Primary Gastrointestinal Kaposi’s Sarcoma in a Patient with Human Immunodeficiency Virus

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Abstract

Gastrointestinal bleeding in HIV patients secondary to coinfection by HHV8 and development of Kaposi’s sarcoma (KS) is a rare complication even if no skin lesions are detected on physical examination. This article indicates which patients might develop this type of clinical sign and also tries to recall that absence of skin lesions never rules out the presence of KS, especially if gastrointestinal involvement is documented. Gastrointestinal bleeding in terms of hematemesis has rarely been reported in the literature. We review some important clinical findings, diagnosis, and treatment approach. We present the case of an HIV patient who presented to the emergency department with hematemesis and gastrointestinal signs of KS on upper gastrointestinal endoscopy without any dermatological involvement.

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Gastrointestinal Kaposi's sarcoma: Case report and review of the literature.

Bashar Mourad, Ann Lee, Lacie Brenner … (2015)

Kaposi's sarcoma (KS) of the gastrointestinal tract is not an uncommon disease among individuals with acquired immunodeficiency syndrome (AIDS). The majority is asymptomatic, and for this reason, gastrointestinal KS (GI-KS) remains undiagnosed. With continued tumor growth, considerable variation in clinical presentation occurs including abdominal pain, nausea, vomiting, iron deficiency anemia (either chronic or frank gastrointestinal bleeding), and rarely mechanical obstruction alone or combined with bowel perforation. Endoscopy with biopsy allows for histological and immunohistochemical testing to confirm the diagnosis of GI-KS among those with clinical symptoms. In previous studies, dual treatment with highly active antiretroviral therapy and systemic chemotherapy have been associated with improved morbidity and mortality in individuals with visceral KS. Therefore, investigators have suggested performing screening endoscopies in select patients for early detection and treatment to improve outcome. In this review, we describe a 44 years old man with AIDS and cutaneous KS who presented for evaluation of postprandial abdominal pain, vomiting, and weight loss. On upper endoscopy, an extensive, infiltrative, circumferential, reddish mass involving the entire body and antrum of the stomach was seen. Histologic examination later revealed spindle cell proliferation, and confirmatory immunohistochemical testing revealed human herpes virus 8 latent nuclear antigen expression consistent with a diagnosis of gastric KS. Following this, we present a comprehensive review of literature on KS with emphasis on gastrointestinal tract involvement and management.

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Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi's sarcoma.

B Espina, M Ilaw, Andrew M Brown … (1999)

Liposomal anthracyclines are the present standard treatment for advanced AIDS-related Kaposi's sarcoma (KS). No effective therapies have been defined for use after treatment failure of these agents. A phase II trial was thus conducted with paclitaxel in patients with advanced KS to assess safety and antitumor activity. A regimen of paclitaxel at a dose of 100 mg/m(2) was given every 2 weeks to patients with advanced AIDS-related KS. Patients were treated until complete remission, disease progression, or unacceptable toxicity occurred. Fifty-six patients with advanced AIDS-related KS were accrued. Tumor-associated edema was present in 70% of patients and visceral involvement in 45%. Forty patients (71%) had received prior systemic therapy; 31 of these were resistant to an anthracycline. The median entry CD4(+) lymphocyte count was 20 cells/mm(3) (range, 0 to 358). A median of 10 cycles (range, 1 to 54+) of paclitaxel was administered. Fifty-nine percent of patients showed complete (n = 1) or partial response (n = 32) to paclitaxel. The median duration of response was 10.4 months (range, 2.8 to 26.7+ months) and the median survival was 15.4 months. The main side effects of therapy were grade 3 or 4 neutropenia in 61% of patients and mild-to-moderate alopecia in 87%. Paclitaxel at 100 mg/m(2) given every 2 weeks is active and well tolerated in the treatment of advanced and previously treated AIDS-related KS. The median duration of response is among the longest observed for any regimen or single agent reported for AIDS-related KS. Paclitaxel at this dosage and schedule is a treatment option for patients with advanced AIDS-related KS, including those who have experienced treatment failure of prior systemic therapy.

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Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi's sarcoma.

Alvin Friedman-Kien, Brian R. Saltzman (1990)

Kaposi's sarcoma, first described in 1972, is a rare, chronic neoplasm that occurs most often in elderly men of Eastern European origin. In the mid-twentieth century, more aggressive forms of Kaposi's sarcoma were found to be an endemic disease especially common among young black men in central Africa. Kaposi's sarcoma also occurs in iatrogenically immunosuppressed patients, such as kidney transplant recipients. In 1981, the sudden occurrence of an unusual, disseminated form of Kaposi's sarcoma in homosexual men in New York and California heralded the epidemic now known as the acquired immunodeficiency syndrome (AIDS). Ninety-five percent of all AIDS-associated Kaposi's sarcoma (AIDS-KS) has been in homosexual men; however, the incidence of AIDS-KS has diminished from greater than 40% of men with AIDS since 1981 to less than 20% in 1989. The remaining 5% of AIDS-KS has been seen in all other populations at risk for AIDS. The reasons for the remarkable persistent increased prevalence of AIDS-KS among homosexual men remains obscure. Clinically, AIDS-KS is a highly varied neoplastic disease characterized by multifocal mucocutaneous lesions often with lymphatic and visceral involvement. The etiology of Kaposi's sarcoma remains unknown although various hypotheses have been suggested, including endothelial-tumor growth factors, oncogenic expression, genetic predisposition, and environmental cofactors. An as-yet unidentified viruslike agent has been proposed as a possible direct cause of this neoplasm. Different treatment modalities for Kaposi's sarcoma have been employed with varying success, these include localized radiation therapy, cryotherapy, electrocauterization, surgical excision, and a variety of systemic chemotherapeutic regimens, as well as alpha-interferon. Although all available treatments help control the lesions, none lengthens survival.

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Journal

Journal ID (publisher-id): CRO

Journal ID (pmc): CRO

Journal ID (doi): 10.1159/issn.1662-6575

Title: Case Reports in Oncology

Publisher: S. Karger AG

ISSN (Electronic): 1662-6575

Publication date Subscription-year: 2018

Publication date Collection: September – December 2018

Publication date (Electronic): 22 October 2018

Volume: 11

Issue: 3

Pages: 638-647

Affiliations

[_a] _aInternal Medicine, Universidad El Bosque, Bogotá, Colombia

[_b] _bInternal Medicine, Universidad de La Sabana, Bogotá, Colombia

[_c] _cGastroenterology, Fundación Universitaria Sanitas, Bogotá, Colombia

[_d] _dPathology, Fundación Universitaria Sanitas, Bogotá, Colombia

[_e] _eInternship in Medicine, Fundacion Universitaria Sanitas, Bogotá, Colombia

Author notes

*Martin Ignacio Zapata Laguado, Department of Internal Medicine, Universidad El Bosque, Calle 8a 78-09, 110821 Bogotá (Colombia), E-Mail martinzapatalaguado@hotmail.com

Article

Publisher ID: 492715 Pmcid ID: PMC6244015 Other ID: Case Rep Oncol 2018;11:638–647

DOI: 10.1159/000492715

PMC ID: PMC6244015

PubMed ID: 30483091

SO-VID: df0dd0eb-3109-4d26-a95e-12c40b0a324f

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This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 26 July 2018

Date accepted : 06 August 2018

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Figures: 11, Pages: 10

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Primary Gastrointestinal Kaposi’s Sarcoma in a Patient with Human Immunodeficiency Virus

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Abstract

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Karger: Oncology

Most cited references 19

Gastrointestinal Kaposi's sarcoma: Case report and review of the literature.

Paclitaxel is safe and effective in the treatment of advanced AIDS-related Kaposi's sarcoma.

Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi's sarcoma.

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