Lymphoblastic leukaemia and Kaposi's sarcoma

Oral-visceral iatrogenic Kaposi sarcoma following treatment for acute lymphoblastic leukemia: a case report and review of the literature

Background

There have hardly been any reported cases of children presenting with Kaposi sarcoma as a second malignancy following treatment for acute lymphoblastic leukemia outside a transplant setting.

Case presentation

We report a case of a 5-year-old boy of Bantu origin, which, to our knowledge, could be only the second reported case of oral–visceral Kaposi sarcoma after acute lymphoblastic leukemia treatment. The patient presented with a 1-month history of progressive, non-painful, soft tissue oral mass, 1 month after completing treatment for high-risk acute lymphoblastic leukemia. He was successfully treated for Kaposi sarcoma on a two-drug regimen (bleomycin and vincristine) with good clinical response.

Conclusion

Visceral Kaposi sarcoma as a second malignancy may occur after pediatric acute lymphoblastic leukemia treatment, but its rarity makes it unlikely to raise suspicion among clinicians, thus precluding early diagnosis and treatment. We recommend routine evaluation for Kaposi sarcoma lesions in children undergoing long-term surveillance following treatment for childhood acute leukemia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13256-022-03620-3.

Primary vascular tumors of the lungs: a review

Unlike their counterparts in other organ systems, primary vascular neoplasms of the lung are rare. Most of these lesions have only been reported as isolated case studies or small series. When dealing with malignant lesions, metastasis from extrapulmonary sites will have to be excluded before a primary location in the lungs can be confirmed. In this review, the clinicopathologic, immunophenotypical, ultrastructural, and molecular biologic characteristics of primary vascular tumors of the lungs are discussed. The tumoral conditions that will be addressed include hemangioma, lymphangioma, epithelioid hemangioendothelioma, angiosarcoma, and Kaposi's sarcoma. Their respective differential diagnoses will also be discussed.

Second thyroid neoplasms after prophylactic cranial irradiation for acute lymphoblastic leukemia

An understanding of the pathogenesis of second cancers may help in their prevention. We report on two children who were treated for acute lymphoblastic leukemia (ALL), with an exclusively cranial prophylactic irradiation (18 Gy) and who presented with a thyroid carcinoma (TC) 12 and 13 years later. From a thorough review of the literature of TC after ALL and of radiation-induced TC, a strong case can be made that these tumors are caused by late effects of scattered radiation. The risk is at its highest in small children. After cranial irradiation, patients require clinical monitoring of the thyroid and cervical area for nodules, continued indefinitely. We suggest that, in most cases, an alternative form of neuromeningeal prophylaxis should be offered in small children with ALL.

Primary Kaposi's sarcoma of the lung in an immunocompetent 32-year-old heterosexual white man

Primary visceral involvement by Kaposi's sarcoma in the immunocompetent adult American population is extremely rare. Six cases of primary Kaposi's sarcoma of the lung have been previously reported; all four patients in whom immune function was evaluated had abnormalities. A case of primary Kaposi's sarcoma of the lung in a young adult heterosexual man with normal immunologic function is described. The patient had no response to either weekly vinblastine or doxorubicin (Adriamycin). A subsequent solitary right occipital metastasis responded to 3500 rad of radiotherapy. The patient died 3 months after diagnosis; postmortem examination revealed only two small nodules of extrathoracic Kaposi's sarcoma, one in the liver and the other in the right posterior occipital lobe of the brain. Bacterial, mycobacterial, fungal, and viral cultures were negative.

Oropharyngeal Kaposi's sarcoma. Report of two cases and review of the literature

Two cases of Kaposi's sarcoma involving the oropharynx are described. The pathology of the condition is reviewed and the problems of treatment outlined.

Second neoplasms in acute lymphoblastic leukemia

The authors reviewed 61 reported cases of second neoplasms in acute lymphoblastic leukemia (ALL), including 17 patients with ALL followed by another type of acute leukemia, 12 patients with ALL followed by chronic myelocytic leukemia, 19 patients with ALL followed by lymphoma, and 13 patients with ALL followed by other solid tumors. From a review of the literature, it is believed that there is no firm evidence yet that patients with ALL, intensively treated with chemotherapy and/or radiotherapy, are at increased risk of developing therapy-related second neoplasms. Because the number of cases reported is small, there is even insufficient data to firmly suggest that acute myeloblastic leukemia, following intensive therapy for ALL, occurs in a higher-than-expected frequency.