Classical Kaposi sarcoma: an ınsight into demographic characteristics and survival outcomes

BACKGROUND

Classical Kaposi's sarcoma (CKS) is a rare angioproliferative disease associated with HHV-8, usually seen in the Mediterranean and Middle East regions. Knowing the subtypes, affected regions, and factors influencing prognosis is important for disease management.

OBJECTIVE

To analyze the demographic characteristics, prognostic factors, treatment modalities, and survival of patients diagnosed with CKS.

METHODS

Our center's records of patients diagnosed with CKS between January 2010 and December 2021 were retrospectively analyzed. Thirty-eight patients with histopathologically proven CKS were included in the study. Demographic and clinical characteristics of the patients, macroscopic, histopathologic, and immunohistochemical features of the lesions, treatments, and responses to treatment were evaluated. Kaplan-Meier survival curves were used to estimate survival outcomes, and log-rank test analyses were performed for intergroup comparisons.

RESULTS

The median age at diagnosis of the patients was 71.0(39.0-93.0) years. Ten patients were female, and 28 were male. At the time of diagnosis, 63.2% of the patients had localised disease, nine patients were locally advanced, and five patients were metastatic. The tumor was most commonly localised in the lower extremity (65.8%), followed by the upper extremity. The median follow-up period was 69 (49-77.6) months. Local recurrence was detected in 24 patients during the follow-up. Median overall survival was not reached (NR) in localised disease(95% CI: 70.5-NR). In locally advanced disease, it was 31.1 months (95% CI: 13.8-63.0). In metastatic disease, it was 16.3 (95% CI: 12.6-20.0) months (p = 0.005).

CONCLUSION

This study emphasizes that CKS in our centre predominantly affects older males and typically manifests with nodular, early-stage lesions at the time of diagnosis. The majority of patients exhibited localised disease with no evidence of systemic involvement, while lymphedema was a frequent accompanying condition. Ulcerative manifestations were relatively uncommon, and survival outcomes varied significantly based on disease stage, with a marked decline in overall survival for patients with metastatic disease. The findings emphasize the importance of early diagnosis and the development of tailored treatment strategies to improve patient outcomes.

Clinical Outcome Features of Non-HIV Kaposi's Sarcoma and the Role of Wide Excision on Survival: A Retrospective Cohort Study

ABSTRACT

This single-center retrospective study enrolled 22 patients, who were divided into two groups: those who underwent wide excision (group A) and those who did not (group B). Group A included 13 patients, and group B included 9. Most of the cases fell into early stages (I and II). In group A, six patients solely underwent wide excision, whereas seven received additional treatments such as radiotherapy or chemotherapy. Conversely, in group B, four patients received chemotherapy, four received radiotherapy, and one was managed through observation alone. The mean follow-up times were 60.15 and 43.44 months in groups A and B, respectively, with no significant difference observed. In group A, nine patients died, whereas, in group B, six died during the follow-up period. Lesion-free intervals after surgery were observed predominantly in group A, whereas, in group B, seven patients never experienced freedom from skin lesions. Kaplan-Meier survival curve analysis demonstrated a significant difference between the survival curves of the two groups (P = 0.046). Group A exhibited a more favorable outcome in the survival curve analysis. This significant difference could be attributed to the higher survival rates observed in group A during the first 5 years of follow-up. This finding underscores the potential benefit of surgical intervention in the management of non-HIV Kaposi's sarcoma, particularly in the short- to medium-term survival outcomes. Among patients with non-HIV Kaposi's sarcoma, especially those in the early stages, wide excision appears to play a role in treatment.

A Newly Established Cuproptosis-Associated Long Non-Coding RNA Signature for Predicting Prognosis and Indicating Immune Microenvironment Features in Soft Tissue Sarcoma

Cuproptosis, a new type of programmed cell death, is involved in the development and progression of malignancies. The study of cuproptosis-associated long non-coding RNAs (lncRNAs) in soft tissue sarcomas (STSs) is however limited. There is also uncertainty regarding the prognostic accuracy of cuproptosis-associated lncRNAs in STSs and their relationship to the tumor immune microenvironment. The aim of this study was to determine the prognostic significance of cuprotosis-associated lncRNAs in STSs and their relationship to the tumor immune microenvironment. Transcriptomic and clinical data from patients with STSs were obtained through The Cancer Genome Atlas (TCGA). Overall, 259 patients were randomly allocated to a training group or a testing group. In the training group, a cuproptosis-associated lncRNA signature was constructed, and the signature was verified in the testing group. On the basis of risk scores and clinical features, we later developed a hybrid nomogram. We also performed functional and tumor immune microenvironment analysis based on the cuproptosis-associated lncRNA signature. A signature of 5 cuproptosis-associated lncRNAs was created. Based on this signature, we categorized STS patients into high-risk and low-risk groups. The study showed that patients at high risk had a worse prognosis than those at low risk. A nomogram was then constructed combining clinical characteristics with the risk scores, and it was shown to have credible predictive power. Functional enrichment and tumor immune microenvironmental analyses showed that high-risk STSs tend to be immunologically sensitive tumors. In our study, we found a cuproptosis-associated lncRNAs signature, which serves as an independent prognostic indicator. Cuproptosis-associated lncRNAs may play a role in the tumor immune microenvironment, which might be a therapeutic target for patients with STSs.

Virus-associated human cancers in Moroccan population: From epidemiology to prospective research

Eight human viruses have been classified by the International Agency for Research on Cancer as carcinogenic or probably carcinogenic for humans. Infection with high risk human papillomaviruses, hepatitis B and C viruses, Epstein-Barr virus (EBV), human T-Cell Lymphotropic Virus Type 1 (HTLV-1), Human herpesvirus 8 (HHV-8), Merkel cell polyomavirus and human immunodeficiency virus-1 (HIV1) alone or in combination with other agents are the main etiologic factors of many cancers. This review highlights some aspects of virus-associated human cancers, potentially responsible for >14,000 malignancies per year in Morocco. Given that not all individuals infected with these viruses develop cancer, somatic alterations, genetic predisposition, and lifestyle or environmental factors obviously play potentializing roles modulating viral activity. These viral, host genetic signatures and lifestyle interactions may represent a reservoir of biomarkers for early detection, prevention of cancer and rationale-based therapy.

Ultrasonographic intraoperative monitoring and follow-up of Kaposi's sarcoma nodules under treatment with intralesional vincristine

BACKGROUND

Intralesional vincristine is an effective treatment for Kaposi's sarcoma (KS) nodules on the skin, but there is little evidence of its action through imaging techniques. Ultrasonography can be an adjunctive tool in the diagnosis and management of KS skin lesions, but data in the literature are few.

MATERIALS AND METHODS

Five patients with classic KS nodules were treated with intralesional vincristine. Ultrasonographic and color Doppler assessment were performed during vincristine injection and monitoring was repeated 1 and 3 months after the procedure. Partial response was defined as a reduction of more than 50% lesion volume and reduction of the vascular signal; complete response as a resolution of lesion associated with the absence of vascular signal.

RESULTS

Six KS nodules were included in the study. On ultrasonography examination, KS nodules appeared as oval or round, hypoechoic, homogeneous structures, with intralesional vascularization, more prominent in the deepest pole of the nodule. At month 1, 4 nodules achieved a complete response, while two nodules showed a partial response and were retreated with intralesional vincristine. At month 3, all lesions achieved a complete response.

CONCLUSION

Ultrasonography may be a valuable tool in assessing clinical response to intralesional vincristine therapy of cutaneous KS nodules.

Kaposi Sarcoma in an Human Immunodeficiency Virus (HIV)-Seronegative Mediterranean Female: Report of a Rare Case

Patient: Female, 57

Final Diagnosis: Classic Kaposi sarcoma

Symptoms: Skin

Medication: —

Clinical Procedure: Biopsy

Specialty: Surgery

A case report of immunosuppression-related Kaposi's sarcoma after autologous stem cell transplantation

BACKGROUND

Kaposi's sarcoma (KS) is a tumor formed by angioproliferations driven by Human herpes virus 8 also known as Kaposi's sarcoma-associated herpes virus (KSHV). It is best known as an acquired immune deficiency syndrome (AIDS) defining illness that may be fatal. There are only a few reports of KS after hematopoietic cell transplantation (HCT). This is the first case describing the disappearance of KS with immune recovery after autologous HCT.

CASE PRESENTATION

We present the case of a 61-year-old male heterosexual patient of Moroccan origin treated for primary mediastinal non-Hodgkin lymphoma. Because of refractory disease he received multiple lines of chemotherapy prior to autologous HCT. After the second course of low-dose bis-chloroethylnitrosourea, etoposide, cytarabine, melphalan (BEAM) the patient developed several round blue skin lesions. A biopsy was performed, showing many small vessels and positive immune histochemical staining for Human herpes virus 8 (HHV-8), confirming diagnosis of KS. Human immunodeficiency virus testing was negative and work-up showed that there were no visceral lesions. When KS are limited to the skin, prognosis is usually better. The extensive chemotherapy resulted in an important immunosuppression; on day 105 after autologous HCT CD4(+) count was 82/mm(3). Since KS were limited to the skin and attributed to severe immune suppression a watchful waiting strategy was adopted even though in the first months after autologous HCT new skin lesions appeared. With immune recovery (CD4(+) count > 200/mm(3)) 277 days after transplant, skin lesions faded.

CONCLUSION

Kaposi's sarcoma remains a rare tumor that should be thought of in any patient whose immunity is down. If immune recovery is expected and disease is limited to the skin, a watchful waiting strategy can be more rewarding than intensive chemotherapy.

G-quadruplex-interacting compounds alter latent DNA replication and episomal persistence of KSHV

Kaposi's sarcoma associated herpesvirus (KSHV) establishes life-long latent infection by persisting as an extra-chromosomal episome in the infected cells and by maintaining its genome in dividing cells. KSHV achieves this by tethering its epigenome to the host chromosome by latency associated nuclear antigen (LANA), which binds in the terminal repeat (TR) region of the viral genome. Sequence analysis of the TR, a GC-rich DNA element, identified several potential Quadruplex G-Rich Sequences (QGRS). Since quadruplexes have the tendency to obstruct DNA replication, we used G-quadruplex stabilizing compounds to examine their effect on latent DNA replication and the persistence of viral episomes. Our results showed that these G-quadruplex stabilizing compounds led to the activation of dormant origins of DNA replication, with preferential bi-directional pausing of replications forks moving out of the TR region, implicating the role of the G-rich TR in the perturbation of episomal DNA replication. Over time, treatment with PhenDC3 showed a loss of viral episomes in the infected cells. Overall, these data show that G-quadruplex stabilizing compounds retard the progression of replication forks leading to a reduction in DNA replication and episomal maintenance. These results suggest a potential role for G-quadruplex stabilizers in the treatment of KSHV-associated diseases.

Kaposi sarcoma secondary to endogenous adrenocorticotropic hormone-dependent Cushing syndrome

Kaposi sarcoma (KS) is an angioproliferative tumour that develops as a result of an infection by human herpesvirus 8, which is considered a necessary cause but not sufficient. Other factors - genetic, immunological and environmental - might play a role in the development of the disease. We report a case of KS secondary to endogenous Cushing syndrome (ECS) due to a pituitary adenoma, an association that has been reported only once. We also conducted a search through the Medline and PubMed databases for cases involving KS and ECS, finding only three additional cases that shared common clinical and prognostic features with ours. ECS might favour the development of KS due to immunosuppression. Dermatologists and other clinicians should be aware of this association, as it might be an underdiagnosed condition. It also has an important impact on the management of KS, and based on this review it relies on a good prognosis when ECS is well controlled.

Classic Kaposi Sarcoma: to treat or not to treat?

Background

Classic Kaposi Sarcoma (KS) is vascular sarcoma, known to be more common in Mediterranean elderly men and characterized by an indolent clinical behavior. To our knowledge, this is the first evidence in literature, describing a spontaneous partial regression in a non-HIV, non-iatrogenic KS.

Case presentation

A 68-years old woman, presenting with weight loss and respiratory symptoms, was diagnosed with a classic KS involving lungs and mediastinal lymph nodes. No skin or mucosal lesions were identified, HIV positivity was ruled out. Due to patient’s choice, she was kept under surveillance with 3-monthly thorax-abdomen-pelvis computed tomography scan (TAP CT). A first reassessment proved progressive disease (PD) associated with symptoms worsening. A new TAP CT, performed at 5 months from the diagnosis, showed stable disease (SD), with a minor reduction in size of mediastinal lymphadenopathies. A further reassessment, performed 5 months later, resulted in a partial response (PR) despite the absence of any medical treatment. Up to date, the disease is in remission, patient is asymptomatic and still on surveillance.

Conclusion

Given the possible indolent behaviour of KS, we believe that close surveillance can represent a valuable approach in selected cases.

Kaposi's sarcoma: a computational approach through protein-protein interaction and gene regulatory networks analysis

Interactomic data for Kaposi's Sarcoma Associated Herpes virus (KSHV)-the causative agent of vascular origin tumor called Kaposi's sarcoma-is relatively modest to date. The objective of this study was to assign functions to the previously uncharacterized ORFs in the virus using computational approaches and subsequently fit them to the host interactome landscape on protein, gene, and cellular level. On the basis of expression data, predicted RNA interference data, reported experimental data, and sequence based functional annotation we also tried to hypothesize the ORFs role in lytic and latent cycle during viral infection. We studied 17 previously uncharacterized ORFs in KSHV and the host-virus interplay seems to work in three major functional pathways-cell division, transport, metabolic and enzymatic in general. Studying the host-virus crosstalk for lytic phase predicts ORF 10 and ORF 11 as a predicted virus hub whereas PCNA is predicted as a host hub. On the other hand, ORF31 has been predicted as a latent phase inducible protein. KSHV invests a lion's share of its coding potential to suppress host immune response; various inflammatory mediators such as IFN-γ, TNF, IL-6, and IL-8 are negatively regulated by the ORFs while Il-10 secretion is stimulated in contrast. Although, like any other computational prediction, the study requires further validation, keeping into account the reproducibility and vast sample size of the systems biology approach the study allows us to propose an integrated network for host-virus interaction with good confidence. We hope that the study, in the long run, would help us identify effective dug against potential molecular targets.