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Debordes PA, Hamoudi C, Di Marco A. Metastatic Kaposi sarcoma in a non-HIV patient leading to metacarpal lysis then upper-limb amputation: a case report. Case Reports Plast Surg Hand Surg 2023; 10:2251581. [PMID: 37655127 PMCID: PMC10467514 DOI: 10.1080/23320885.2023.2251581] [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: 11/29/2022] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
We report the case of a HIV-seronegative 57 year-old man, with known classic Kaposi's disease and in whom a secondary localization in the upper left limb led to carpal and metacarpal lysis in the left hand. This unfavorable local evolution led to left transhumeral amputation.
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Affiliation(s)
| | - Ceyran Hamoudi
- Department of Orthopedics Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - Antonio Di Marco
- Department of Orthopedics Surgery, University Hospital of Strasbourg, Strasbourg, France
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2
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Endemic Kaposi's Sarcoma. Cancers (Basel) 2023; 15:cancers15030872. [PMID: 36765830 PMCID: PMC9913747 DOI: 10.3390/cancers15030872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
Kaposi's sarcoma (KS) is a common neoplasm in Eastern and central Africa reflecting the spread of human gammaherpesvirus-8 (HHV-8), now considered a necessary causal agent for the development of KS. The endemic KS subtype can follow an aggressive clinical course with ulcerative skin lesions with soft tissue invasion or even bone or visceral involvement. In the latter cases, a thorough imaging work-up and better follow-up schedules are warranted. As KS is a chronic disease, the therapeutic goal is to obtain sustainable remission in cutaneous and visceral lesions and a good quality of life. Watchful monitoring may be sufficient in localized cutaneous forms. Potential therapeutic modalities for symptomatic advanced KS include systemic chemotherapies, immunomodulators, immune checkpoint inhibitors, and antiangiogenic drugs.
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3
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Pesqué L, Delyon J, Lheure C, Baroudjian B, Battistella M, Merlet P, Lebbé C, Vercellino L. Yield of FDG PET/CT for Defining the Extent of Disease in Patients with Kaposi Sarcoma. Cancers (Basel) 2022; 14:cancers14092189. [PMID: 35565319 PMCID: PMC9102885 DOI: 10.3390/cancers14092189] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary The potential role of positron emission tomography/computed tomography with fluorodeoxyglucose (FDG PET/CT) for assessing the extent of Kaposi sarcoma is not well studied. We analyzed FDG PET/CTs performed on 75 patients referred to our department for Kaposi sarcoma staging or restaging. FDG PET/CTs detected most lymph nodes, bone, and muscle lesions, whereas digestive and mucous lesions could be missed. Most cutaneous lesions can be identified when whole-body FDG PET/CT (including lower limbs) is performed. Thus, a true whole-body FDG PET/CT can be recommended for staging purposes in patients with active Kaposi sarcoma and, if positive, be useful for therapeutic evaluation and follow-up. Abstract Background: Positron emission tomography/computed tomography with fluorodeoxyglucose (F-18) (FDG PET/CT) is increasingly used in Kaposi sarcoma (KS), but its value has not been assessed. Objectives: In this study, we aimed to evaluate the diagnostic accuracy of FDG PET/CT to define the extent of disease in KS. Methods: Consecutive patients with KS referred to our department for FDG PET/CT were included. The diagnostic accuracy of FDG PET/CT for cutaneous and extra-cutaneous KS staging was assessed on a per lesion basis compared to staging obtained from clinical examination, standard imaging, endoscopy, histological analyses, and follow-up. Results: From 2007 to 2017, 75 patients with FDG PET/CT were analyzed. The sensitivity and specificity of FDG PET/CT for the overall detection of KS lesions were 71 and 98%, respectively. Sensitivity and specificity were 100 and 85% for lymph nodes, 87 and 98% for bone, 87 and 100% for lungs, and 100 and 100% for muscle involvement, whereas sensitivity was only 17% to detect KS digestive involvement. The sensitivity of the diagnostic for KS cutaneous involvement increased from 73 to 88% when using a whole-body examination. Conclusion: FDG PET/CT showed good sensitivity and specificity for KS staging (digestive involvement excepted) and could be used for staging patients with active KS.
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Affiliation(s)
- Louise Pesqué
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
| | - Julie Delyon
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Coralie Lheure
- Université de Paris Cité, 75006 Paris, France;
- Department of Dermatology, Cochin University Hospital, 27, Rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Barouyr Baroudjian
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
| | - Maxime Battistella
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
- Department of Pathology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Pascal Merlet
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris Cité, 75006 Paris, France;
| | - Céleste Lebbé
- Department of Dermatology, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (J.D.); (B.B.); (C.L.)
- INSERM HIPI Team 1, U976, Saint Louis University Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France;
- Université de Paris Cité, 75006 Paris, France;
| | - Laetitia Vercellino
- Nuclear Medicine Department, Saint Louis University Hospital, Assistance-Publique Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010 Paris, France; (L.P.); (P.M.)
- Université de Paris, INSERM, UMR_S942 MASCOT, 75006 Paris, France
- Correspondence: ; Tel.: +33-142499411
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4
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Connolly SP, McGrath J, Sui J, Muldoon EG. Rare, disseminated Kaposi sarcoma in advanced HIV with high-burden pulmonary and skeletal involvement. BMJ Case Rep 2021; 14:14/12/e245448. [PMID: 34853045 PMCID: PMC8638125 DOI: 10.1136/bcr-2021-245448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 30-year-old man who presented to our institution with hypoxia and widespread pulmonary infiltrates managed initially as COVID-19 before receiving a new diagnosis of HIV-associated Kaposi sarcoma (KS) with widespread pulmonary and skeletal involvement. Initial differential diagnoses included Pneumocystis jirovecii pneumonia, disseminated mycobacterial infection and bacillary angiomatosis. A bone marrow biopsy showed heavy infiltration by spindle cells, staining strongly positive for human herpes virus-8 (HHV-8) and CD34, suggesting symptomatic, disseminated KS as the unifying diagnosis. The patient commenced cytotoxic therapy with weekly paclitaxel, with a clinical and radiological response. To our knowledge, this case is among the most severe described in the literature, which we discuss, along with how COVID-19 initially hindered developing a therapeutic allegiance with the patient.
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Affiliation(s)
- Stephen P Connolly
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland .,School of Medicine, University College Dublin, Dublin, Dublin, Ireland
| | - Jonathan McGrath
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jane Sui
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eavan G Muldoon
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Dublin, Ireland
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5
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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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Abstract
Vascular tumors of bone can be diagnostically challenging because of their rarity and histologic overlap with diverse mimics. Vascular tumors of bone can be categorized as benign (hemangioma), intermediate-locally aggressive (epithelioid hemangioma), intermediate-rarely metastasizing (pseudomyogenic hemangioendothelioma), and malignant (epithelioid hemangioendothelioma and angiosarcoma). Recurrent genetic alterations have been described, such as FOSB rearrangements in pseudomyogenic hemangioendothelioma and a subset of epithelioid hemangiomas; CAMTA1 or TFE3 rearrangements in epithelioid hemangioendothelioma. This review discusses the clinical, histologic, and molecular features of vascular tumors of bone, along with diagnostic pitfalls and strategies for avoidance.
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Affiliation(s)
- Yin P Hung
- Department of Pathology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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7
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Zhou J, Shen X, Wang X, Xiao K, Cao Y, Jiang Y. Classic Kaposi sarcoma in a patient of Miao ethnicity followed up for 7 years: a case report. J Med Case Rep 2021; 15:179. [PMID: 33866974 PMCID: PMC8054400 DOI: 10.1186/s13256-021-02777-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Classic Kaposi sarcoma (CKS) is a vascular sarcoma associated with human herpesvirus 8 (HHV-8), which is known to be more common in Mediterranean elderly men and is characterized by indolent clinical behavior. Xinjiang province in China is considered an endemic region for Kaposi’s sarcoma-associated herpesvirus (KSHV), with higher incidence among adults of Kazak and Uyghur ethnicities. Cases of CKS are rarely reported in inland China. Here, we followed a case of CKS for 7 years in a patient of Miao ethnic background in southwestern China. Case presentation A 63-year-old Miao (southwestern China) man was initially diagnosed with CKS in 2010, having a history of limb lesions for 37 years, with left eyelid and binaural lesions for 9 years. He did not have sexual contact with men and was human immunodeficiency virus (HIV)-negative. Due to his lumbago and fever, spinal tuberculosis in the lumbar vertebra was highly suspected after computed tomography (CT) scan. However, diagnostic antituberculosis treatment for 4 weeks failed. The patient was followed up in 2016, when the rash was recovering as the systemic symptoms improved. A new CT was performed, which showed a partial response despite the absence of any medical treatment. The open reading frame (ORF)-K1 of KSHV from skin tissue of the foot was amplified and sequenced, and K1 belonged to subtype A. This genotype is consistent with the typical subtype present in Xinjiang. Conclusions We describe spontaneous partial regression of CKS in a patient of Miao ethnicity in inland China. Our sample may represent an unknown, novel genotype. Surveillance and regulating the immune state may represent a valuable approach for this rare disease.
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Affiliation(s)
- Jing Zhou
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Xiaoping Shen
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Xiaodong Wang
- Department of Dermatology, The Affiliated Hospital, XingJiang Medical University, Urumqi, China
| | - Kun Xiao
- Department of Radiology, Guiyang Third People's Hospital, Guiyang, China
| | - Yu Cao
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China. .,Centre of Expertise in Mycology of RadboudUMC / CWZ, Nijmegen, The Netherlands.
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8
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High CD4 count and bone marrow infiltration in untreated hiv-associated Kaposi sarcoma: A case report and literature review. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2021.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Narita C, Lukies M, Tay HS, Marovic P. Disseminated intraosseous Kaposi's sarcoma: A rare manifestation of HIV/AIDS. J Med Imaging Radiat Oncol 2020; 65:86-88. [PMID: 33058479 DOI: 10.1111/1754-9485.13112] [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: 09/02/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
Abstract
Kaposi Sarcoma (KS), a mucocutaneous cancer that most frequently occurs in the context of Acquired Immunodeficiency Syndrome (AIDS) secondary to Human Immunodeficiency Virus (HIV), is a relatively benign condition, acting more as a marker of immunodeficiency than directly causing harm itself. However, it has been known to spread both locally and in a metastatic fashion, with reports of KS affecting almost all organ systems. One of the most rarely reported areas of involvement is the musculoskeletal system, with secondary osseous spread representing an even smaller subset of these. We report a case of biopsy proven disseminated intraosseous KS involving the entire imaged skeleton that occurred with HIV/AIDS, despite maximal treatment and normal imaging 8 months prior.
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Affiliation(s)
- Callum Narita
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Matthew Lukies
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
| | - Hui Sien Tay
- Department of Anatomical Pathology, Alfred Health, Melbourne, Victoria, Australia
| | - Paul Marovic
- Department of Radiology, Alfred Health, Melbourne, Victoria, Australia
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10
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Udayakumar H, Indiran V, Muthu PM. Unanticipated diagnosis of skeletal muscle Kaposi sarcoma: a case report. Pan Afr Med J 2020; 37:158. [PMID: 33425191 PMCID: PMC7757331 DOI: 10.11604/pamj.2020.37.158.26412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 11/18/2022] Open
Abstract
Kaposi sarcoma (KS) is a cancer, characteristically manifesting as red or purple patches of abnormal tissue growing subcutaneously around the mouth, nose, and throat. Primary musculoskeletal KS is a never reported as skeletal muscles sarcomas are first differentials. Pertaining to the musculoskeletal system complicity of KS, African and classic KS lesions are inclined to manifest lesion in the peripheral skeleton. On the other hand AIDS-related KS routinely involves the maxillofacial bones and/or axial skeleton. KS distinguishably involves the tempo-parietal bones, paranasal sinus, hands and feet and other facial bones. Asymmetric involvement of the bones by KS is the rule. Though reported, involvement of the joints in KS is unusual. Skeletal muscle involvement has only sparingly been reported in AIDS-related KS patient. A primary KS of the skeletal muscle in an otherwise normal patient with no skin manifestations has never been reported thus far. The occurrence of KS in any atypical site may pose as difficulty to diagnose it. It is important for the radiologist to acquaintance with the spectrum of imaging manifestations of KS in various affected organs. Particularly in asymptomatic patients, lesions go unrecognized on routine imaging studies (e.g. KS on plain x-ray films) and clinicians are unwary of their existence. Awareness that KS can occur in any of these unusual locations may help avoid potential misdiagnosis with serious consequences (e.g. spinal cord compression) and/or mis-management.
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Affiliation(s)
- Harshini Udayakumar
- Department of Radiodiagnosis, Sreebalaji Medical College and Hospital, CLC Works, Road, Chromepet, Chennai, Tamilnadu 600044, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sreebalaji Medical College and Hospital, CLC Works, Road, Chromepet, Chennai, Tamilnadu 600044, India
| | - Prabhakaran Madurai Muthu
- Department of Radiodiagnosis, Sreebalaji Medical College and Hospital, CLC Works, Road, Chromepet, Chennai, Tamilnadu 600044, India
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Catedral LIG, Caro-Chang LA, Tan HN, Velasco R, King RE, Ting FI, Mondragon KM, So RB, Vergara JP, Fernando G. AIDS-Related Kaposi Sarcoma in a Tertiary University Hospital in Manila, Philippines: A Report of Six Cases. ASIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.1055/s-0040-1713317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
AbstractWe report six cases of Kaposi sarcoma (KS) seen at the University of the Philippines–Philippine General Hospital, a tertiary university hospital with a 1,500-bed capacity in Manila, from 2017 to February 2020. All cases involved males (21–47 years old) infected with human immunodeficiency virus (HIV). Majority came from Metro Manila and had opportunistic infections at the time of KS diagnosis, most commonly pulmonary tuberculosis. Four patients presented with multiple hyperpigmented cutaneous patches. One patient had both cutaneous lesions and necrotic gingival mass. One patient presented with a gastrointestinal mass. One patient underwent systemic chemotherapy (liposomal doxorubicin) but was eventually lost to follow-up. Although considered the most common tumor arising from HIV-infected persons, KS is considered rare in the Philippines. No studies have been undertaken to determine its incidence. However, the incidence may be expected to rise due to the increasing number of Filipinos diagnosed with HIV daily.
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Affiliation(s)
- Lance Isidore G. Catedral
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Leah Antoinette Caro-Chang
- Department of Dermatology, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Harold Nathan Tan
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Rogelio Velasco
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Rich Ericson King
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Frederic Ivan Ting
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Karen M. Mondragon
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Roizza Beth So
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - John Paulo Vergara
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Gracieux Fernando
- Division of Medical Oncology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
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12
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Linhares LS, Vaz A, Trippia CR, Reifegerste CP. Test yourself: cutaneous mass on the thigh. Skeletal Radiol 2020; 49:331-332. [PMID: 31781786 DOI: 10.1007/s00256-019-03350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Lucas Savaris Linhares
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil
| | - André Vaz
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil.
| | - Cesar Rodrigo Trippia
- Radiology Department, Nossa Senhora das Gracas Hospital, Rua Alcides Munhoz 433, Curitiba, Parana, 80810-040, Brazil
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13
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Sharma S, Kurra C, Hyska-Campbell M, Taylor K, Hernandez M, Palma C, Alkhasawneh A, Wasserman P. Kaposi Sarcoma mimicking pedal osteomyelitis in a patient with HIV. Radiol Case Rep 2019; 14:1495-1499. [PMID: 31660095 PMCID: PMC6807071 DOI: 10.1016/j.radcr.2019.09.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 09/20/2019] [Accepted: 09/20/2019] [Indexed: 11/30/2022] Open
Abstract
Kaposi Sarcoma (KS) is an angio-proliferative mesenchymal neoplasm that typically affects the skin. In the setting of AIDS, it is usually disseminated, commonly involving noncutaneous sites like oral cavity, lymph nodes, pulmonary, and gastrointestinal systems. Musculoskeletal system involvement by KS is rare, and when encountered, it typically involves the axial skeleton (vertebrae, ribs, sternum, and pelvis) and/or maxillofacial bones. This report describes an unusual case of a 44-year old patient with HIV, who presented with a foot ulcer that fit the typical clinical features of osteomyelitis until MRI of the foot demonstrated atypical findings that challenged the original clinical diagnosis. This case highlights the role that advanced diagnostic imaging plays in the diagnosis of musculoskeletal Kaposi Sarcoma and serves as a reminder to radiologists to include Kaposi Sarcoma in the differential of multifocal osteolytic lesions in patients with HIV.
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Affiliation(s)
- Swati Sharma
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | - Chandana Kurra
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | | | - Kristin Taylor
- Department of Radiology, University of Florida, Jacksonville FL, USA
| | | | - Christine Palma
- Department of Podiatry, University of Florida, Jacksonville FL, USA
| | - Ahmad Alkhasawneh
- Department of Pathology, University of Florida, Jacksonville FL, USA
| | - Paul Wasserman
- Department of Radiology, University of Florida, Jacksonville FL, USA
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14
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Verdecia J, Warda F, Rechcigl K, Sokanovic M, Isache C. Kaposi sarcoma with musculoskeletal manifestations in a well-controlled HIV patient. IDCases 2019; 17:e00571. [PMID: 31275805 PMCID: PMC6587020 DOI: 10.1016/j.idcr.2019.e00571] [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: 04/30/2019] [Revised: 06/06/2019] [Accepted: 06/06/2019] [Indexed: 11/28/2022] Open
Abstract
We present here a case of relapsed HIV-related Kaposi Sarcoma (KS), manifesting as a plantar ulcer with underlying bone involvement in a patient with well-controlled HIV. Radiographic and magnetic resonance imaging of the patient's right foot showed bone destruction suggestive of osteomyelitis. However, when a bone biopsy was done, this was consistent with KS, without any signs of bone infection. Patient was initially diagnosed with KS four years prior. He was successfully treated at the time with doxorubicin, radiation therapy, and began HIV therapy. At the time of the KS recurrence, his HIV viral load was undetectable and his CD4 count was over 900 cells/uL (CD4 percentage of 42%). Musculoskeletal (MSK) involvement in KS is a rare manifestation of this disease. The argest series of skeletal KS in people living with HIV by Papanastasopoulos at el. showed a prevalence of only 1.1%. The radiological features of MSK-KS are generally lytic osseous lesions, but presentations may differ. Bone biopsy remains the gold standard for diagnosis, as many other infectious and neoplastic processes can mimic MSK-KS radiographically. In the era of highly active antiretroviral therapy, people living with HIV who are diagnosed with MSK-KS appear to have a substantially improved survival rate than previously described.
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Affiliation(s)
- Jorge Verdecia
- Department of Medicine, University of Florida-COM, Jacksonville, United States
| | - Firas Warda
- Department of Medicine, University of Florida-COM, Jacksonville, United States
| | - Kevin Rechcigl
- Department of Medicine, University of Florida-COM, Jacksonville, United States
| | - Mladen Sokanovic
- Department of Infectious Diseases, University of Florida-COM, Jacksonville, United States
| | - Carmen Isache
- Department of Medicine, University of Florida-COM, Jacksonville, United States.,Department of Infectious Diseases, University of Florida-COM, Jacksonville, United States
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Javadi S, Menias CO, Karbasian N, Shaaban A, Shah K, Osman A, Jensen CT, Lubner MG, Gaballah AH, Elsayes KM. HIV-related Malignancies and Mimics: Imaging Findings and Management. Radiographics 2018; 38:2051-2068. [PMID: 30339518 DOI: 10.1148/rg.2018180149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The risk of developing malignancy is higher in patients with human immunodeficiency virus (HIV) infection than in non-HIV-infected patients. Several factors including immunosuppression, viral coinfection, and high-risk lifestyle choices lead to higher rates of cancer in the HIV-infected population. A subset of HIV-related malignancies are considered to be acquired immunodeficiency syndrome (AIDS)-defining malignancies, as their presence confirms the diagnosis of AIDS in an HIV-infected patient. The introduction of highly active antiretroviral therapy (HAART) has led to a significant drop in the rate of AIDS-defining malignancies, including Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical carcinoma. However, non-AIDS-defining malignancies (eg, Hodgkin lymphoma, lung cancer, hepatocellular carcinoma, and head and neck cancers) now account for an increasing number of cancer cases diagnosed in HIV-infected patients. Although the number has decreased, AIDS-defining malignancies account for 15%-19% of all deaths in HIV-infected patients in the post-HAART era. Most HIV-related malignancies in HIV-infected patients manifest at an earlier age with a more aggressive course than that of non-HIV-related malignancies. Understanding common HIV-related malignancies and their specific imaging features is crucial for making an accurate and early diagnosis, which impacts management. Owing to the weakened immune system of HIV-infected patients, other entities such as various infections, particularly opportunistic infections, are prevalent in these patients. These processes can have confounding clinical and imaging manifestations that mimic malignancy. This article reviews the most common AIDS-defining and non-AIDS-defining malignancies, the role of imaging in their diagnosis, and the imaging mimics of malignancies in HIV-infected patients. ©RSNA, 2018.
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Affiliation(s)
- Sanaz Javadi
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Christine O Menias
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Niloofar Karbasian
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Akram Shaaban
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Komal Shah
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Adam Osman
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Corey T Jensen
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Meghan G Lubner
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Ayman H Gaballah
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
| | - Khaled M Elsayes
- From the Departments of Diagnostic Radiology (S.J., K.S., A.O., C.T.J., K.M.E.) and Interventional Radiology (N.K.), University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030; Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L.); and Department of Radiology, University of Missouri Health Care, Columbia, Mo (A.H.G.)
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Ramsingh J, Watson C. Adrenal incidentaloma in a patient with HIV/AIDS. J Surg Case Rep 2017; 2017:rjx125. [PMID: 28852452 PMCID: PMC5570053 DOI: 10.1093/jscr/rjx125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 06/14/2017] [Indexed: 12/27/2022] Open
Abstract
Human immunodeficiency virus (HIV) is well known to be associated with various neoplasms and opportunistic infections. Kaposi sarcoma (KS), associated with human herpes virus 8 (HHV8) infection, is the most common tumour in HIV positive patients and is also an acquired immune deficiency syndrome (AIDS) defining illness. Cutaneous manifestations are the most common presenting symptom; however, visceral involvement is also recognized. We present the case of a 55-year-old male who was diagnosed with AIDS-related KS, who was referred to our surgical unit with an indeterminate left adrenal lesion. He subsequently started antiretroviral therapy and given the indeterminate nature of his adrenal lesion, we performed a laparoscopic left adrenalectomy, with KS of the adrenal gland confirmed on histology.
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Affiliation(s)
- Jason Ramsingh
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Carol Watson
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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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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18
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Rapidly progressive Kaposi's Sarcoma in an Iraqi boy received Valproic acid: a case report and review of literature. BMC Pediatr 2016; 16:111. [PMID: 27459853 PMCID: PMC4962423 DOI: 10.1186/s12887-016-0653-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Kaposi’s sarcoma (KS), an endothelial neoplasm, is associated with human herpes virus (HHV) -8 infection. KS has four clinical sub-types: Mediterranean/classic, African/endemic, human immunodeficiency virus (HIV) -associated/epidemic, and transplantation-related/iatrogenic. Immunosuppression is an important cofactor in KS process. Classic KS (CKS) is exceedingly rare in children and when occurs, it is much more disseminated than adults. The epidemic, HIV-associated and the iatrogenic forms of childhood KS are a result of a profound and acquired T-cell deficiency. To our knowledge, this is the first paediatric KS case report from Iraq. Our patient was showing an unusual aggressive course of the disease while receiving Valproic acid (VPA) of the potential immune-suppressive effect. Case presentation A six-year-old Iraqi boy, who had cerebral palsy (CP) and epilepsy since the age of 9-months, had received VPA to control his seizures. He developed skin discoloration followed by nodules that disseminated proximally from the lower extremities to the groin, face, ears and oral cavity, and then he died from severe respiratory distress after 110 days from the disease evolution. KS diagnosis was proved by a skin biopsy. As the patient was of Arab-Asian ethnicity and was HIV-seronegative status, accordingly, his condition best fitted the classic form of KS. However, recent studies showed the link of VPA with the reactivation of HHV-8. Moreover, accumulated experimental and clinical data elucidated that VPA induces T-cell suppression. Given that there was a lack of facilities to perform the laboratory immunological diagnostic tests in Iraq, the VPA-induced effect on immunity in our case (iatrogenic KS) could not be evaluated. Conclusions Our report demonstrates a rare, rapidly progressing paediatric KS case and highlights the possible role of the 5-years’ administration of VPA and its challenging effect on cellular immunity based on recent studies. Thus, VPA could have promoted the development of the KS in our patient. This report also recalls the need of paediatricians to consider KS especially when the skin lesion appears at the child’s foot even in countries outside the geographical map of the disease. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0653-3) contains supplementary material, which is available to authorized users.
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Pretell-Mazzini J, Subhawong T, Hernandez VH, Campo R. HIV and Orthopaedics: Musculoskeletal Manifestations and Outcomes. J Bone Joint Surg Am 2016; 98:775-86. [PMID: 27147691 DOI: 10.2106/jbjs.15.00842] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤Advances in combined antiretroviral therapy (cART) in recent years have transformed HIV infection into a chronic disease when treatment is available, increasing a patient's life expectancy and the chances that orthopaedic surgeons will encounter such patients in their clinical practice.➤Musculoskeletal manifestations in patients with HIV infection are common and sometimes are the initial presentation of the disease. Knowledge about neoplasms and associated conditions affecting muscle, bones, and joints is essential for successful management.➤Since the advent of cART, total joint arthroplasty has been shown to be a safe procedure; however, perioperative infection is still a small risk in patients with uncontrolled viral loads or CD4 counts of <400 cells/mm(3).➤With regard to trauma surgery, the rates of early and late infection around implants, as well as union rates, are comparable with those in the HIV-negative population; however, there is an increased risk of pulmonary, renal, and infectious or septic complications in the polytrauma setting.➤Factors such as CD4 count, nutritional status, cART therapy, viral load count, and other comorbidities (hemophilia, infection among intravenous drug users, etc.) should be considered when treating these patients in order to optimize their clinical outcomes.
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Affiliation(s)
- Juan Pretell-Mazzini
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Ty Subhawong
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Victor H Hernandez
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
| | - Rafael Campo
- Departments of Orthopaedic Surgery (J.P.-M. and V.H.H.) and Radiology (T.S.), and Division of Infectious Diseases, Department of Internal Medicine (R.C.), University of Miami Miller School of Medicine, Miami, Florida
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Mouden K, Khmou M, Loughmari S, Semmar A, El Kacemi H, El Khannoussi B, Kebdani T, Elmajjaoui S, Benjaafar N. Primary Kaposi's sarcoma of the nasal cavity: a case report and review of the literature. Clin Sarcoma Res 2016; 6:4. [PMID: 26998222 PMCID: PMC4797219 DOI: 10.1186/s13569-016-0044-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/10/2016] [Indexed: 12/25/2022] Open
Abstract
Background Kaposi sarcoma is a neoplastic vascular disorder. It usually present on the skin of the upper and lower extremities, rarely in the mucosa of the head and neck. The most common sites reported are within the oral cavity, particularly on the palate. Other mucosal sites are rare. We present an unusual case where the primary manifestation of the Kaposi’s sarcoma was in the nasal mucosa. Case presentation A 56-year-old female of Mediterranean descent presented with a 1 year history of swelling on the left side of her nose, nasal obstruction and occasional minor epistaxes. Physical examination showed a firm and bulging polypoid mass which filled the left nasal cavity without cutaneous lesions. Computed tomography (CT) demonstrated a tumor, measuring 77 mm in diameter, occupying the left nasal cavity causing erosion of nasal septum and extending posteriorly to the left choana and nasopharynx. There was bilateral cervical lymphadenopathy. Patient treated with chemotherapy alone. She was in a complete response after the first cycle. The patient received no further treatment. She needs a regular medical checkups that include a review of a patient’s medical history and a complete physical exam. She is in excellent local control over 12 months. Conclusions A review of the literature revealed that only seven cases of primary Kaposi sarcoma of the nasal cavity have previously been published and only two of them presented in a patient not associated with the acquired immunodeficiency syndrome. Here, we report the third case where the primary manifestation of the Kaposi sarcoma was in the nasal cavity in a patient with an adequate immune system.
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Affiliation(s)
- Karima Mouden
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Mouna Khmou
- Department of Pathology, National Institute of Oncology, Rabat, Morocco
| | - Saida Loughmari
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Afaf Semmar
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Hanan El Kacemi
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | | | - Tayeb Kebdani
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Sanaa Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - Noureddine Benjaafar
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
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21
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Jackson CC, Dickson MA, Sadjadi M, Gessain A, Abel L, Jouanguy E, Casanova J. Kaposi Sarcoma of Childhood: Inborn or Acquired Immunodeficiency to Oncogenic HHV-8. Pediatr Blood Cancer 2016; 63:392-7. [PMID: 26469702 PMCID: PMC4984265 DOI: 10.1002/pbc.25779] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 12/13/2022]
Abstract
Kaposi sarcoma (KS) is an endothelial malignancy caused by human herpes virus-8 (HHV-8) infection. The epidemic and iatrogenic forms of childhood KS result from a profound and acquired T cell deficiency. Recent studies have shown that classic KS of childhood can result from rare single-gene inborn errors of immunity, with mutations in WAS, IFNGR1, STIM1, and TNFRSF4. The pathogenesis of the endemic form of childhood KS has remained elusive. We review childhood KS pathogenesis and its relationship to inherited and acquired immunodeficiency to oncogenic HHV-8.
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Affiliation(s)
- Carolyn C. Jackson
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Department of PediatricsMemorial Sloan Kettering Cancer CenterNew York
| | - Mark A. Dickson
- Department of MedicineMemorial Sloan Kettering Cancer CenterNew York
- Department of MedicineWeill Cornell Medical CollegeNew York
| | - Mahan Sadjadi
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
| | - Antoine Gessain
- Unit of Epidemiology and Physiopathology of Oncogenic VirusesInstitut PasteurParisFrance
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
| | - Emmanuelle Jouanguy
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
| | - Jean‐Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious DiseasesRockefeller BranchThe Rockefeller UniversityNew York
- Laboratory of Human Genetics of Infectious DiseasesNecker BranchINSERM U1163ParisFrance
- Paris Descartes UniversityImagine InstituteParisFrance
- Howard Hughes Medical Institute
- Pediatric Hematology‐Immunology UnitNecker Hospital for Sick ChildrenParisFrance
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22
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Bell BM, Syed A, Carmack SW, Thomas CA, Layton KF. Disseminated Kaposi sarcoma with osseous metastases in an HIV-positive patient. Proc (Bayl Univ Med Cent) 2016; 29:52-4. [PMID: 26722170 DOI: 10.1080/08998280.2016.11929358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Kaposi sarcoma is a neoplasm commonly associated with human herpesvirus 8 and HIV/AIDS. We present a 44-year-old African immigrant woman who presented to the emergency department after several months of abdominal pain. She was found to be HIV positive, and computed tomography demonstrated numerous lesions of the lungs, liver, and spleen, gastric wall thickening, and several lytic lesions of the spine. Fluoroscopy-guided biopsy of a lytic lesion of the spine yielded the diagnosis of Kaposi sarcoma. AIDS-related Kaposi sarcoma with osseous involvement is rare, with approximately 30 cases reported in the literature. When osteolytic lesions are encountered in an HIV-positive patient, Kaposi sarcoma should remain in the differential.
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Affiliation(s)
- Bruce M Bell
- Departments of Radiology (Bell, Syed, Layton) and Pathology (Carmack, Thomas), Baylor University Medical Center at Dallas
| | - Almas Syed
- Departments of Radiology (Bell, Syed, Layton) and Pathology (Carmack, Thomas), Baylor University Medical Center at Dallas
| | - Susanne W Carmack
- Departments of Radiology (Bell, Syed, Layton) and Pathology (Carmack, Thomas), Baylor University Medical Center at Dallas
| | - Cody A Thomas
- Departments of Radiology (Bell, Syed, Layton) and Pathology (Carmack, Thomas), Baylor University Medical Center at Dallas
| | - Kennith F Layton
- Departments of Radiology (Bell, Syed, Layton) and Pathology (Carmack, Thomas), Baylor University Medical Center at Dallas
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23
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Kaposi sarcoma presenting as “diffuse gingival enlargement”: Report of three cases. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Wakoh M, Sasaki Y, Otonari-Yamamoto M, Goto T, Ogane S, Matsushima J, Nakatani Y. Imaging Findings in AIDS-related Oral Kaposi's Sarcoma. THE BULLETIN OF TOKYO DENTAL COLLEGE 2016; 58:145-154. [PMID: 28954949 DOI: 10.2209/tdcpublication.2016-0025] [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: 11/06/2022]
Abstract
Kaposi's sarcoma (KS) is one of the most common diseases in patients with acquired immunodeficiency syndrome, but is rarely encountered in dental practice in Japan. We encountered a case of oral KS (OKS) presenting in the hard palate, gingiva, and tongue in a 41-year-old man. We report the results of imaging, including computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT in this case. The process leading to an imaging diagnosis of OKS is discussed, emphasizing the importance of collating clinical, laboratory, pathological, and radiological findings. The present results suggest that mapping of accurate tumors is very important in cases of OKS, and that multiple or bilateral manifestations, ill-defined margins, osteolysis, and swollen lymph nodes, in particular, need to be taken into account.
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Affiliation(s)
- Mamoru Wakoh
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College.,Division of Dental Radiology, Tokyo Dental College Chiba Hospital
| | - Yoshinori Sasaki
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College
| | | | - Tazuko Goto
- Department of Oral and Maxillofacial Radiology, Tokyo Dental College
| | - Satoru Ogane
- Oral Cancer Center, Tokyo Dental College Ichikawa General Hospital
| | - Jun Matsushima
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Chiba University Graduate School of Medicine
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Lababidi MH, Alhawasli H, Iroegbu N. Kaposi sarcoma can also involve the heart. J Community Hosp Intern Med Perspect 2015; 5:29054. [PMID: 26653688 PMCID: PMC4677581 DOI: 10.3402/jchimp.v5.29054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/17/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Kaposi sarcoma (KS) is a low-grade angioproliferative tumor associated with infection with human herpes virus 8 (HHV-8). The disease was named after Moritz Kaposi, a Hungarian dermatologist who first described it in 1872 as 'idiopathic multiple pigmented sarcoma of the skin.' HHV-8 infection is required for the development of KS, but not all infected persons develop the disease. KS is also considered an acquired immune deficiency syndrome (AIDS)-defining illness by the Centers for Disease Control and Prevention guidelines. According to data from the United States AIDS and cancer registries, both KS and non-Hodgkin lymphoma are the most common malignancies associated with human immunodeficiency virus (HIV) infection. However, the incidence of both malignancies has decreased dramatically since 1996 following the widespread utilization of highly active antiretroviral therapies. HIV-associated KS can involve virtually any site in the body including lymph nodes, gastrointestinal tract, respiratory system, heart, pericardium, bone marrow, and other visceral organs. However, cutaneous disease is the most common and is the usual initial presentation for KS. KS-related pericardial effusion can be a life-threatening emergency and should be considered in HIV/AIDS patients who present with signs and symptoms of pericardial effusion. The importance of diagnosing and differentiating KS-related pericardial effusion from other causes of pericardial effusion lies in the differences in the treatment and management in comparison to other etiologies of pericardial effusion. We report a case of a 54-year old man who presented to our hospital with a large pericardial effusion and was subsequently diagnosed to have HIV-related KS pericardial effusion. A brief review of the literature on the diagnosis and management is also presented.
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Affiliation(s)
| | - Hazem Alhawasli
- Department of Medicine, St Joseph Hospital, Chicago, IL, USA
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Abstract
Hoffa's syndrome involves inflammation of the infrapatellar fat pad secondary to direct trauma or microtrauma. Alternative sources of inflammation of Hoffa's fat pad include synovial processes such as pigmented villonodular synovitis (PVNS) and osteochondromatosis. Recently, a few cases of inflammation of Hoffa's fat pad secondary to human immunodeficiency virus (HIV) have been described. Our case presents an HIV patient with Hoffa's fat-pad inflammation as well as prefemoral fat-pad edema, posterior soft-tissue inflammation, and bone infarction. Since patients with HIV now live longer due to improved treatment regimens, it is important for radiologists to recognize HIV-related musculoskeletal manifestations, such as non-neoplastic inflammation in Hoffa's fat pad (as seen in our patient).
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Yergiyev O, Mohanty A, Curran-Melendez S, Latona CR, Bhagavatula R, Greenberg L, Silverman JF. Fine-needle aspiration cytology of disseminated Kaposi sarcoma of the bone in an AIDS patient. Acta Cytol 2014; 59:113-7. [PMID: 25547261 DOI: 10.1159/000369855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 11/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Kaposi sarcoma (KS) is a vascular neoplasm associated with human herpesvirus 8 (HHV-8). Skin and mucous membranes are the most common sites, but other organs may be involved. Skeletal KS is rare and occurs either by direct spread of mucocutaneous lesions or through dissemination. Patients present with bone pain and lytic lesions for which they may undergo fine-needle aspiration (FNA). While there are about 70 published case reports of skeletal KS, there is limited literature specifically describing its cytomorphology. Our literature search yielded only a single prior reported case of FNA biopsy of skeletal KS in a Nigerian AIDS patient. CASE We present a case of disseminated KS of the axial skeleton in a 45-year-old African-American man with AIDS which was diagnosed on FNA cytologic examination. The patient presented with multiple lytic lesions in the axial skeleton. The aspirate, core-needle biopsy and touch imprint cytology of a bone lesion demonstrated clusters of spindle and epithelioid cells in radial and streaming arrangement with indistinct intercytoplasmic borders, elongated nuclei, fine chromatin and inconspicuous nucleoli. Immunohistochemical studies revealed positivity for HHV-8 and vascular markers. The cytomorphologic and ancillary features of the case are presented and discussed.
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Affiliation(s)
- Oleksandr Yergiyev
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, Pa., USA
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18F-FDG PET/CT findings in a case with HIV (−) Kaposi Sarcoma. Rev Esp Med Nucl Imagen Mol 2014. [DOI: 10.1016/j.remnie.2014.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ioannidou M, Panayiotakopoulos G, Skarlos D, Petraki K, Doulas N, Mileounis K, Christodoulou C. From the lymph nodes to the muscles: an unusual case of refractory familial Mediterranean classic Kaposi sarcoma. Int J Dermatol 2014; 55:1143-5. [PMID: 24739057 DOI: 10.1111/ijd.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Maria Ioannidou
- Department of Second Oncology, Metropolitan Hospital, Athens, Greece.
| | | | | | | | - Nikolaos Doulas
- Department of Angiosurgery, Metropolitan Hospital, Athens, Greece
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Huang H, Deng YY, Le XH, Lu PX. Primary intraosseous Kaposi's sarcoma of the maxilla in AIDS: a case report. Quant Imaging Med Surg 2014; 3:334-8. [PMID: 24404448 DOI: 10.3978/j.issn.2223-4292.2013.12.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/12/2013] [Indexed: 11/14/2022]
Abstract
In China, Kaposi's sarcoma (KS) is very rare. However, KS does occur as one of the complications in patients with acquired immunodeficiency syndrome (AIDS). Usually AIDS-related KS involves the lymph nodes, the skin and gastrointestinal tract. Intraosseous KS have been reported but it is very rare. We report a case of primary intraosseous KS of the maxilla in an AIDS patient, proven by pathology findings and showed multiple metastasis by positron emission tomography and computed tomography (PET/CT). To our knowledge, this is the first report of primary intraosseous KS of the maxilla in an AIDS patient in China.
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Affiliation(s)
- Hua Huang
- Radiology Department, Shenzhen Third People's Hospital, Shenzhen 518000, China
| | - Ying-Ying Deng
- Radiology Department, Shenzhen Yantian People's Hospital, Shenzhen 518083, China
| | - Xiao-Hua Le
- Pathology Department, Shenzhen Third People's Hospital, Shenzhen 518000, China
| | - Pu-Xuan Lu
- Radiology Department, Shenzhen Third People's Hospital, Shenzhen 518000, China
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Mu A, Nassar N. A man with oral lesions, constipation and back pain. Int J STD AIDS 2013; 25:526-8. [PMID: 24352119 DOI: 10.1177/0956462413515660] [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] [Received: 08/27/2013] [Accepted: 11/11/2013] [Indexed: 11/16/2022]
Abstract
We describe an unusual presentation of disseminated Kaposi sarcoma in a 49-year-old African-American man with AIDS who was admitted to the hospital for constipation and back pain. Magnetic resonance imagings of the thoracic and lumbar spine were grossly abnormal, however, a biopsy of the iliac crest was interpreted as normal. The patient remained a diagnostic enigma until disseminated Kaposi sarcoma was suspected, based on vascular plaque-like lesions observed on his hard palate and right conjunctiva. Slides of the bone biopsy with were stained for human herpes virus-8 (HHV-8) antigen, and were positive. AIDS-related skeletal manifestations of Kaposi sarcoma have been reported in the literature but are infrequent.
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Affiliation(s)
- Anandit Mu
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA
| | - Naiel Nassar
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, CA, USA
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Ozdemir E, Poyraz NY, Keskin M, Kandemir Z, Turkolmez S. (18)F-FDG PET/CT findings in a case with HIV (-) Kaposi sarcoma. Rev Esp Med Nucl Imagen Mol 2013; 33:175-7. [PMID: 24119549 DOI: 10.1016/j.remn.2013.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
Although mucocutaneous sites are the most frequently encountered sites of involvement, Kaposi Sarcoma (KS) may also occasionally involve the breast and the skeletal, endocrine, urinary and nervous systems.. Various imaging modalities may be used to delineate the extent of the disease by detecting unexpected sites of involvement. Herein, we report a case of classical type KS, in whom staging with (18)F-FDG PET/CT imaging disclosed widespread disease and unexpected findings of bone and salivary gland involvement.
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Affiliation(s)
- E Ozdemir
- Department of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara, Turkey.
| | - N Y Poyraz
- Department of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara, Turkey
| | - M Keskin
- Department of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Z Kandemir
- Department of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara, Turkey
| | - S Turkolmez
- Department of Nuclear Medicine, Ataturk Training and Research Hospital, Ankara, Turkey
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Disseminated bone lesions in AIDS-associated Kaposi sarcoma, a bad prognosis? About four cases. J Int AIDS Soc 2012. [DOI: 10.7448/ias.15.6.18437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Booth TC, Chhaya NC, Bell JRG, Holloway BJ. Update on imaging of non-infectious musculoskeletal complications of HIV infection. Skeletal Radiol 2012; 41:1349-63. [PMID: 22618760 DOI: 10.1007/s00256-012-1425-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/27/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
Acquired immunodeficiency syndrome (AIDS) results from infection with human immunodeficiency virus (HIV), producing an immunodeficient state and severe pathology across multiple organ systems. Musculoskeletal involvement is particularly prevalent in this population with both infectious and non-infectious complications encountered, but it is suggested that the latter will affect 72% of HIV-infected individuals. In this review we aim to provide an update on the imaging characteristics of the non-infectious manifestations. The conditions include HIV-related arthritis as well as various malignancies, myositis, anaemia, osteonecrosis, rhabdomyolysis, hypertrophic osteoarthropathy and therapy-related side effects. For the clinician, the diagnostic challenge lies in differentiating disease-related symptoms from therapy-related side effects, particularly when clinical and laboratory features can be non-specific. This is especially difficult following the widespread introduction of highly active anti-retroviral therapy (HAART). Imaging investigations and MRI in particular have proven vital for facilitating early diagnosis and enabling prompt treatment. Furthermore, wider availability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has allowed whole-body assessment for staging and treatment response of malignancy. Understanding the pathogenesis of the various conditions and recognising their imaging features is essential for the clinical radiologist.
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Affiliation(s)
- T C Booth
- Department of Radiology, The Royal Free Hospital, London, UK.
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Eleventh International Congress on Drug Therapy in HIV Infection. J Int AIDS Soc 2012. [DOI: 10.7448/ias.15.6.18447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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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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Alteraciones osteoarticulares en la infección por el VIH. Enferm Infecc Microbiol Clin 2011; 29:515-23. [DOI: 10.1016/j.eimc.2011.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 01/17/2011] [Indexed: 11/30/2022]
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Usefulness of F-18 FDG PET/CT in a Case of Kaposi Sarcoma With an Unexpected Bone Lesion. Clin Nucl Med 2011; 36:231-4. [DOI: 10.1097/rlu.0b013e318208f4ea] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography images before and after chemotherapy for Kaposi sarcoma and highly active antiretrovirus therapy. Jpn J Radiol 2010; 28:759-62. [DOI: 10.1007/s11604-010-0481-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 06/25/2010] [Indexed: 10/18/2022]
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Kaposi’s sarcoma of the head and neck: A review. Oral Oncol 2010; 46:135-45. [DOI: 10.1016/j.oraloncology.2009.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 12/15/2022]
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Potter BK, Adams SC, Qadir R, Pitcher JD, Temple HT. Fungating soft-tissue sarcomas. Treatment implications and prognostic importance of malignant ulceration. J Bone Joint Surg Am 2009; 91:567-74. [PMID: 19255216 DOI: 10.2106/jbjs.h.00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several variables have been reported as being prognostic with regard to the outcomes of soft-tissue sarcomas. Although the tumors are subjectively ominous, no prior study has been performed to evaluate the treatment or prognosis of fungating soft-tissue sarcomas. METHODS We performed a retrospective review of all soft-tissue sarcomas treated at our institution between 1989 and 2004 that had been followed for a minimum of two years or until the death of the patient. Our study group consisted of twenty-four patients with a primary high-grade fungating tumor, and our control group consisted of 146 consecutive patients with a primary high-grade non-fungating tumor. The study cohorts were compared with regard to disease presentation, treatment, and oncologic outcomes. RESULTS There were no significant differences in tumor size, tumor depth, or histopathologic diagnoses between the cohorts, although the patients with a fungating tumor tended to be older (mean, sixty-five years compared with fifty-five years in the control group; p = 0.004) and have shorter postoperative follow-up (mean, thirty-eight months compared with sixty-five months in the control group; p = 0.03). The proportion of patients presenting with metastases was significantly greater in the group with a fungating tumor (33% compared with 9% in the control group; p = 0.003). Significantly more patients with a fungating tumor underwent amputation (35% compared with 12% in the control group; p = 0.01), while a greater proportion of control patients received radiation therapy (68% compared with 39% in the group with a fungating tumor; p = 0.02). There was no difference in the proportions of patients receiving chemotherapy or in the local recurrence rates between the two cohorts. The Kaplan-Meier five-year overall survival estimates were 20% in the group with a fungating tumor compared with 63% (p < 0.0001) in the control group. The Kaplan-Meier five-year disease-specific survival estimates for patients presenting with localized disease was 58% in the group with a fungating tumor and 74% in the control group (p = 0.05). Multivariate analysis demonstrated that disease stage, fungation, and a tumor size of > or = 10 cm were significant independent negative prognostic factors for disease-specific survival. CONCLUSIONS Malignant tumor ulceration is an independent predictor of a poor prognosis for patients with a high-grade soft-tissue sarcoma. Despite the discouraging overall prognosis, aggressive multidisciplinary treatment can lead to long-term survival in an important subgroup of patients with fungating lesions.
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Paycha F, Mortier E, Sassi R, Mahjoub WK, Huchet V, Talbot JN. Localisation osseuse de la maladie de Kaposi sans atteinte cutanéomuqueuse contiguë : intérêt de la tomographie par émission de positons au fluorodésoxyglucose-(18F). Presse Med 2009; 38:327-33. [DOI: 10.1016/j.lpm.2008.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 04/06/2008] [Accepted: 04/21/2008] [Indexed: 11/16/2022] Open
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Successful treatment with liposomal doxorubicin for widespread Kaposi's sarcoma and human herpesvirus-8 related severe hemophagocytic syndrome in a patient with acquired immunodeficiency syndrome. Int J Hematol 2009; 89:195-200. [PMID: 19130173 DOI: 10.1007/s12185-008-0232-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 08/11/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
Hemophagocytic syndrome (HPS) sometimes occurres in patients with acquired immunodeficiency syndrome (AIDS). Human herpesvirus-8 (HHV-8)/Kaposi's sarcoma (KS)-associated herpesvirus has so far been recognized as a trigger of HPS in immunosuppressed subject. We describe a 39-year-old man with AIDS who had widespread mucocutaneous and pulmonary KS and severe HPS. No opportunistic infections or neoplasias were detected except for KS. HHV-8-DNA could be detected in this patient by polymerase chain reaction (PCR) in the serum. Clinical symptoms and cytopenia originating from HPS were reduced by pulse therapy of corticosteroid, antibiotics, and virucides, but recurred with dose reduction of the steroid. Mucocutaneous tumors, edema, and dyspnea had progressed rapidly at this time. Liposomal doxorubicin was given and showed marked effects on both mucocutaneous and plural tumors. HPS also subsided and the serum HHV-8 DNA level markedly decreased after initial treatment with liposomal doxorubicin. HHV-8 clearance with liposomal doxorubicin has recently been reported. Liposomal doxorubicin suppressed not only the widespread KS tumors, but also HHV-8 viremia resulting in decreased HPS in this patient.
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Pantanowitz L, Mullen J, Dezube BJ. Primary Kaposi sarcoma of the subcutaneous tissue. World J Surg Oncol 2008; 6:94. [PMID: 18764944 PMCID: PMC2538530 DOI: 10.1186/1477-7819-6-94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 09/02/2008] [Indexed: 11/14/2022] Open
Abstract
Background Involvement of the subcutis by Kaposi sarcoma (KS) occurs primarily when cutaneous KS lesions evolve into deep penetrating nodular tumors. Primary KS of the subcutaneous tissue is an exceptional manifestation of this low-grade vascular neoplasm. Case presentation We present a unique case of acquired immune deficiency syndrome (AIDS)-associated KS manifesting primarily in the subcutaneous tissue of the anterior thigh in a 43-year-old male, which occurred without overlying visible skin changes or concomitant KS disease elsewhere. Radiological imaging and tissue biopsy confirmed the diagnosis of KS. Conclusion This is the first documented case of primary subcutaneous KS occurring in the setting of AIDS. The differential diagnosis of an isolated subcutaneous lesion in an human immunodeficiency virus (HIV)-infected individual is broad, and requires both imaging and a histopathological diagnosis to guide appropriate therapy.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer 2008; 8:190. [PMID: 18605999 PMCID: PMC2464778 DOI: 10.1186/1471-2407-8-190] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/07/2008] [Indexed: 11/10/2022] Open
Abstract
Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
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