1
|
Herrera-Goepfert R, Volkow P, Ochoa-Murillo M. Anaplastic Kaposi Sarcoma of the Right Colon, in a Young Man With Acquired Immunodeficiency Syndrome: A Rare Variant in an Unreported Organ. Int J Surg Pathol 2024; 32:533-538. [PMID: 37403378 DOI: 10.1177/10668969231185075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Kaposi sarcoma (KS) arises in the context of 4 epidemiologic-clinical settings: Classic, endemic, epidemic, and iatrogenic; the most serious types are endemic and epidemic, and visceral involvement occurs mostly in the latter. Several morphological variants of KS have been described, of which the anaplastic one is highly aggressive. We report the case of an anaplastic KS arising from the ascending colon in a 32-year-old human immunodeficiency virus (HIV)-positive male patient with a 6-year history of multiple mucocutaneous KS. Anaplastic KS is most frequent in endemic and classic settings; there are ten cases of anaplastic KS reported in HIV-positive male patients. There is now strong evidence that KS is a clonal neoplasm characterized by chromosomal instability at the molecular level. According to the morphological spectrum and contemporary hypotheses of oncogenesis, conventional KS should be considered an incipient endothelial neoplasia, multiple or single, and anaplastic KS, the fully developed stage of the malignant neoplasm.
Collapse
Affiliation(s)
| | - Patricia Volkow
- Department of Infectology, Instituto Nacional de Cancerología, Ciudad de México, México
| | | |
Collapse
|
2
|
Salto JN, Volkow P, Herrera-Goepfert R, López-Garcia AI, Cortes-Garcia BY, García-Pérez FO, Arroyo-Hernandez M, Rivera-Rosales RM. Unmasked Kaposi and sarcoidosis immune reconstitution inflammatory syndrome in a patient with AIDS. AIDS 2024; 38:933-934. [PMID: 38578965 DOI: 10.1097/qad.0000000000003851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
|
3
|
Lopez M, Kainthla R, Lazarte S, Chen W, Nijhawan AE, Knights S. Outcomes in Kaposi's sarcoma-associated herpesvirus -associated primary effusion lymphoma and multicentric Castleman's disease in patients with human immunodeficiency virus (HIV) in a safety-net hospital system. Eur J Haematol 2024; 112:723-730. [PMID: 38155405 DOI: 10.1111/ejh.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To describe cases of Kaposi's sarcoma-associated herpesvirus (KSHV)-associated multicentric Castleman's disease (MCD) and primary effusion lymphoma (PEL) in patients with HIV from a large, safety-net hospital system in Dallas, Texas, USA. METHODS We conducted a retrospective review of patients with HIV-associated PEL and/or MCD. RESULTS Twelve patients with PEL and 10 patients with MCD were identified. All patients were male and 17 of 20 were men who have sex with men; 66.7% of PEL patients and 50% of MCD patients had concurrent KS at the time of diagnosis; 42% of patients with PEL and 20% of patients with MCD died during the follow-up period. We noted improved survival in our cohort compared to previous studies, particularly in our PEL patients with a median survival of 11.4 months compared to 3-6-month median survival historically. Median follow-up time for MCD patients was 17.5 months. This improved survival is despite suboptimal antiretroviral therapy (ART) adherence at diagnosis, with only 50% of patients on ART at the time of MCD/PEL diagnosis. CONCLUSION These data highlight the importance of early recognition of PEL and MCD, and the larger-scale efforts needed to better understand the pathogenetic drivers of clinical outcomes in patients affected by KSHV-related diseases.
Collapse
Affiliation(s)
- Melanie Lopez
- Department of Undergraduate Medical Education, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Radhika Kainthla
- Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Susana Lazarte
- Parkland Health, Dallas, Texas, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weina Chen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ank E Nijhawan
- Parkland Health, Dallas, Texas, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheena Knights
- Parkland Health, Dallas, Texas, USA
- Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
4
|
Saowapa S, Polpichai N, Siladech P, Wannaphut C, Tanariyakul M, Wattanachayakul P, Lalitnithi P. CLO24-067: Evaluating Kaposi Sarcoma in Kidney Transplant Patients: A Systematic Review and Meta-Analysis. J Natl Compr Canc Netw 2024; 22:CLO24-067. [PMID: 38579827 DOI: 10.6004/jnccn.2023.7268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Affiliation(s)
- Sakditad Saowapa
- 1Department of Medicine, Texas Tech University Health Sciences Center at Lubbock, Lubbock, TX
| | | | | | | | | | | | | |
Collapse
|
5
|
Qiu T, Zhang Z, Liu J, Zhou J, Gong X, Lan Y, Zhang X, Chen S, Ji Y. Kaposiform Hemangioendothelioma with Bone Destruction: A 16-Year Follow-Up Cohort Study of the Clinical Characteristics and Prognosis. J Pediatr Surg 2024; 59:599-604. [PMID: 38158257 DOI: 10.1016/j.jpedsurg.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor that often occurs in infants and young children. The goal of this study was to analyze the clinical characteristics of KHE patients with bone destruction and provide clinical guidance for diagnosis and treatment. METHODS We conducted a descriptive cohort study with follow-up from January 2007 to January 2023 to collect demographic information and tumor-related clinical information from KHE patients with bone destruction. RESULTS A total of 269 KHE patients were included in the study, of whom 70 (26.0%) patients had tumors with bone destruction. The median age at diagnosis of patients with bone destruction was 19.0 months, which was much later than that of patients without bone destruction (P < 0.001). Patients with bone destruction were more likely to have a decreased range of motion (ROM) (P < 0.001). Metaphysis involvement was more likely to occur in the lower limb bones (P = 0.039), and the lower limb bones were more likely to be associated with decreased ROM (P = 0.001). Tumors involving extracompartmental bone were more likely to have decreased ROM (P = 0.003) and exhibit the Kasabach-Merritt phenomenon (P = 0.006). CONCLUSIONS Based on the rarity and significant heterogeneity of KHE patients with bone destruction, we should give full play to the role of multidisciplinary teams in addressing disease to reduce the long-term complications of KHE with bone destruction and improve the quality of life of patients. TYPE OF STUDY Prognostic Study. LEVEL OF EVIDENCE Level II.
Collapse
Affiliation(s)
- Tong Qiu
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Zixin Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Jie Liu
- Department of Pediatric Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China
| | - Xue Gong
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuru Lan
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
6
|
Goto A, Hashimoto S, Nakamura K, Takami T. Kaposi's Sarcoma of the Stomach. Intern Med 2024; 63:607-609. [PMID: 37316267 PMCID: PMC10937130 DOI: 10.2169/internalmedicine.2157-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 06/16/2023] Open
Affiliation(s)
- Atsushi Goto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan
| | - Shinichi Hashimoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan
| | - Katsuhiko Nakamura
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Japan
| |
Collapse
|
7
|
Hitzenbichler F, Weber M, Salzberger B. Infection image: reoccurrence of Kaposi`s sarcoma after SARS-CoV-2 mRNA vaccination in an HIV-infected patient. Infection 2024; 52:283-284. [PMID: 38055117 PMCID: PMC10811143 DOI: 10.1007/s15010-023-02121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/20/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Weber
- Department of Sarcoma Surgery, Barmherzige Brueder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| |
Collapse
|
8
|
Barone HE, Schapiro B, Fivenson D. Nonepidemic Kaposi Sarcoma: A Case of a Rare Epidemiologic Subtype. Cutis 2024; 113:E4-E6. [PMID: 38593104 DOI: 10.12788/cutis.0959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Hope E Barone
- Drs. Barone and Fivenson are from the Department of Dermatology, Trinity Health Ann Arbor Hospital, Ypsilanti, Michigan. Dr. Schapiro is from CTA Pathology, Ann Arbor
| | - Brian Schapiro
- Drs. Barone and Fivenson are from the Department of Dermatology, Trinity Health Ann Arbor Hospital, Ypsilanti, Michigan. Dr. Schapiro is from CTA Pathology, Ann Arbor
| | - David Fivenson
- Drs. Barone and Fivenson are from the Department of Dermatology, Trinity Health Ann Arbor Hospital, Ypsilanti, Michigan. Dr. Schapiro is from CTA Pathology, Ann Arbor
| |
Collapse
|
9
|
Colecchia M, Pini GM, Pruneri G, Nicolai N, Servillo S. Soft tissue tumours of the penis. The 30-year Istituto Nazionale Tumori di Milano experience. Pathologica 2024; 116:46-54. [PMID: 38482674 PMCID: PMC10938274 DOI: 10.32074/1591-951x-953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Small series and individual cases of penile soft tissue tumours are reported in the literature: these are rare tumours that represent less than 5% of all penile tumours. Methods Penile soft tissue tumours were collected from the archive of the Department of Pathology at the Istituto Nazionale dei Tumori of Milan between January 1990 and October 2021. All available medical records were retrieved and reviewed to obtain clinical information. Results Our series refers to the 30-year experience of highlighting the heterogeneity in the presentation and microscopic features of these rare sarcomas. 18 penile soft tissue tumours are described, 4 benign and 14 malignant. The mean age at diagnosis was 58.2 years (range 24-96 years) and 53.6 years among malignancies (range 24-89). The most frequent histotype was Kaposi's sarcoma (nr = 4) and very unusual histotypes were observed, namely low-grade fibromyxoid sarcoma, synovial sarcoma, proximal type epithelioid sarcoma and the first reported case of dedifferentiated liposarcoma of the penis. Conclusions Among sarcomas of the genitourinary tract, tumours of the soft tissues of the penis are the rarest. Penile sarcomas can present at a young age. Kaposi's sarcoma in HIV-negative patients has a favorable outcome, while deep sarcomas have an aggressive behavior and poor prognosis.
Collapse
Affiliation(s)
- Maurizio Colecchia
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Maria Pini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Foundation IRCCS National Cancer Institute, Milan, Italy
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sascia Servillo
- Pathology Unit, Azienda Ospedaliera di Bergamo, Bergamo, Italy
| |
Collapse
|
10
|
Ozer EE, Soydemir GP, Bolukbas MK, Kocbiyik A. Radiotherapy result of a case of Kaposi's sarcoma located on the vocal cord. J Cancer Res Ther 2024; 20:469-471. [PMID: 38554367 DOI: 10.4103/jcrt.jcrt_226_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 10/03/2022] [Indexed: 04/01/2024]
Abstract
Kaposi's sarcoma (KS) is an angiogenic tumor. KS lesions frequently develop in the skin and oral cavity mucosa in the head and neck regions, and pure laryngeal localization is extremely rare. We reported a 64-year-old male patient without HIV, HBV, and HCV positivity presented with a hemangiomatous lesion detected incidentally in the right vocal cord. Biopsy was taken for histopathological and immunohistochemical evaluation. Examination revealed that spindle cells were of vascular origin and expressed HHV-8, a specific marker associated with Kaposi's sarcoma-associated herpesvirus. Positron emission tomography-computed tomography (PET/CT) demonstrated an increased fluorodeoxyglucose (FDG) uptake in the vocal cord. The patient was treated with a 30 Gy volumetric arc plan. Disease-free follow-up continues in the first year after low-dose definitive RT. This is the first case report of KS in the vocal cord in which the most detailed data about RT were shared.
Collapse
Affiliation(s)
- Elif Eda Ozer
- Department of Radiation Oncology, Health Sciences University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dr. Tevfik Saglam Street, Bakirkoy-Istanbul, Turkey
| | - Gulsen P Soydemir
- Department of Radiation Oncology, Health Sciences University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dr. Tevfik Saglam Street, Bakirkoy-Istanbul, Turkey
| | - Meltem Kirli Bolukbas
- Department of Radiation Oncology, Health Sciences University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dr. Tevfik Saglam Street, Bakirkoy-Istanbul, Turkey
| | - Alper Kocbiyik
- Department of Pathology, Health Sciences University, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Dr. Tevfik Saglam Street, Bakirkoy-Istanbul, Turkey
| |
Collapse
|
11
|
Imeh M, Gutierrez JO, Bhatija R, Shiza S, Murillo BA, Lubarsky R, Khanna R. Gastrointestinal Kaposi Sarcoma without Dermatological Lesions: A Case Report. Am J Case Rep 2023; 24:e941815. [PMID: 38060456 PMCID: PMC10711638 DOI: 10.12659/ajcr.941815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/01/2023] [Accepted: 10/12/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Kaposi sarcoma is a malignancy of the vascular endothelium. It is associated with human herpesvirus 8 (HHV-8) infection, typically found with HIV/AIDS. It is rarely seen presenting as visceral involvement without any cutaneous lesions. Few case reports have described this. CASE REPORT We report a case of visceral Kaposi sarcoma (specifically, gastrointestinal lesions) without any cutaneous lesions in a 35-year-old man with HIV/AIDS who presented with abdominal pain, fatigue, and melena of a 15-day duration. Physical examination revealed tachycardia and hypertension, with a negative orthostatic sign. There were no visible signs of bleeding or cutaneous lesions, no abdominal pain, and a digital rectal examination was negative. Laboratory test results were significant for severe microcytic anemia, with hemoglobin level of 3.3 g/dL, decreased ferritin and iron levels, high red cell distribution width, and reticulocyte index lower than appropriate for anemia level. The absolute CD4 count was 33/uL, and the viral load was 56 895 copies/mL. Hemoglobin was optimized with packed red cells prior to endoscopy, and Pneumocystis jirovecii pneumonia prophylaxis was started. Esophagogastroduodenoscopy and colonoscopy revealed small and large bowel hemorrhagic stellate and annular lesions of varying sizes. Pathology reports from biopsy of the lesions seen in the procedure reported Kaposi sarcoma positive for HHV-8. He underwent chemotherapy with doxorubicin and showed clinical and laboratory improvement after treatment. CONCLUSIONS Kaposi sarcoma should be considered and investigated in patients with HIV/AIDS who are not on highly active antiretroviral therapy and present with gastrointestinal bleeding as an initial symptom, without any cutaneous lesions.
Collapse
Affiliation(s)
- Michael Imeh
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | | | - Rinku Bhatija
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Saher Shiza
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| | - Brian A. Murillo
- Department of Internal Medicine, New York Medical College, Valhalla, NY, USA
| | - Ryan Lubarsky
- Department of Internal Medicine, New York Medical College, Valhalla, NY, USA
| | - Rajan Khanna
- Department of Internal Medicine, Lincoln Medical Center, Bronx, NY, USA
| |
Collapse
|
12
|
Gonzalez-Ballesteros P, de la Mora Levy JG, Amaya-Fragoso E, Sánchez Jíménez BA. The role of gastrointestinal endoscopy in Kaposi sarcoma. Rev Esp Enferm Dig 2023; 115:724-725. [PMID: 36866841 DOI: 10.17235/reed.2023.9534/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
We are writing to make endoscopists aware of the paramount of a prompt diagnosis of gastrointestinal Kaposi sarcoma (GI-KS). Patients with GI involvement have a two to five times higher risk of death and will benefit from chemotherapy to improve their survival. However, current evidence found that one out of three patients might have a false negative result even with HHV-8 since other entities such as gastrointestinal stromal tumors, angiosarcoma, and lymphoma shared macroscopic and histopathological characteristics. These cause a delay in treatment and significantly worsen the prognosis. We observed a trend for a positive diagnosis from ulcers and nodules. To our knowledge, this is the largest cohort of patients with GI-KS in the world. Our study suggests that in cases where a complete immunochemistry panel for KS is not available, HHV-8 remains as a bare minimum. However, other gastrointestinal lesions shared histopathological characteristics. Therefore, we suggest taking biopsies from nodular and ulcer-type lesions to increase the probability to establish a histopathological diagnosis.
Collapse
|
13
|
Liu L, Gu W, Teng L, Xu Y, Zheng F, Hu M, Lu M, Xu X. Kaposiform hemangioendothelioma presented with raynaud phenomenon: a case report. BMC Pediatr 2023; 23:574. [PMID: 37978357 PMCID: PMC10655467 DOI: 10.1186/s12887-023-04407-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm affecting infants or young children. KHE includes a spectrum of lesions, ranging from small and superficial tumors to large and invasive lesions with Kasabach-Merritt phenomenon (KMP). Currently, no published studies have reported a KHE presenting as thrombocytopenia and Raynaud phenomenon. CASE PRESENTATION A 2-year-old boy with right hand swelling and thrombocytopenia was admitted to our hospital. His right hand turned swelling and red, even occasionally cyanotic. This condition became worse in response to cool environments and improved with warming, and platelet counts were between 50 ~ 80 × 10^9/L. Physical examination on admission revealed the swelling and frostbite-like rash of the right-hand fingers, and the skin temperature of the right hand was lower than the left. On day 3 of admission, chest CT results showed an irregular mass on the right side of the spine. The puncture biopsy demonstrated positive CD31, D2-40, and FLI1 immunohistochemical staining, but negative GLUT1 staining, confirming the diagnosis of KHE. Furthermore, endothelin-1 (ET1) expression levels significantly increased, and eNOS and A20 expression levels significantly decreased comparing with control patients. The patient received methylprednisolone and sirolimus treatments, and his condition gradually improved during the follow-up. CONCLUSIONS We reported the first case of KHE presenting with thrombocytopenia and Raynaud phenomenon. The development of Raynaud phenomenon could be associated with increased ET-1 and reduced eNOS and A20 expressions. Careful differential diagnosis of hidden KHE should be considered in children with thrombocytopenia and Raynaud phenomenon.
Collapse
Affiliation(s)
- Lingke Liu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
- Pediatrics, The Affiliated Hospital of Shaoxing University, Shaoxing, 312000, PR China
| | - Weizhong Gu
- Pathology, National Clinical Research Center for Child Health, Hangzhou, 310003, PR China
| | - Liping Teng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Yiping Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Fei Zheng
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Minfei Hu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Meiping Lu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China
| | - Xuefeng Xu
- Department of Rheumatology Immunology & Allergy, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Binsheng Rd 3333, Binjiang District, Hangzhou, 310052, P.R. China.
| |
Collapse
|
14
|
Dauguet M, Lebbé C, Vignes S. Lymphedema and Kaposi sarcoma: A narrative review. J Med Vasc 2023; 48:181-187. [PMID: 38035924 DOI: 10.1016/j.jdmv.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Kaposi sarcoma (KS), due to HHV-8 infection is classified in 4 subtypes: epidemic, endemic, HIV-related and iatrogenic essentially after organ transplant. Lymphedema is a complication of KS. We reviewed the interactions between HHV-8 infection and lymphedema according an analysis of the literature. MAIN BODY HHV-8 can infect different types of cells, among them a privileged tropism for lymphatic endothelial cells. It induces multi-centric endothelial proliferation leading to the occlusion of lymphatic vascular lumen. Lymphatic obstruction progressively lead to the blockage of lymphatic drainage, lymph stasis and lymphedema. Lymphedema mostly involved the lower limb affected by KS. It can then develop simultaneously or after the appearance of KS lesions but also be the first sign of KS, a long time before KS skin lesion onset. Lymphedema diagnosis is clinical and lymphoscintigraphy can confirm it if necessary. Lymphedema may be associated with active lesions of KS or non-evolutive, with only cicatricial lesions. KS should be treated according to the KS subtype, aggressive form, with local or systemic treatments associating with causal treatment, such as HIV infection or reducing immuno-suppressive drugs in transplant patients. In most of the cases, KS treatment may slightly reduce (or not) lymphedema volume which remains a chronic disease. Lymphedema management should be associated in order to reduce the volume and then stabilizing it. Low-stretch bandage, elastic garments and skin care are the cornerstone of treatment. CONCLUSION Lymphedema is a frequent complication of KS, and may reveal KS or occurs throughout its course. Association of KS and lymphedema must be known because lymphedema is a chronic disease affecting the quality of life. Beyond the treatment of KS, its management must be specific including a long follow-up to optimize the patient's observance required to maintain the best lymphedema control.
Collapse
Affiliation(s)
- M Dauguet
- Department of Lymphology, Referral Center for Primary Lymphedema, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015 Paris, France
| | - C Lebbé
- Université Paris Cité, AP-HP Dermato-Oncology, Cancer Institute AP-HP Nord Paris Cité, INSERM U976, Saint-Louis Hospital, Paris, France
| | - S Vignes
- Department of Lymphology, Referral Center for Primary Lymphedema, Cognacq-Jay Hospital, 15, rue Eugène-Millon, 75015 Paris, France.
| |
Collapse
|
15
|
Pum-Im P, Chularojanamontri L, Chantharasamee J. Classic Kaposi sarcoma mimicking cellulitis in a middle-aged Asian man. Australas J Dermatol 2023; 64:e379-e381. [PMID: 37706595 DOI: 10.1111/ajd.14159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/27/2023] [Accepted: 09/03/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Patinya Pum-Im
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jomjit Chantharasamee
- Division of Oncology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
16
|
Fan D, Cui Y, Chen J, He X. Kaposiform hemangioendothelioma of the heart: a case report and literature review. Cardiol Young 2023; 33:2411-2414. [PMID: 37332166 DOI: 10.1017/s1047951123001269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Kaposiform hemangioendothelioma is a rare tumour of vascular origin that rarely occurs in the heart. We provided a rare case of a 26-day-old infant with tachypnoea. Echocardiography showed a solid tumour in the pericardial cavity and a large amount of pericardial effusion. The solid tumour was confirmed by surgery, and the pathology was kaposiform hemangioendothelioma. We analysed this case and reviewed the related literature to explore the clinical features and echocardiographic manifestations to improve the understanding, diagnosis, and treatment of this disease for clinicians and sonographers.
Collapse
Affiliation(s)
- Di Fan
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Yun Cui
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Jing Chen
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Xinjian He
- Department of Ultrasound Diagnosis, Children's Hospital of Hebei Province, Shijiazhuang, China
| |
Collapse
|
17
|
Norton B, Pelkonen O, Watkins J, Mann S. Localised intestinal Kaposi sarcoma in a patient with non-coeliac seronegative villous atrophy. BMJ Case Rep 2023; 16:e254073. [PMID: 37751975 PMCID: PMC10533734 DOI: 10.1136/bcr-2022-254073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Seronegative villous atrophy (SNVA) is a diagnostic challenge for gastroenterologists, which is defined by villous atrophy and negative coeliac serology. Non-coeliac forms of SNVA, such as autoimmune enteropathy, can be life-threatening leading to intractable diarrhoea and severe malabsorption that require systemic immunosuppression. When all known causes have been excluded, it is termed idiopathic villous atrophy (IVA). We present a case of non-coeliac SNVA complicated by Kaposi sarcoma (KS). A previously well HIV-negative man in his 30s presented with a 4-month history of watery diarrhoea and 25 kg weight loss. After prolonged investigation, he was diagnosed with non-coeliac SNVA without an identified aetiology that would be consistent with IVA. Clinical recovery was achieved with parenteral nutrition for type II intestinal failure and immunosuppression using high-dose corticosteroids. On subsequent gastroscopy, he was diagnosed with localised intestinal KS prompting cessation of all immunosuppression but remained in clinical remission.
Collapse
Affiliation(s)
- Benjamin Norton
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, London, UK
- Department of Gastroenterology, Digestive Diseases & Surgery Institute, Cleveland Clinic London, London, UK
| | - Otso Pelkonen
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
| | | | - Steven Mann
- Gastroenterology, Barnet and Chase Farm Hospitals NHS Trust, London, UK
| |
Collapse
|
18
|
Saiki T, Harada A, Suekane H, Torisu T. Multiple Gastrointestinal Angiosarcoma Mimicking Kaposi's Sarcoma. Intern Med 2023; 62:2577-2578. [PMID: 36575019 PMCID: PMC10518554 DOI: 10.2169/internalmedicine.1177-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/20/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Takuto Saiki
- Division of Gastroenterology, Yamaguchi Red Cross Hospital, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akira Harada
- Division of Gastroenterology, Yamaguchi Red Cross Hospital, Japan
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Hiroshi Suekane
- Division of Gastroenterology, Yamaguchi Red Cross Hospital, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Japan
| |
Collapse
|
19
|
Fischer GM, Gliem TJ, Greipp PT, Rosenberg AE, Folpe AL, Hornick JL. Anaplastic Kaposi Sarcoma: A Clinicopathologic and Molecular Genetic Analysis. Mod Pathol 2023; 36:100191. [PMID: 37080393 DOI: 10.1016/j.modpat.2023.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
Kaposi sarcoma (KS) is a human herpesvirus 8 (HHV8)-associated vascular proliferation that most often involves the skin. Rarely, KS shows marked nuclear atypia or pleomorphism; such examples are known as "anaplastic" KS. This poorly characterized variant often pursues an aggressive course; little is known of its genetic landscape. This study evaluated the clinicopathologic and genomic features of anaplastic KS. We identified 9 anaplastic KS cases from 7 patients and 8 conventional KS cases, including a matched conventional KS and primary metastasis anaplastic KS pair from a single patient (anaplastic KS diagnosed 9 years after conventional KS). All patients with anaplastic KS were men, aged 51 to 82 years, who had locally aggressive tumors predominantly affecting the soft tissue and bone of the lower extremities (5/7 patients). Four patients were known to be HIV positive (all on antiretrovirals), 2 were HIV negative, and 1 was of unknown HIV status. The tumors showed angiosarcoma-like or pleomorphic spindle cell sarcoma morphology. Plasma cell-rich chronic inflammation and hemosiderin deposition were commonly present. Single-nucleotide polymorphism-based chromosomal microarray analysis showed the anaplastic KS cohort to demonstrate highly recurrent whole chromosome (chr) gains of chr 7, 11, 19, and 21, which primarily affected olfactory and G protein-coupled receptor signaling and losses of chr6_q and chrY. Compared with conventional KS, anaplastic KS cases showed significantly more total copy number alterations and more frequent gains of chr7 and chr11_q13.1 (MARK2, RELA, and ESRRA, including high copy number gain in 1 case). Pathway analysis demonstrated that these gains preferentially affected genes that facilitate cyclin-dependent cell signaling. Furthermore, anaplastic KS cases were phylogenetically distinct from conventional KS cases, including the patient-matched primary metastasis anaplastic KS pair and conventional KS. Our study is the first to demonstrate that a more complex genome and distinct copy number alterations distinguish anaplastic KS from conventional KS. Gains of chr7 and chr11_q13.1 appear central to biological transformation.
Collapse
Affiliation(s)
- Grant M Fischer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Troy J Gliem
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Patricia T Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrew E Rosenberg
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
20
|
Patel R, Lurain K, Yarchoan R, Ramaswami R. Clinical management of Kaposi sarcoma herpesvirus-associated diseases: an update on disease manifestations and treatment strategies. Expert Rev Anti Infect Ther 2023; 21:929-941. [PMID: 37578202 PMCID: PMC10529793 DOI: 10.1080/14787210.2023.2247161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Kaposi sarcoma herpes virus (KSHV) is associated with several diseases including Kaposi sarcoma, a form of multicentric Castleman's disease, primary effusion lymphoma, and an inflammatory cytokine syndrome. These KSHV-associated diseases (KAD) can present with heterogenous signs and symptoms that are often associated with cytokine dysregulation that may result in multiorgan dysfunction. The inability to promptly diagnose and treat these conditions can result in long-term complications and mortality. AREAS COVERED Existing epidemiological subtypes of existing KSHV-associated diseases, specifically Kaposi sarcoma as well as the incidence of several KSHV-associated disorders are described. We review the KSHV latent and lytic phases as they correlate with KSHV-associated diseases. Given the complicated presentations, we discuss the clinical manifestations, current diagnostic criteria, existing treatment algorithms for individual KAD, and when they occur concurrently. With emerging evidence on the virus and host interactions, we evaluate novel approaches for the treatment of KAD. An extensive literature search was conducted to support these findings. EXPERT OPINION KSHV leads to complex and concurrent disease processes that are often underdiagnosed both in the United States and worldwide. New therapies that exist for many of these conditions focus on chemotherapy-sparing options that seek to target the underlying viral pathogenesis or immunotherapy strategies.
Collapse
Affiliation(s)
- Roshani Patel
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Kathryn Lurain
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Robert Yarchoan
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Ramya Ramaswami
- HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
21
|
Xie Y, Wang C, An Q, Wang D. Glottic Kaposi's sarcoma. AIDS 2023; 37:1343-1344. [PMID: 37930316 PMCID: PMC10242513 DOI: 10.1097/qad.0000000000003559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/16/2023] [Indexed: 11/07/2023]
Affiliation(s)
| | - Chuan Wang
- Science and Education Division, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Qi An
- Science and Education Division, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| | - Dongmei Wang
- Science and Education Division, Public Health Clinical Center of Chengdu, Chengdu, Sichuan, China
| |
Collapse
|
22
|
Tekcan Sanli DE, Kiziltas S. Gastrointestinal Kaposi's Sarcoma. N Engl J Med 2023; 388:e45. [PMID: 36971274 DOI: 10.1056/nejmicm2102502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
|
23
|
Mann BK, D’Assumpcao C, Okumoto L, Aboaid S, Abooed A, Cobos E, Heidari A. Spurious Presentation of Pulmonary Kaposi Sarcoma as Unresolved Pneumonia Led to Fatal Outcome. J Investig Med High Impact Case Rep 2023; 11:23247096231208996. [PMID: 37919962 PMCID: PMC10624085 DOI: 10.1177/23247096231208996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/23/2023] [Accepted: 09/30/2023] [Indexed: 11/04/2023] Open
Abstract
Acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma (KS) is an angioproliferative neoplasia caused by infection with human herpesvirus 8 (HHV-8). It typically presents with mucocutaneous involvement, but it can be disseminated. Initial presentation with primarily pulmonary KS is rare. We present a case of a 32-year-old male with untreated human immunodeficiency virus (HIV) diagnosed 1 year before presentation who developed progressively worsening cough and shortness of breath for 6 months. He was hospitalized twice and treated for unresolved pneumonia in an outside hospital. The patient concomitantly developed purplish nodules on his face, then the upper trunk, back, chest, and thighs bilaterally that gradually increased in size and number. Histopathology findings from skin lesions were consistent for KS. Bronchoscopy found multiple erythematous plaques throughout the tracheobronchial tree with telangiectasias and inflammation suggestive of pulmonary KS. His imaging findings and positive serum HHV-8 polymerase chain reaction (PCR) were consistent with disseminated KS. He started antiretroviral therapy (ART) to treat his HIV infection, followed by liposomal doxorubicin chemotherapy. But both ART and chemotherapy were interrupted due to adherence and insurance issues. The patient was readmitted with acute respiratory failure requiring mechanical ventilation with multiple vasopressors that led to the patient's demise. The late recognition of KS diagnosis and delayed treatment can lead to worse outcomes.
Collapse
|
24
|
Plaza JA, Sangueza OP, Giubellino A, Gru AA, Kaffenberger B, Wakely PE, Sangueza MJ. Angiosarcoma-like Kaposi Sarcoma: A Distinctive Histomorphologic Variant Representing an Important Diagnostic Pitfall. Am J Surg Pathol 2022; 46:1732-1738. [PMID: 35948518 DOI: 10.1097/pas.0000000000001946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Kaposi sarcoma (KS) is a rare low-grade angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8) infection with multiple clinical subtypes and varying histopathologic patterns. Histologically, many different variants of KS have been reported, yet all can be difficult to recognize and must be differentiated from other vascular tumors. In this report, we studied fourteen cases of a newly described variant of KS reminiscent of a well-differentiated angiosarcoma (angiosarcoma-like KS). All cases showed a diffuse, ill-defined infiltrative dermal-based lesion composed of numerous anastomosing vascular channels of varying caliber lined by a single layer of endothelium with minimal pleomorphism. The vascular proliferation ramified through the dermis and dissected the collagen bundles along with infiltration into the subcutaneous fat and around skin appendages. All cases showed expression of vascular markers (CD31, CD34, and ERG) and were positive for HHV-8. None showed the classic histopathology associated with KS. Without clinical guidance these tumors can be difficult to recognize as KS, creating significant diagnostic challenges. Our study expands on a rare histologic variant of KS that ought to be considered in the differential diagnosis of any cutaneous well-differentiated angiosarcoma. Awareness of this variant of KS is of important for proper diagnosis and management of these patients; thus, careful attention to the histomorphology and clinical history can help lead the pathologist to the correct diagnosis.
Collapse
Affiliation(s)
- Jose A Plaza
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Omar P Sangueza
- Department of Pathology and Dermatology, Wake Forest Baptist Health, Winston-Salem, NC
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Benjamin Kaffenberger
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | - Paul E Wakely
- Department of Pathology and Dermatology, The Ohio State University Wexner Medical Center (OSUWMC), Columbus, OH
| | | |
Collapse
|
25
|
Ning J. A rare case of retroperitoneal kaposiform haemangioendothelioma with Kasabach-Merritt phenomenon. Asian J Surg 2022; 46:1904-1905. [PMID: 36347741 DOI: 10.1016/j.asjsur.2022.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Junjie Ning
- Department of Pediatrics, First People's Hospital of Zigong City, Sichuan Province, Zigong, 643000, China.
| |
Collapse
|
26
|
McMahon DE, Chemtai L, Grant M, Singh R, Semeere A, Byakwaga H, Laker-Oketta M, Maurer T, Busakhala N, Martin J, Bassett IV, Butler L, Freeman EE. Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study. J Acquir Immune Defic Syndr 2022; 90:494-503. [PMID: 35499523 PMCID: PMC9283252 DOI: 10.1097/qai.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. METHODS We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. RESULTS The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support. CONCLUSIONS Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.
Collapse
Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Rhea Singh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | | | | | - Toby Maurer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
27
|
Affiliation(s)
- Michael Megaly
- Department of Internal Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA.
| | - Nasser Boshra
- Department of Internal Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA
| |
Collapse
|
28
|
Treister-Goltzman Y, Peleg R. Transplant-associated Kaposi's Sarcoma in a White Man. Isr Med Assoc J 2022; 24:124. [PMID: 35187906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Yulia Treister-Goltzman
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Clalit Health Services, Southern District, Israe
| | - Roni Peleg
- Department of Family Medicine and Siaal Research Center for Family Practice and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Clalit Health Services, Southern District, Israe
| |
Collapse
|
29
|
Affiliation(s)
- G Sakina
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Y T Liew
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
30
|
de Lima Piña GP, Carrascosa Gil J, Díaz Galvis LA, Fuertes Jiménez C. Gastrointestinal infection by Mycobacterium avium with unusual endoscopic presentation. Rev Esp Enferm Dig 2022; 115:190-191. [PMID: 35469407 DOI: 10.17235/reed.2022.8845/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 38-year-old male with medical history of HIV group C3 with voluntary abandonment of antiretroviral therapy, was hospitalized due to general deterioration, abdominal pain, diarrhea and rectal bleeding without signs of acute abdomen. The patient presented anemia, renal and hepatic dysfunction, and metabolic acidosis. Abdominal CT and CT angiography were performed without observing signs of perforation or active bleeding. In the same year, he was also diagnosed of intestinal Cryptosporidiosis, cutaneous Kaposi's sarcoma and disseminated infection by Mycobacterium avium (MA) with lung, liver and bone marrow involvement. Panendoscopy was performed, showing violaceous lesions on the soft palate. In the stomach and duodenum, he presented multiple, large, well-defined and occasionally confluent red-violet lesions Colonoscopy did not show macroscopic alterations.
Collapse
|
31
|
|
32
|
Borowski DW, Lyeshchuk Y. Two sides of one coin: pan-gastrointestinal Kaposi sarcoma presenting with small bowel intussusception and severe gastrointestinal haemorrhage. S AFR J SURG 2021; 59:68a-68b. [PMID: 34212577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report a case of multi-focal pan-gastrointestinal Kaposi sarcoma in an HIV positive patient, presenting with two life-threatening complications of the disease, intestinal obstruction and upper gastrointestinal haemorrhage. The patient responded well to combined surgical and oncological treatment. The reported complications of the disease are regarded as relatively rare events, and this report aims to highlight the need for more intensive screening for Kaposi sarcoma in immune-compromised individuals.
Collapse
|
33
|
Mendoza-Mori LM, Valenzuela-Medina JB, Gotuzzo E, Mejía-Cordero FA, González-Lagos EV. Cancer in people living with HIV-AIDS at a referral hospital in Lima, Peru. Rev Peru Med Exp Salud Publica 2021; 38:278-283. [PMID: 34468576 PMCID: PMC10733228 DOI: 10.17843/rpmesp.2021.382.6341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/12/2021] [Indexed: 11/06/2022] Open
Abstract
This study was carried out to describe and compare the demographic, clinical, and therapeutic characteristics of HIV patients who developed some cancer. We identified 276 cancer cases diagnosed at Hospital Cayetano Heredia between 2000 and 2018. 80,8% (223/276) had AIDS-defining-cancers (ADCs), being Kaposi's Sarcoma the most frequent type; meanwhile, among non-AIDS-defining-cancers (NADCs), the most frequent was Hodgkin lymphoma. The median age was 36,5 years, being highest among the cases diagnosed with NADCs. Concerning CD4 lymphocyte counts, the median among ADCs was much lower than NADCs, 87,5 cells/µl and 216 cells/µl, respectively. Therefore, NADCs cases have a longer history of HIV infection, and an older age at cancer diagnosis, as well as higher CD4 cells counts.
Collapse
Affiliation(s)
| | | | - Eduardo Gotuzzo
- Instituto de Medicina Tropical "Alexander von Humboldt", Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | | |
Collapse
|
34
|
Ruiz-Villaverde R, Faro-Miguez N, Sánchez-Cano D, Martín-Pérez AJ. [Classic Kaposi sarcoma: Beyond the skin]. Rev Esp Geriatr Gerontol 2021; 56:371-372. [PMID: 33771358 DOI: 10.1016/j.regg.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Naya Faro-Miguez
- Servicio de Enfermedades Infecciosas. Hospital Universitario San Cecilio, Granada, España
| | - Daniel Sánchez-Cano
- Servicio de Medicina Interna. Hospital Universitario San Cecilio, Granada, España
| | | |
Collapse
|
35
|
Affiliation(s)
- Adan Rios
- The UT McGovern Medical School at Houston, Texas, USA
| |
Collapse
|
36
|
Reznitsky C, Resnik SR, Calame A, Erickson CP, Resnik BI. An unusual case of pyogenic granuloma-like Kaposi sarcoma. Dermatol Online J 2021; 27:13030/qt3rw719np. [PMID: 33560794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023] Open
Abstract
Kaposi sarcoma (KS) is not typically included in the differential diagnosis of lesions with clinical characteristics of pyogenic granuloma. However, cases of pyogenic granuloma-like Kaposi sarcoma have been reported in the literature. This variant is extremely rare and possesses clinical and histological findings consistent with both conditions. We report an elderly, immunocompetent man with pyogenic granuloma-like Kaposi sarcoma, which was clinically consistent with a pyogenic granuloma and possessed histological findings consistent with Kaposi sarcoma and pyogenic granuloma.
Collapse
Affiliation(s)
| | | | | | | | - Barry I Resnik
- Resnik Skin Institute, Aventura, FL Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL.
| |
Collapse
|
37
|
Abstract
Urogenital cancers are frequently encountered in daily practice. Prostate cancer is the second most common type in adult males, and 2-3% of all adult cancers are renal cell carcinoma. Kaposi's sarcoma originates from vascular endothelial cells and is the most common type of sarcoma observed in HIV-positive patients. However, the development of all these types of cancer in a patient without immunodeficiency is very rare. Incidence of urological malignancies increase with aging. In contrast to normal population, patient who have one urological malignancy have increased risk of getting another urological malignancy in a follow-up. So follow-up of this kind of patients is crucial and needs to be done carefully. In this case report, we aimed to discuss a 68-year-old patient who was diagnosed with concurrent prostate and kidney cancer and developed penile Kaposi's sarcoma in follow-up.
Collapse
Affiliation(s)
| | | | - Aytac Sahin
- Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Ramazan Topakta
- Department of Urology, Haydarpasa Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Urkmez
- Haydarpasa Numune Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| |
Collapse
|
38
|
Nabli N, Boussofara L, Fetoui NG, Sriha B, Denguezli M. Pyogenic Granuloma-Like Kaposi Sarcoma: A Diagnostic Challenge. Skinmed 2020; 18:378-379. [PMID: 33397570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An 81-year-old woman presented with a 2-month history of a painless nodule on the left foot that bled easily after minor trauma. She had no medical history and did not report any preexisting lesion. Physical examination revealed a 2 cm × 3 cm, exophytic and reddish-colored nodule, with an ulcerated and soft surface (Figure 1). There were no other skin lesions or abnormal physical findings. The diagnosis of a pyogenic granuloma (PG) was suggested. A biopsy specimen was obtained from the center of the lesion and stained with hematoxylin and eosin. Histopathologic examination revealed a marked proliferation of both capillary cells and spindle-shaped cells separated by slit-like vessels containing multiple erythrocytes (Figure 2A). Immunochemical analysis showed positivity for CD34 and human herpes virus (HHV)-8 in both endothelial and spindle cells (Figure 2B). Perls' staining showed abundant hemosiderin deposits in the tumor stroma (Figure 2C). These findings were consistent with the diagnosis of Kaposi sarcoma (KS). Laboratory tests eliminated a human immunodeficiency virus (HIV) infection, and no metastatic lesions were found on radiologic examinations. The lesion was treated with laser excision, with no recurrence at the 2-year follow-up.
Collapse
Affiliation(s)
- Nadia Nabli
- Department of Dermatology Farhat Hached University Hospital, Sousse, Tunisia;
| | - Lobna Boussofara
- Department of Dermatology Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Badreddine Sriha
- Department of Pathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- Department of Dermatology Farhat Hached University Hospital, Sousse, Tunisia
| |
Collapse
|
39
|
Vangimalla SS, Dhaliwal A, Bhat I. Widespread Gastrointestinal Kaposi Sarcoma in an HIV Negative Renal Transplant Patient. Clin Gastroenterol Hepatol 2020; 18:e146-e147. [PMID: 31499246 DOI: 10.1016/j.cgh.2019.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/26/2019] [Accepted: 08/27/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Shiva Shankar Vangimalla
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Amaninder Dhaliwal
- Department of Gastroenterology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ishfaq Bhat
- Department of Gastroenterology, University of Nebraska Medical Center, Omaha, Nebraska
| |
Collapse
|
40
|
Abstract
In resource-limited settings, point-of-care diagnostic devices have the potential to reduce diagnostic delays and improve epidemiologic surveillance of dermatologic conditions. We outline novel-point-of care diagnostics that have recently been developed for dermatologic conditions that primarily affect patients living in resource-limited settings, namely, Kaposi sarcoma, cutaneous leishmaniasis, leprosy, Buruli ulcer, yaws, onchocerciasis, and lymphatic filariasis. All of the technologies described in this article are prototypes, and some have undergone field testing. These devices still require validation in real-world settings and effective pricing to have a major impact on dermatologic care in resource-limited settings.
Collapse
Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA
| | - Linda Oyesiku
- Department of Dermatology, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA; University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Esther E Freeman
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA.
| |
Collapse
|
41
|
Bieliauskiene G, Zaar O, Kolmodin I, Gillstedt M, Paoli J. Incidence of Kaposi Sarcoma in Sweden is Decreasing. Acta Derm Venereol 2020; 100:adv00305. [PMID: 33074339 PMCID: PMC9274928 DOI: 10.2340/00015555-3670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Kaposi sarcoma is a rare skin cancer, and epidemiological research into Kaposi sarcoma is therefore scarce. The current epidemiological situation for Kaposi sarcoma in Sweden is unknown. The authors hypothesized that the incidence of Kaposi sarcoma should have decreased after the introduction of antiretroviral therapy in 1996. Using data from the Swedish Cancer Registry, this study aimed to determine the incidence rates and survival for Kaposi sarcoma in Sweden from 1993 to 2016. The results showed that a total of 657 patients (74.0% men, 26.0% women) were diagnosed with Kaposi sarcoma in Sweden during 1993 to 2016. The overall incidence per 100,000, age-standardized to the world population, decreased from 0.40 to 0.10 (p = 0.003) for both sexes combined, from 0.76 to 0.14 (p = 0.003) for men, and from 0.07 to 0.06 (p = 0.86) for women. The 10-year overall survival rate was significantly lower for the study population (30%) compared with the age- and sex-matched Swedish population (56%) (p < 0.00001). Over the study period, incidence rates of Kaposi sarcoma decreased significantly in men, especially during the late 1990s.
Collapse
Affiliation(s)
- Giedre Bieliauskiene
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | |
Collapse
|
42
|
Ramos MC, Oliveira FBD, Antonello VS, Boff AL. Case for diagnosis. Penile lesion in HIV-negative patient. An Bras Dermatol 2020; 95:655-657. [PMID: 32747011 PMCID: PMC7562993 DOI: 10.1016/j.abd.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/28/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Ana Leticia Boff
- Dermatology Service, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
43
|
Limmer AL, Park KE, Patel AB, Huen AO. Unusual presentation of Kaposi sarcoma in an HIV-negative woman. Dermatol Online J 2020; 26:13030/qt7pz3z82d. [PMID: 32621687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023] Open
Abstract
Kaposi sarcoma typically presents as violaceous macules and papules in immunocompromised, specifically HIV-positive, patients. Its distinct clinical features often facilitate rapid diagnosis. In this article, we report a case of Kaposi sarcoma presenting as a concerning yet nondescript lesion in an HIV-negative woman. Although Kaposi sarcoma is frequently part of the differential diagnosis for skin lesions affecting HIV-positive patients, it is less frequently considered in HIV-negative individuals. Additionally, this case differs from the classic clinical presentation of Kaposi sarcoma by resembling a squamous cell carcinoma or superficial basal cell carcinoma. Therefore, it illustrates the importance of suspicious lesion biopsies to ensure accurate diagnosis and appropriate treatment.
Collapse
Affiliation(s)
| | | | | | - Auris O Huen
- The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
44
|
Affiliation(s)
- Devon E. McMahon
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Toby Maurer
- Indiana University School of Medicine, Indianapolis, IN
| | | |
Collapse
|
45
|
Chow ML, Crew AJ, Harter NN. Not so classic, classic kaposi sarcoma. Cutis 2020; 105:E13-E15. [PMID: 32186536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Maggie L Chow
- Department of Dermatology, University of California, San Diego, USA
| | - Ashley J Crew
- Department of Dermatology, University of Southern California, Los Angeles, USA
| | - Nicole N Harter
- Department of Dermatology, University of Southern California, Los Angeles, USA
| |
Collapse
|
46
|
Tejedor-Tejada J, Núñez Rodríguez H, Madrigal Rubiales B, González-González D. Kaposi sarcoma involving gastrointestinal tract in VIH. Dig Liver Dis 2020; 52:238-239. [PMID: 31735522 DOI: 10.1016/j.dld.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Javier Tejedor-Tejada
- Endoscopy Unit of Department of Gastroenterology and Hepatology, Río Hortega Universitary Hospital, Valladolid, Spain.
| | - Henar Núñez Rodríguez
- Endoscopy Unit of Department of Gastroenterology and Hepatology, Río Hortega Universitary Hospital, Valladolid, Spain
| | | | | |
Collapse
|
47
|
Freeman EE, Busakhala N, Regan S, Asirwa FC, Wenger M, Seth D, Moon KC, Semeere A, Maurer T, Wools-Kaloustian K, Bassett I, Martin J. Real-world use of chemotherapy for Kaposi's sarcoma in a large community-based HIV primary care system in Kenya. BMC Cancer 2020; 20:71. [PMID: 31996161 PMCID: PMC6990575 DOI: 10.1186/s12885-019-6506-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. METHODS We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or "severe" disease defined by WHO KS treatment guidelines. RESULTS Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1-50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46-3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). CONCLUSIONS A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.
Collapse
Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA.
| | | | - Susan Regan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Fredrick Chite Asirwa
- AMPATH, Moi University, Eldoret, Kenya
- Indiana University, Indianapolis, Indiana, USA
| | | | - Divya Seth
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Khatiya Chelidze Moon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Aggrey Semeere
- University of California, San Francisco, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Toby Maurer
- University of California, San Francisco, USA
| | | | - Ingrid Bassett
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | | |
Collapse
|
48
|
Affiliation(s)
- Michael Saag
- From the Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham (M.S.); and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Dexter P Mendoza
- From the Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham (M.S.); and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Marc S Sherman
- From the Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham (M.S.); and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Gregory M Cote
- From the Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham (M.S.); and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| | - Angela R Shih
- From the Department of Medicine, University of Alabama Birmingham School of Medicine, Birmingham (M.S.); and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Massachusetts General Hospital, and the Departments of Radiology (D.P.M.), Medicine (M.S.S., G.M.C.), and Pathology (A.R.S.), Harvard Medical School - both in Boston
| |
Collapse
|
49
|
Luu M. Neonatal consultations: vascular lumps, bumps, and tumors in the neonate. Cutis 2019; 104:260-262. [PMID: 31886780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Minnelly Luu
- Children's Hospital, Los Angeles, California, USA
| |
Collapse
|
50
|
Williams VL, Narasimhamurthy M, Rodriguez O, Mosojane K, Bale T, Kesalopa K, Kayembe MA, Grover S. Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana. J Glob Oncol 2019; 5:1-7. [PMID: 31702944 PMCID: PMC6882519 DOI: 10.1200/jgo.19.00181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS. METHODS Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals. RESULTS A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00). CONCLUSION Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.
Collapse
Affiliation(s)
- Victoria L. Williams
- University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Mukendi A. Kayembe
- University of Botswana, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Surbhi Grover
- University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
- University of Pennsylvania, Philadelphia, PA
| |
Collapse
|