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Mazzitelli M, Leoni D, Maraolo A, Marinello S, Calandrino L, Panese A, Calabrò ML, Marino D, Scaglione V, Cattelan A. Kaposi sarcoma and vertebral involvement in people with HIV: a case report and systematic literature review. HIV Res Clin Pract 2024; 25:2393057. [PMID: 39182187 DOI: 10.1080/25787489.2024.2393057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Kaposi Sarcoma (KS) has been historically associated with HIV, especially in people with advanced immunosuppression. Its prevalence decreased over time, but management remains difficult especially when the diagnosis is late and there is a visceral involvement. Bone localization, and particularly the vertebral one, is rare. We herein present a case of vertebral localizations of KS and performed a review literature to assess demographic, clinical characteristics and treatment outcomes in people with HIV. METHODS The systematic review was carried out by following the PRISMA guidelines and registering the protocol in PROSPERO database (n. registration: CRD42024548626). We included all cases of vertebral localizations of KS from January 1rst 1981 to December 31rst, 2023. RESULTS Twenty-two cases, including ours, were ever reported in people with HIV, mostly males (95.4%), with a median age of 35 years (IQR: 32-44), median CD4+ T cell count of 80 cell/mm3 (IQR 13-111), 31.8% with high HIV viral load. Five people received HIV and KS diagnosis simultaneously. In all cases, but one, there were multiple sites involved. Most spine lesions were localized at thoracic and lumbar levels (59.1%), causing pathological fractures in 2 cases. Chemotherapy and radiotherapy were performed in 50% and 18.2% cases, respectively. 22.7% persons died, stability and improvement/disease regression were reported for 13.6% and 22.7% persons, respectively, while 9.9% had a significant disease progression and a person was lost to follow-up. CONCLUSIONS Despite progresses in treatment, late presentation of KS, especially with spine involvement may have a poor prognosis. More efforts are needed to promote access to HIV testing, especially when indicating conditions are present.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Alberto Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Serena Marinello
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Lucrezia Calandrino
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Angela Panese
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Maria Luisa Calabrò
- Immunology and Molecular Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Dario Marino
- Oncology 1 Unit, Department of Oncology, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padova, Italy
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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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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: 3] [Impact Index Per Article: 0.6] [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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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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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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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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Johnson EL, Pierpont YN, Donate G, Hiro MH, Mannari RJ, Strickland TJ, Robson MC, Payne WG. Clinical challenge: cutaneous Kaposi's sarcoma of the lower extremity. Int Wound J 2011; 8:163-8. [PMID: 21310005 DOI: 10.1111/j.1742-481x.2010.00763.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Kaposi's sarcoma (KS) typically presents as multiple bilateral cutaneous patches or plaques of the lower extremities. This malignancy, however, can evolve with atypical presentation masquerading as a chronic wound. Lesions can mimic venous stasis ulcers, arterial insufficiency, vascular ulcers or chronic-infected wounds. With acquired immune deficiency syndrome (AIDS)-associated KS, lesions are even more widespread, and can affect the respiratory tract, lymph nodes, gastrointestinal tract, spleen, liver and, rarely, bone. As the initial diagnosis of KS is generally determined clinically, a high index of suspicion is necessary for all patients with a known or suspected history of HIV/AIDS. Tissue biopsy with histological analysis is essential for all wound types in this patient subset, regardless of wound presentation. The purpose of this report is to review the pathogenesis as well as the typical and atypical presentations of KS with an example of a diagnostic dilemma.
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Affiliation(s)
- Erika L Johnson
- Institute for Tissue Regeneration, Repair, & Rehabilitation, Bay Pines V.A. Healthcare System, Bay Pines, FL, 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: 108] [Impact Index Per Article: 6.8] [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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Maclean FM, Schatz J, McCarthy SW, Scolyer RA, Stalley P, Bonar SF. Epithelioid and spindle cell haemangioma of bone. Skeletal Radiol 2007; 36 Suppl 1:S50-7. [PMID: 16688448 DOI: 10.1007/s00256-006-0135-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2005] [Revised: 03/10/2006] [Accepted: 03/28/2006] [Indexed: 02/02/2023]
Abstract
A case of epithelioid and spindle cell haemangioma of bone occurring in the proximal femur is presented. The tumour had typical microscopic features with a striking lobular pattern comprising spindled and epithelioid areas with admixed inflammatory cells. The case represents only the eighth reported example of this rare tumour, which appears to fit in the spectrum of epithelioid haemangioma. This is the first case to involve the proximal portion of a long bone. A review of the classification and features of similar vascular tumours of bone is presented.
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Affiliation(s)
- Fiona M Maclean
- Douglass Hanly Moir Pathology, 95 Epping Road, Macquarie Park 2113, Australia.
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Caponetti G, Dezube BJ, Restrepo CS, Pantanowitz L. Kaposi sarcoma of the musculoskeletal system. Cancer 2007; 109:1040-52. [PMID: 17265518 DOI: 10.1002/cncr.22500] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Kaposi sarcoma (KS) of bone and skeletal muscle is unusual. In this report, the authors review 66 published patients with KS who had involvement of the musculoskeletal system reported from 1925 to 2006. In only 3 patients was acquired immunodeficiency syndrome (AIDS)-related KS identified within skeletal muscle. Osseous KS lesions were more frequent and occurred with African, classic, and AIDS-related KS and occurred rarely in transplantation-associated KS. Patients seldom were asymptomatic. They usually had bone pain with limited mobility or infrequently developed serious sequelae like spinal cord compression. Locally aggressive African and classic KS lesions typically involved the peripheral skeleton; whereas, in patients with AIDS, the axial (vertebrae, ribs, sternum, and pelvis) and/or maxillofacial bones more commonly were involved. Almost all patients had concomitant nonosseous KS lesions. Joint involvement was exceptional, and pathologic fractures were not observed. Computed tomography scans and magnetic resonance images were better at detecting osseous KS lesions, which frequently went undetected on plain x-ray films or bone scans. Pathologic diagnosis was important to exclude similar lesions like bacillary angiomatosis. Treatment options, including surgery and, in more recent patients, radiation and/or chemotherapy, had limited success.
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Affiliation(s)
- Gabriel Caponetti
- Department of Pathology, Baystate Medical Center, Tufts School of Medicine, Springfield, Massachusetts 01199, USA
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