patients were followed-up at baseline (W0), 4 (W4), and 12 weeks (W12) of the study protocol. Among them, 10 patients received a conventional treatment scheme (CT), solely antiretroviral therapy (ART), and 10 patients received a modified treatment regime (MT), including VGC plus ART. In both groups, bleomycin/vincristine was administrated according to the treating physician’s decision. The soluble levels of IL-15, PD-L1, PD-L2, and E-cadherin were quantified across the follow-up. Our results showed that the higher IL-15 levels and lower NK frequencies cells in KS/HIV patients reach almost normal values with both treatments regimes at W12. CD27+ NK and NKT cell frequencies increased since W4 on KS/HIV patients with MT. Furthermore, PD-1 expression decreased while KLRG1 increased on NK and NKT subpopulations at W12, and it is accompanied by increased PD-L1 plasma level since W4. Our study highlights the disruption of NK and NKT subpopulations in patients with KS/HIV and explores VGC treatment’s contribution to immune reconstitution during the first weeks of treatment.
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Affiliation(s)
- Julio Flores-Gonzalez
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (J.F.-G.); (L.A.R.-L.); (R.O.-G.)
| | - Lucero A. Ramon-Luing
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (J.F.-G.); (L.A.R.-L.); (R.O.-G.)
| | - Ranferi Ocaña-Guzman
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (J.F.-G.); (L.A.R.-L.); (R.O.-G.)
| | - Ivette Buendia-Roldan
- Laboratory of Translational Research in Aging and Pulmonary Fibrosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico;
| | - Beda Islas-Muñoz
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (B.I.-M.); (P.V.-F.)
| | - Patricia Volkow-Fernández
- Infectious Diseases Department, Instituto Nacional de Cancerología, Mexico City 14080, Mexico; (B.I.-M.); (P.V.-F.)
| | - Leslie Chavez-Galan
- Laboratory of Integrative Immunology, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City 14080, Mexico; (J.F.-G.); (L.A.R.-L.); (R.O.-G.)
- Correspondence: or ; Tel.: +52-555-487-1700 (ext. 5270)
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Matiza T, Boyd KF, Lyall RA, Kwon DS, McGregor AM, Fiorillo S, Campbell TB, Borok M, Corleis B. Compartmentalized T cell profile in the lungs of patients with HIV-1-associated pulmonary Kaposi sarcoma. Medicine (Baltimore) 2021; 100:e28328. [PMID: 34941134 PMCID: PMC8702193 DOI: 10.1097/md.0000000000028328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/29/2021] [Indexed: 01/05/2023] Open
Abstract
Pulmonary Kaposi sarcoma (pKS) caused by Human herpesvirus 8 (HHV-8) is a devastating form of KS in patients with advanced acquired immunodeficiency syndrome (AIDS) and is associated with increased morbidity and mortality. Blood T cells play a central role in the response of HIV-1 and HHV-8. However, little information is available on T cells in the alveolar space of HIV-1-associated pKS patients.Therefore, we examined CD8+ and CD4+ T cells in the alveolar space in comparison with the blood of patients with pKS. We recruited 26 HIV-1 positive patients with KS, including 15 patients with pKS. Bronchoalveolar lavage (BAL) cells and blood mononuclear cells were analyzed for T cell memory phenotypes, surface markers associated with exhaustion, and intracellular cytokine staining (ICS) using flow cytometry. HIV-1 and HHV-8 viral loads were measured in plasma by quantitative PCR.BAL T cells showed reduced inflammatory capacities and significantly diminished polyfunctionality compared to blood T cells from patients with pKS. This was not accompanied by increased expression of exhaustion markers, such as TIM-3 and PD-1.More importantly, we found a negative correlation between the production of MIP1-β and TNF-α in T cells in BAL and blood, indicating compartmentalised immune responses to pKS and accentuated chronic HIV-1/HHV-8 pathogenesis via T cells in the lungs of people with pKS.
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Affiliation(s)
- Tarisiro Matiza
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Kathryn F. Boyd
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Rebecca A. Lyall
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Douglas S. Kwon
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Department of Internal Medicine and Division of Infectious Diseases, Boston, MA
| | - Alan M. McGregor
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Suzanne Fiorillo
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Thomas B. Campbell
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Margaret Borok
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Björn Corleis
- Ragon Institute of MGH, MIT, and Harvard, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Institute of Immunology, Friedrich-Loeffler-Institute, Federal Research Institute for Animal Health, Greifswald, Isle of Riems, Germany
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15
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Dupin N, Jary A, Boussouar S, Syrykh C, Gandjbakhche A, Bergeret S, Palich R. Current and Future Tools for Diagnosis of Kaposi's Sarcoma. Cancers (Basel) 2021; 13:cancers13235927. [PMID: 34885035 PMCID: PMC8657166 DOI: 10.3390/cancers13235927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
Simple Summary Kaposi’s sarcoma, a rare opportunistic tumor, is observed in four epidemiological conditions (AIDS-related, iatrogenic, endemic or classic KS). Although in most cases KS is an indolent disease, it can be locally aggressive and/or it can invade other organs than the skin, resulting in more severe presentations, especially in patients with severe immunosuppression. There is no consensus on the imaging workup that is necessary for either the initial staging of the disease or the follow-up. Future perspectives include the use of certain non-invasive imaging tools that may help to evaluate the clinical response to treatment, as well as certain new histological markers that may help in guiding the treatment planning for this atypical neoplasm. Abstract Kaposi’s sarcoma (KS) is a rare, atypical malignancy associated with immunosuppression and can be qualified as an opportunistic tumor, which responds to immune modulation or restoration. Four different epidemiological forms have been individualized (AIDS-related, iatrogenic, endemic or classic KS). Although clinical examination is sufficient to diagnose cutaneous lesions of KS, additional explorations are necessary in order to detect lesions involving other organs. New histological markers have been developed in recent years concerning the detection of HHV-8 latent or lytic proteins in the lesions, helping to confirm the diagnosis when it is clinically doubtful. More recently, the evaluation of the local immune response has also been shown to provide some guidance in choosing the appropriate therapeutic option when necessary. We also review the indication and the results of conventional radiological imaging and of non-invasive imaging tools such as 18F-fluoro-deoxy-glucose positron emission tomography, thermography and laser Doppler imaging for the diagnosis of KS and for the follow-up of therapeutic response in patients requiring systemic treatment.
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Affiliation(s)
- Nicolas Dupin
- Dermatology Department, Cochin Hospital, AP-HP, Institut Cochin, INSERM 1016, Université de Paris, 75014 Paris, France;
| | - Aude Jary
- Virology Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Sorbonne University, 75013 Paris, France;
| | - Samia Boussouar
- Cardiothoracic Imaging Unit, Pitié-Salpêtrière Hospital, AP-HP, ICAN Institute of Cardiometabolism and Nutrition, INSERM, Sorbonne University, 75013 Paris, France;
| | - Charlotte Syrykh
- Department of Pathology, University Cancer Institute of Toulouse-Oncopole, 31000 Toulouse, France;
| | - Amir Gandjbakhche
- Section on Analytical and Functional Biophotonics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Sébastien Bergeret
- Nuclear Medicine Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France;
| | - Romain Palich
- Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Sorbonne University, 75013 Paris, France
- Correspondence: ; Tel.: +33-1-42-16-01-71; Fax: +33-1-42-16-04-45
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Maaliki N, Ali AA, Isache CL, Aung W. Unusual aetiology of respiratory compromise in a patient with AIDS. BMJ Case Rep 2021; 14:e240849. [PMID: 33758048 PMCID: PMC7993348 DOI: 10.1136/bcr-2020-240849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/04/2022] Open
Abstract
A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm3 Empiric therapy with trimethoprim-sulfamethoxazole was initiated for presumed Pneumocystis jirovecii pneumonia. The patient's clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient's clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.
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Affiliation(s)
- Naji Maaliki
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Aleem Azal Ali
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - Carmen Liliana Isache
- Infectious Diseases, University of Florida Health at Jacksonville, Jacksonville, Florida, USA
| | - Win Aung
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
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Guan C, Shi Y, Liu J, Yang Y, Zhang Q, Lu Z, Zheng G, Ye W, Xue M, Zhou X, Zhang N, Li H, Xie R, Chen B, Lu P. Pulmonary involvement in acquired immunodeficiency syndrome-associated Kaposi's sarcoma: a descriptive analysis of thin-section manifestations in 29 patients. Quant Imaging Med Surg 2021; 11:714-724. [PMID: 33532271 DOI: 10.21037/qims-20-284] [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] [Indexed: 12/12/2022]
Abstract
Background Acquired immunodeficiency syndrome-associated Kaposi's sarcoma (AIDS-KS) was the first malignant neoplasm to be described as being related to AIDS. The lungs are the most common visceral site of AIDS-KS. This study aimed to analyze the computed tomography (CT) manifestations of pulmonary involvement in AIDS-KS. Methods Twenty-nine male patients were enrolled in this retrospective study. Imaging evaluation parameters included lesion distribution, the flame sign, interlobular septal thickening, peribronchovascular interstitium thickening, ground-glass opacity (GGO), dilated blood vessels in lesions, and pleural effusion. Results A peribronchovascular distribution was observed in all patients, predominantly in the lower lobes. Of the patients, 58.62% (17/29) exhibited the flame sign, 75.86% (22/29) had interlobular septal thickening, 72.41% (21/29) had peribronchovascular interstitium thickening, 82.76% (24/29) had GGO, and 34.48% (10/29) had pleural effusion. Enlarged lymph nodes with a short-axis diameter >1.0 cm were found in 41.38% (12/29) of the patients. Of the 12 patients who underwent contrast-enhanced CT (CECT), 90.91% (11/12) had dilated blood vessels, and nodules, consolidations, and lymph nodes were observed to be strongly enhanced. Intrapulmonary lesions decreased in size or number after appropriate treatment during follow-up. Conclusions Common CT manifestations of pulmonary AIDS-KS include the flame sign, peribronchovascular distribution, peribronchovascular interstitium thickening, interlobular septa thickening, GGO, dilated blood vessel, and strong enhancement of nodules, consolidations, and lymph nodes. It is helpful to follow up the therapeutic effect of pulmonary AIDS-KS by chest CT.
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Affiliation(s)
- Chunshuang Guan
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Jinxin Liu
- Department of Radiology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuxin Yang
- Department of Radiology, The Sixth People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Qianqian Zhang
- Department of Radiology, Zhoukou Central Hospital, Zhoukou, China
| | - Zhiyan Lu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guangping Zheng
- Department of Radiology, The Shenzhen No. 3 People's Hospital, Guangdong Medical College, Shenzhen, China
| | - Wen Ye
- Department of Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Ming Xue
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xingang Zhou
- Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Na Zhang
- Department of Radiology, Chengdu Public Health Clinical Center, Chengdu, China
| | - Hongjun Li
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Ruming Xie
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Budong Chen
- Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Puxuan Lu
- Department of Radiology, Shenzhen Center for Chronic Disease Control, Shenzhen, China
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Primary Intrathoracic Sarcomas: A Review of Cross-sectional Imaging and Pathology. J Comput Assist Tomogr 2020; 44:821-832. [PMID: 33196594 DOI: 10.1097/rct.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.Key points:Primary intrathoracic sarcomas are rare but clinically important.Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.
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Silva SQE, Frank CHM, Almeida TVR. Extensive pulmonary involvement in Kaposi sarcoma in a patient with human immunodeficiency virus-acquired immunodeficiency syndrome. Rev Soc Bras Med Trop 2020; 54:e20200192. [PMID: 33206879 PMCID: PMC7670751 DOI: 10.1590/0037-8682-0192-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/25/2020] [Indexed: 11/22/2022] Open
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Williams SC, Sweeney J, Parameswaran L. Diagnostic and management considerations in the modern patient with AIDS: a case of concurrent disseminated Kaposi sarcoma and colesional Cryptococcus neoformans. BMJ Case Rep 2020; 13:e233860. [PMID: 32295799 PMCID: PMC7199148 DOI: 10.1136/bcr-2019-233860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/04/2022] Open
Abstract
In the era of highly active antiretroviral therapy (HAART), disseminated Kaposi sarcoma (KS) has become much rarer in the USA. We report a case of a 34-year-old man with KS of the skin, oropharynx, lung and rectum. Within the same lung nodule, we discovered significant burden of colesional Cryptococcus neoformans, in the context of a positive asymptomatic cryptococcal antigenemia, which was a previously unreported occurrence. The gold standard of treatment for KS continues to be HAART. The role of chemotherapy is still controversial. In addition, a cryptococcal antigen screen-and-treat approach with fluconazole is still not routinely recommended in the USA to prevent serious meningeal disease despite recent studies showing efficacy and applicability. We discuss both issues here and the outcome of our patient. We also present the patient's own unique perspective in dealing with the ramifications of these diagnoses.
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Affiliation(s)
- Samuel Clay Williams
- Tri-Institutional MD PhD Program, Weill Cornell Medical College, New York, New York, USA
| | - Jacob Sweeney
- Weill Cornell Medicine Department of Pathology and Laboratory Medicine, New York, New York, USA
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Vosoughi E, Sheth CA, Gill AS, Saadat MS. A rare case of pulmonary Kaposi sarcoma presented with respiratory failure. J Community Hosp Intern Med Perspect 2019; 9:351-354. [PMID: 31528288 PMCID: PMC6735298 DOI: 10.1080/20009666.2019.1640017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/28/2019] [Indexed: 12/20/2022] Open
Abstract
Kaposi sarcoma (KS) is the most commonly diagnosed malignancy in HIV-infected patients. With new treatments, incidence and severity of KS have significantly decreased. A 57-year-old African American male with medical history of AIDS presented with progressively worsening cough, shortness of breath, fever, night sweats, and 60 lb weight loss. On physical examination, he had diffused dark purple skin lesions and decreased air entry in the right lower lung fields. Chest x-ray and subsequent chest computed tomography (CT) showed moderate right lung pleural effusion with scattered bilateral diffuse infiltrates. The patient’s absolute CD4 count was 27 cells/microliter. Thoracentesis was negative for infection or malignancy. He was started on chemotherapy paclitaxel along with HAART for extensive pulmonary KS. Since starting the treatment, his condition has significantly improved with near complete resolution of the pleural effusion, oral, and skin lesions. In conclusion, the diagnosis of AIDS-related pulmonary KS is often clinical, typically based on the presence of mucocutaneous disease and compatible features on CT chest. The differential diagnosis of pulmonary KS is broad. A detailed evaluation should exclude an infectious etiology or other tumors. Chemotherapy along with HAART can be used for treatment of severe pulmonary KS.
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Affiliation(s)
- Elham Vosoughi
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Chirag A Sheth
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Amandeep S Gill
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
| | - Mohsen S Saadat
- Department of Internal medicine, San Joaquin General Hospital, French Camp, CA, USA
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23
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Diaz R, Almeida P, Morgan D. Rare presentation of bronchopulmonary Kaposi sarcoma. BMJ Case Rep 2019; 12:12/8/e229436. [PMID: 31451457 DOI: 10.1136/bcr-2019-229436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kaposi sarcoma (KS) is an angioproliferative disorder that is commonly associated with human herpes virus 8 as well as the HIV. In fact, KS is one of the most common AIDS-defining illnesses. KS typically presents with diffuse, violaceous cutaneous nodules, and may have concomitant visceral involvement. However, visceral involvement rarely occurs without skin manifestations. A rare case of localised bronchopulmonary KS without skin involvement is described in a patient with previously undiagnosed HIV. This atypical presentation represents a challenge for modern-day physicians in developed countries where the prevalence of AIDS-related diseases is decreasing.
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Affiliation(s)
- Raiko Diaz
- Department of Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Patricia Almeida
- Department of Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
| | - Dionne Morgan
- Department of Pulmonary Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
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24
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Nguyen P, Knapp-Wachsner A, Hsieh CG, Kamangar N. Pulmonary Kaposi Sarcoma without Mucocutaneous Involvement: The Role of Sequential Thallium and Gallium Scintigraphy. J Clin Imaging Sci 2019; 9:12. [PMID: 31448163 PMCID: PMC6702861 DOI: 10.25259/jcis_76_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 12/15/2018] [Indexed: 11/30/2022] Open
Abstract
Kaposi sarcoma (KS) is a vascular-related tumor that has been associated with human immunodeficiency virus (HIV). It commonly involves the skin and lymph nodes, and infrequently involves the lungs. In very rare instances, pulmonary KS can be found in the absence of endobronchial and mucocutaneous involvement. Utilization of sequential thallium and gallium scintigraphy can aid in the diagnosis of pulmonary KS in the absence of mucocutaneous and endobronchial involvement. In this report, we discuss a case of a patient with acquired immunodeficiency syndrome who presented with dyspnea and cough and was found to have subtle pulmonary parenchymal nodular airspace opacities. He underwent negative infectious evaluation, including bronchoscopy. Despite the absence of mucocutaneous findings, sequential positive thallium and negative gallium scintigraphy led to an early diagnosis of pulmonary KS. Pulmonary KS in the absence of mucocutaneous involvement is a rare finding that is exceedingly difficult to diagnose. However, pulmonary KS should be considered in patients with HIV who present with respiratory symptoms even if the typical mucocutaneous manifestations of KS are absent. In such circumstances, sequential thallium and gallium scintigraphy can help differentiate pulmonary KS from other processes such as infections and lymphoma, and assist in establishing an earlier diagnosis.
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Affiliation(s)
- Peter Nguyen
- Department of Medicine, Olive View-UCLA Medical Center Sylmar, California USA
| | - Adam Knapp-Wachsner
- Department of Medicine, Olive View-UCLA Medical Center Sylmar, California USA
| | - Caleb G Hsieh
- Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center Sylmar, California USA
| | - Nader Kamangar
- Division of Pulmonary and Critical Care Medicine, Olive View-UCLA Medical Center Sylmar, California USA
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Tang ASO, Teh YC, Chea CY, Yeo ST, Chua HH. Disseminated AIDS-related Kaposi's sarcoma. Oxf Med Case Reports 2018; 2018:omy107. [PMID: 30487992 PMCID: PMC6252309 DOI: 10.1093/omcr/omy107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/06/2018] [Accepted: 10/03/2018] [Indexed: 11/22/2022] Open
Abstract
We present a case of disseminated Kaposi’s sarcoma with both cutaneous and extracutaneous involvement in an HIV-infected patient with a relatively high CD4 count of 369 cell/mm3. He developed chronic diarrhea, constitutional symptoms, worsening bilateral pleural effusion with respiratory distress, and progression of skin lesions distributed over his chest and extremities. The temporal relationship between rapid clinical progression and initiation of HAART suggested the possibility of Kaposi’s sarcoma-associated immune reconstitution inflammatory syndrome, which eventually resulted in the death of this patient.
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Affiliation(s)
- Andy Sing Ong Tang
- Department of Internal Medicine, Miri General Hospital, Sarawak, Malaysia
| | - Yeon Chiat Teh
- Department of Internal Medicine, Miri General Hospital, Sarawak, Malaysia
| | - Chin Yung Chea
- Department of Internal Medicine, Miri General Hospital, Sarawak, Malaysia
| | - Siaw Tze Yeo
- Department of Pharmacy, Miri General Hospital, Sarawak, Malaysia
| | - Hock Hin Chua
- Infectious Disease Unit, Department of Internal Medicine, Sarawak General Hospital, Sarawak, Malaysia
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Plastic Bronchitis in an AIDS Patient with Pulmonary Kaposi Sarcoma. Case Rep Pulmonol 2018; 2018:9736516. [PMID: 30363701 PMCID: PMC6180928 DOI: 10.1155/2018/9736516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022] Open
Abstract
Plastic bronchitis is the expectoration of bronchial casts in the mold of the tracheobronchial tree. It is a rare occurrence of unknown etiology that has been primarily described in children with congenital heart disease. In this case report, we present the first reported case of plastic bronchitis in a patient with pulmonary Kaposi sarcoma and underlying HIV infection.
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Fardin RB, Leite LAC, Bezerra LMDS, Alves PMP, Dos Santos LL, Salvá MDA, Rezende Filho ALSM, Lima GS, Matos JDA, Ferreira SMS, Costa DLJDF. Fatal Disseminated Kaposi's Sarcoma in Two Patients with Human Immunodeficiency Virus (HIV) Infection. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:868-874. [PMID: 30042376 PMCID: PMC6071497 DOI: 10.12659/ajcr.910004] [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] [Indexed: 11/26/2022]
Abstract
Case series Patient: Male, 25 • Male, 30 Final Diagnosis: Kaposi sarcoma Symptoms: Oral lesions Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
| | - Luiz Arhur Calheiros Leite
- Department of Infectious Disease, State University of Health Sciences of Alagoas (UNCISAL), Maceió, Alagoas, Brazil
| | | | | | | | | | | | - Gilberto Salustiano Lima
- Department of Infectious Disease, State University of Health Sciences of Alagoas (UNCISAL), Maceió, Alagoas, Brazil
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Pires CAA, Noronha MAN, Monteiro JCMS, da Costa ALC, Abreu Júnior JMDC. Kaposi's sarcoma in persons living with HIV/AIDS: a case series in a tertiary referral hospital. An Bras Dermatol 2018; 93:524-528. [PMID: 30066758 PMCID: PMC6063130 DOI: 10.1590/abd1806-4841.20186978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. OBJECTIVES The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. METHODS We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. RESULTS The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. STUDY LIMITATIONS We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. CONCLUSION Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.
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Affiliation(s)
- Carla Andréa Avelar Pires
- Department of Clinical Medicine, Universidade Federal do
Pará, Belém (PA), Brazil
- Department of Dermatology, Universidade do Estado do Pará,
Belém (PA), Brazil
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Castellana G, Liotino V, Vulpi MR, Ali I, Marra L, Resta O. Bilateral pulmonary nodules and acute respiratory failure in a 22-year-old man with dyspnoea and fever. Breathe (Sheff) 2017; 13:317-322. [PMID: 29209425 PMCID: PMC5709794 DOI: 10.1183/20734735.008317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Can you diagnose the cause of this man's bilateral pulmonary nodules and acute respiratory failure? http://ow.ly/NfED30dDBzm.
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Affiliation(s)
- Giorgio Castellana
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Vito Liotino
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Maria Rosaria Vulpi
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Ina Ali
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Lorenzo Marra
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
| | - Onofrio Resta
- Institute of Respiratory Disease, Cardio-Thoracic Department, University of Medicine "Aldo Moro", Bari, Italy
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30
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Martínez-Girón R, Martínez-Torre S. Simultaneous presentation of two noninflammatory lung diseases in an HIV-infected patient. Ann Thorac Med 2017; 12:125-126. [PMID: 28469724 PMCID: PMC5399687 DOI: 10.4103/atm.atm_335_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The simultaneous presentation of two noninflammatory pulmonary diseases, pulmonary alveolar proteinosis and Kaposi's sarcoma (Ks), in an HIV-infected patient, is described. A 29-year-old black race patient was admitted to the hospital because of general malaise, weight loss, dyspnea, chest pain, and cough with hemoptoic expectoration. Chest X-rays revealed a patchy bilateral alveolar pattern with a tendency toward the formation of condensations. The serological test revealed HIV positivity (CD4 counts of 393 cells/mm3). Because there was no response to the treatment course, a thoracic CT was performed, showing interlobular thickening with intralobular septal lines and ground glass opacities ("crazy-paving" pattern). An open lung biopsy was performed. Histopathological diagnosis of pulmonary alveolar proteinosis and pulmonary Ks was made.
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Affiliation(s)
- Rafael Martínez-Girón
- Departament of Anatomic Pathology, INCLINICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, 33007, Oviedo, Spain
| | - Santiago Martínez-Torre
- Department of Family and Community Medicine, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid 28046, Spain
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31
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Esclerosis sistémica y sarcoma de Kaposi con afectación pulmonar: una asociación inesperada. Arch Bronconeumol 2017; 53:165-166. [DOI: 10.1016/j.arbres.2016.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022]
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32
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Dirweesh A, Khan MY, Hamiz SF, Karabulut N. Pulmonary Kaposi Sarcoma with Osseous Metastases in an Human Immunodeficiency Virus (HIV) Patient: A Remarkable Response to Highly Active Antiretroviral Therapy. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:181-185. [PMID: 28216610 PMCID: PMC5328198 DOI: 10.12659/ajcr.902355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Kaposi sarcoma (KS) is known to involve the mucocutaneous tissues and the aero-digestive tracts. In acquired immune deficiency syndrome (AIDS) patients, KS has an aggressive course and carries poor prognosis. We present a case of pulmonary KS with osseous metastases as the first presentation of human immunodeficiency virus (HIV) infection in a young male. The lesions impressively decreased in size and numbers following initiation of highly active antiretroviral therapy (HAART). CASE REPORT A 34-year-old heterosexual male presented with a one month history of cough and 15-20 pound weight loss within six months. Examination revealed oral thrush, decreased breath sounds and crackles on the right lower lung base. Imaging showed a large right perihilar mass with multiple lytic lesions involving thoracic and lumber vertebrae, ribs, sternum, and clavicles. Blood and sputum cultures, smears for acid fast bacilli, and a QUANTIferon gold test were all negative. He tested positive for HIV and his CD4 count was 7 cells/uL. Bronchoscopy with biopsy was unrevealing. Pathology of the right hilar mass was diagnostic of KS. Following initiation of antiretroviral therapy his condition dramatically improved; repeat chest CT scan showed marked regression of the bony and pulmonary lesions. CONCLUSIONS The dual action of HAART on the recovery of the immune system and against human herpes virus 8 (HHV-8) may essentially cause regression of KS lesions.
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Affiliation(s)
- Ahmed Dirweesh
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Muhammad Yasir Khan
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Shaikh Fawad Hamiz
- Department of Internal Medicine, Saint Francis Medical Center, Seton Hall University, Trenton, NJ, USA
| | - Nigahus Karabulut
- Department of Infectious Diseases, Saint Francis Medical Center, Trenton, NJ, USA
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Blayney MJ, Nguyen A, Aboulafia DM. Diagnosis and Management of a Pancreaticopleural Fistula in a Patient with AIDS and a Large Pleural Effusion. J Int Assoc Provid AIDS Care 2016; 15:459-462. [PMID: 27655836 DOI: 10.1177/2325957416668578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pleural effusions typically present with nonspecific pulmonary complaints in the setting of either acute or chronic diseases. In the general population, these illnesses include congestive heart failure, infection, and malignancy. However, in people living with HIV/AIDS (PLWHA), pleural effusions often result from opportunistic infections and AIDS-defining malignancies, such as Kaposi sarcoma and non-Hodgkin lymphoma. Since the introduction of highly active antiretroviral therapy, there has been a decline in the frequency of AIDS-defining opportunistic infections and AIDS-defining cancers and an increase in certain non-AIDS-defining malignancies including lung cancer. Throughout this period, longer life expectancy in PLWHA has contributed to an increased risk of those chronic diseases that can result in pleural effusions. This case describes an HIV-infected man who was an active cigarette smoker and alcoholic and who presented with a large pleural effusion of uncertain etiology. The authors review several important noncardiac risk factors associated with pleural effusions in PLWHA. The authors also emphasize the importance of obtaining a detailed medical history and the use of appropriate imaging and laboratory tests in order to identify an underlying cause and to provide optimal treatment.
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Affiliation(s)
- Margaret J Blayney
- Graduate Medical Education, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andy Nguyen
- Graduate Medical Education, Virginia Mason Medical Center, Seattle, WA, USA
| | - David M Aboulafia
- Section of Hematology Oncology, Virginia Mason Medical Center, Seattle, WA, USA.,Division of Hematology, University of Washington, Seattle, WA, USA
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Suresh K, Semaan R, Arias S, Karakousis P, Lee H. Pleuropulmonary Kaposi Sarcoma in the Setting of Immune Reactivation. ACTA ACUST UNITED AC 2016; 6. [PMID: 27429861 PMCID: PMC4943458 DOI: 10.4172/2161-105x.1000352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We present a case of a 26 year with history of HIV/AIDS who presented with a pleural effusion. Serial radiography, pleural fluid analysis as well as clinical symptoms revealed development of Kaposi Sarcoma related immune reconstitution inflammatory syndrome (KS-IRIS) in the setting of initiation of effective anti- retroviral therapy.
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Affiliation(s)
- Karthik Suresh
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Roy Semaan
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Sixto Arias
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Johns Hopkins School of Medicine, Baltimore, USA
| | - Petros Karakousis
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, USA
| | - Hans Lee
- Department of Medicine, Division of Pulmonary and Critical Care medicine, Johns Hopkins School of Medicine, Baltimore, USA
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Khattak M. Bilateral Chest X-Ray Shadowing and Bilateral leg lesions - A case of Pulmonary Kaposi Sarcoma. WEBMEDCENTRAL 2016; 7:WMC005051. [PMID: 27239297 PMCID: PMC4880371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We report a case of a 30 year old gentleman seen on the respiratory ward with no significant past medical history presenting with a three week history of worsening dyspnoea, productive cough, fever, bilateral leg swelling and bilateral leg swelling. Initial differential diagnosis included community-acquired pneumonia, cellulitis and deep vein thrombosis. After much investigation a diagnosis of AIDS-related kaposi's sarcoma with visceral manifestations was made.
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36
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Epelbaum O, Go R, Patel G, Braman S. Pulmonary Kaposi's Sarcoma and Its Complications in the HAART Era: A Contemporary Case-Based Review. Lung 2016; 194:163-9. [PMID: 26826066 DOI: 10.1007/s00408-015-9830-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022]
Abstract
The early years of the acquired immunodeficiency syndrome (AIDS) epidemic introduced the global medical community to Kaposi's sarcoma (KS), a heretofore seldom encountered angiosarcomatous neoplasm associated with human herpesvirus-8. At that time, clinicians treating these KS patients were routinely exposed to the pulmonary manifestations of this malignancy, including characteristic airway lesions, peribronchovascular opacities, and the typically hemorrhagic pleural effusions. They also witnessed uncommon complications of pulmonary KS such as chylous effusions, diffuse alveolar hemorrhage, and immune reconstitution inflammatory syndrome. Since the advent of highly active antiretroviral therapy, the incidence of KS has steadily declined and with that so has clinician familiarity with this disease. Herein, we present four KS cases recently encountered at our institution that illustrate both typical manifestations of pulmonary KS as well as its thoracic complications. The case descriptions are followed by a review of these clinical entities with the aim of restoring awareness among frontline physicians of what is now a rare but not quite extinct AIDS-defining neoplasm.
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Affiliation(s)
- Oleg Epelbaum
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Box D6-4, Elmhurst, NY, 11373, USA
| | - Ronaldo Go
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, 7 Dazian Building, First Avenue at 16 Street, New York, NY, 10003, USA
| | - Geminikumar Patel
- Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, 79-01 Broadway, Room A1-16, Elmhurst, NY, 11373, USA
| | - Sidney Braman
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY, 10029-6754, USA.
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37
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Kodra A, Walczyszyn M, Grossman C, Zapata D, Rambhatla T, Mina B. Case Report: Pulmonary Kaposi Sarcoma in a non-HIV patient. F1000Res 2015; 4:1013. [PMID: 26664711 PMCID: PMC4654435 DOI: 10.12688/f1000research.7137.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 12/31/2022] Open
Abstract
Kaposi Sarcoma (KS) is an angioproliferative tumor associated with human herpes virus 8 (HHV-8). Often known as one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases, pulmonary involvement in KS has only been discussed in a handful of case reports, rarely in a non-HIV patient. Herein we report the case of a 77 year-old- male who presented with a 6-week history of progressive dyspnea on exertion accompanied by productive cough of yellow sputum and intermittent hemoptysis. His past medical history was significant for Non-Hodgkin's Follicular B-Cell Lymphoma (NHL). Patient also had biopsy-confirmed cutaneous KS. His physical exam was notable for a 2cm firm, non-tender, mobile right submandibular lymph node. Lungs were clear to auscultation. He had multiple violet non-tender skin lesions localized to the lower extremities. CT scan of the chest showed numerous nodular opacities and small pleural effusions in both lungs. A thoracenthesis was performed, showing sero-sanguineous exudative effusions. Histopathology failed to demonstrate malignant cells or lymphoma. A subsequent bronchoscopy revealed diffusely hyperemic, swollen mucosa of the lower airways with mucopurulent secretions. Bronchoalveolar lavage PCR for HHV-8 showed 5800 DNA copies/mL. It was believed that his pulmonary symptoms were likely due to disseminated KS. This case illustrates the potential for significant lung injury from KS. It also demonstrates the use of PCR for HHV-8 to diagnose KS in a bronchoalveolar lavage sample in a case when bronchoscopic biopsy was not safe. Furthermore, this case is unique in that the patient did not match the typical KS subgroups as HIV infection and other immune disorders were ruled out. Recognition of this syndrome is critical to the institution of appropriate therapy. As such, this case should be of interest to a broad readership across internal medicine including the specialties of Pulmonology and Critical Care.
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Affiliation(s)
- Arber Kodra
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
| | - Maciej Walczyszyn
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
| | - Craig Grossman
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
| | - Daniel Zapata
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
| | - Tarak Rambhatla
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
| | - Bushra Mina
- Department of Internal Medicine, Lenox Hill Hospital, New York, NY, 10065, USA
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Chylothorax in a patient with metastatic Kaposi sarcoma: Differential diagnostic considerations. Radiol Case Rep 2015. [DOI: 10.2484/rcr.v10i2.1098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Dow DE, Cunningham CK, Buchanan AM. A Review of Human Herpesvirus 8, the Kaposi's Sarcoma-Associated Herpesvirus, in the Pediatric Population. J Pediatric Infect Dis Soc 2014; 3:66-76. [PMID: 24567845 PMCID: PMC3933043 DOI: 10.1093/jpids/pit051] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 06/27/2013] [Indexed: 01/30/2023]
Abstract
Human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma (KS)-associated herpesvirus, is the etiologic agent responsible for all types of KS. Although the majority of pediatric KS cases occur in sub-Saharan Africa, a rise in pediatric transplant KS has been reported in developed countries. In addition, HHV-8 is increasingly described as an infectious cause of hemophagocytic lymphohistiocytosis in children. Transmission of HHV-8 among children is poorly understood; however, the literature strongly suggests that horizontal transmission plays a critical role. Acute infection with HHV-8 and progression to KS in children may be different than in adults, and diagnosis may be overlooked. Currently, neither adult nor pediatric treatment guidelines exist. This review provides an overview of HHV-8 disease in children as it relates to epidemic KS, transplant KS, and other disease manifestations. The current state of the literature is reviewed and knowledge gaps are identified for future exploration.
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Affiliation(s)
- Dorothy E. Dow
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina,Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Coleen K. Cunningham
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Ann M. Buchanan
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina,Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Duke Global Health Institute, Duke University, Durham, North Carolina
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Abstract
This review of lung malignancies in human immunodeficiency virus (HIV) briefly highlights key epidemiologic and clinical features in the pulmonary involvement of AIDS-defining malignancies of Kaposi sarcoma and non-Hodgkin lymphoma. Then, focusing on non-AIDS defining lung cancer, the epidemiology and mechanisms, clinical presentation, pathology, treatment and outcomes, and prevention of HIV-associated lung cancer are discussed. Finally, the important knowledge gaps and future directions for research related to HIV-associated lung malignancies are highlighted.
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Affiliation(s)
- Allison A Lambert
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Cakir FB, Cakir E, Tuzuner N, Kut A. Classic kaposi sarcoma with pulmonary involvement mimicking endobronchial tuberculosis in a child. Pediatr Pulmonol 2013; 48:310-2. [PMID: 22825845 DOI: 10.1002/ppul.22635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/17/2012] [Indexed: 11/09/2022]
Abstract
Kaposi' sarcoma (KS) is a low-grade vascular neoplasm and classic KS, a subtype of KS, is extremely rare in children. Childhood pulmonary involvement in classic KS has not been reported in the literature. We describe an HIV-seronegative pediatric case with a fulminant course of classic KS with pulmonary involvement mimicking endobronchial tuberculosis.
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Affiliation(s)
- Fatma B Cakir
- Department of Pediatric Hematology-Oncology, Bezmialem Vakif University, Istanbul, Turkey
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Baxi S, Platts-Mills J, Dhruva S, Huang L, Hanks D, Dhaliwal G. A double-edged sword. J Hosp Med 2013; 8:47-51. [PMID: 23293015 DOI: 10.1002/jhm.1999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/01/2012] [Accepted: 11/07/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sanjiv Baxi
- Department of Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, California 94110, USA.
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Borie R, Cadranel J, Galicier L, Couderc LJ. [Pulmonary involvement due to HHV-8 virus during the course of HIV infection]. Rev Mal Respir 2012; 29:1209-23. [PMID: 23228679 DOI: 10.1016/j.rmr.2012.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 02/08/2012] [Indexed: 12/01/2022]
Abstract
HHV-8 is a herpes virus discovered in 1994 in Kaposi sarcoma cells. Its involvement was later demonstrated in multicentric Castleman disease and in primary lymphoma effusion lymphoma. These diseases arise almost exclusively in immunocompromised patients, mostly in association with HIV infection. Apart from Kaposi's sarcoma, combined antiretroviral therapy does not seem to have reduced the incidence of these diseases, which remain rare. In these three diseases, pulmonary involvement is common and may be the presenting feature. Kaposi's sarcoma of the lung is usually asymptomatic but may require specific therapy. Pulmonary involvement is mostly associated with cutaneous disease. Patients with Castleman disease typically present with fever and lymphadenopathy, associated with interstitial lung disease without opportunistic infection. Patients with primary lymphoma effusion presents with fever and an exudative lymphocytic pleural effusion, without a pleural mass on the CT-scan. Rapid diagnosis of these conditions avoids unnecessary invasive examinations and leads to prompt specific treatment.
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Affiliation(s)
- R Borie
- Service de Pneumologie A, Centre de Compétence Maladies Rares Pulmonaires, Hôpital Bichat, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75877 Paris Cedex 18, France.
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44
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Abstract
Kaposi's sarcoma (KS), a low-grade malignancy that is associated with human herpesvirus-8 (HHV-8), is a multifocal tumor that most commonly affects mucocutaneous sites. It might also involve lymph nodes and visceral organs, in particular of the respiratory and gastrointestinal tract, but it can affect every organ system. Four forms of the disease have been recognized: the classic, the endemic, the transplant-associated, and the epidemic form. The endemic form, or African KS, currently accounts for 10%-50% of all cancers in adults and up to 25% of cancers in children in certain parts of Africa. The epidemic form or acquired immune deficiency syndrome (AIDS)-associated KS is a frequent neoplasm in bisexual and homosexual men with AIDS in the United States. Even though in North America and Europe the incidence of KS in men with AIDS has decreased significantly after the introduction of highly active antiretroviral therapy (HAART), in some developing countries, the incidence of KS keeps growing. The pathophysiology, clinical manifestations, imaging findings, and more relevant differential diagnoses are reviewed.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Restrepo CS, Chen MM, Martinez-Jimenez S, Carrillo J, Restrepo C. Chest neoplasms with infectious etiologies. World J Radiol 2011; 3:279-88. [PMID: 22224176 PMCID: PMC3251813 DOI: 10.4329/wjr.v3.i12.279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/19/2011] [Accepted: 10/11/2011] [Indexed: 02/06/2023] Open
Abstract
A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi’s sarcoma, Castleman’s disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.
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Allen CM, Al-Jahdali HH, Irion KL, Al Ghanem S, Gouda A, Khan AN. Imaging lung manifestations of HIV/AIDS. Ann Thorac Med 2011; 5:201-16. [PMID: 20981180 PMCID: PMC2954374 DOI: 10.4103/1817-1737.69106] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/16/2010] [Accepted: 04/15/2010] [Indexed: 01/10/2023] Open
Abstract
Advances in our understanding of human immunodeficiency virus (HIV) infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome (AIDS) remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis.
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Affiliation(s)
- Carolyn M Allen
- North Manchester General Hospital, Pennine Acute NHS Trust, Manchester, UK
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Abstract
Kaposi sarcoma is a vascular tumor manifesting as nodular lesions on skin, mucous membranes, or internal organs. This is a case of a 42-year-old human immunodeficiency virus- (HIV) positive bisexual male, not on highly active antiretroviral therapy (HAART) since diagnosis four years ago. He presented with a three-day history of abdominal pains, fever, vomiting, and a one-week history of melena stools. Endoscopy revealed Kaposi sarcoma in the stomach and duodenum. Postendoscopy, he developed acute abdomen. Exploratory laparotomy revealed extensive Kaposi sarcoma of the gastrointestinal tract with appendiceal involvement. The patient underwent appendectomy and had an uneventful recovery. A review of the literature discusses appendiceal Kaposi sarcoma with appendicitis, a rare but critical manifestation of gastrointestinal Kaposi sarcoma.
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