A retrospective review of patients with Kaposi's sarcoma in Botswana.

BACKGROUND: Despite widespread antiretroviral coverage in Botswana, Kaposi's sarcoma (KS) remains among the most common malignancies. To date, adult KS in Botswana is not well characterized. The diagnosis relies on clinical suspicion that is often confirmed by histopathology given the implications of treatment; however, this poses a significant resource burden. METHODS: We conducted a retrospective review of the cohort of patients biopsied for possible KS at Princess Marina Hospital, the main dermatology referral site in Botswana, from September 2008 through June 2015 to describe the demographics, human immunodeficiency virus (HIV) characteristics, and clinical presentations of these patients. Histopathologic diagnoses were reviewed, and positive predictive value (PPV) was used to characterize the accuracy of clinical suspicion of KS. RESULTS: A total of 441 patients received 450 biopsies where KS was on the differential diagnosis, and 239 patients (54%) were ultimately diagnosed with KS. The KS cohort was more likely to be male (58% vs. 37%, P < 0.001), HIV positive (94% vs. 85%, P < 0.05), and have lower CD4 counts at the time of biopsy (274 cells/µl vs. 362 cells/µl, P < 0.05). The PPV of clinical suspicion of KS was 58%. When KS was not histopathologically diagnosed, clinically benign diseases were found in 17%, medically significant conditions requiring alternative therapies in 78%, and life-threatening diseases in 5%. DISCUSSION: Our study reinforces the risk factors in development of KS. The poor PPV supports the important role of histology in KS diagnosis to both ensure appropriate treatment and prevent overtreatment. Improved accessibility to biopsy and augmentation of local dermatopathologic services would likely improve diagnostic accuracy and treatment.

Ecografía cutánea en el sarcoma de Kaposi / Skin Ultrasound in Kaposi Sarcoma

Recientemente ha aumentado el uso de la ecografía cutánea en múltiples enfermedades dermatológicas. Se trata de una técnica no invasiva, que nos proporciona más detalles acerca de la estructura y vascularización de las lesiones cutáneas. El sarcoma de Kaposi es un tumor vascular, que se localiza principalmente en la piel y las mucosas, pudiendo afectar los ganglios linfáticos y los órganos internos. Presentamos 3 pacientes con diagnóstico de sarcoma de Kaposi, sospechado clínicamente, y confirmado histológicamente, a los cuales realizamos exploración ecográfica en modo B y modo Doppler color. Encontramos diferencias en el patrón ecográfico, tanto en modo B como en modo Doppler color, entre las lesiones que clínicamente correspondían a nódulos frente a las que eran placas. Consideramos que la ecografía cutánea podría ser útil como prueba complementaria, en el estudio de las lesiones cutáneas del sarcoma de Kaposi, proporcionándonos más información acerca de sus características estructurales y vasculares

The use of ultrasound imaging has recently been increasing in numerous dermatologic diseases. This noninvasive technique provides additional details on the structure and vascularization of skin lesions. Kaposi sarcoma is a vascular tumor that typically arises in the skin and mucosas. It can spread to lymph nodes and internal organs. We performed B-mode and color Doppler ultrasound studies in 3 patients with a clinical diagnosis of Kaposi sarcoma confirmed by histological examination. We found differences in the ultrasound pattern between nodular and plaque lesions, in both B-mode and color Doppler. We believe that skin ultrasound imaging could be a useful technique for studying cutaneous Kaposi sarcoma, providing additional information on the structural and vascular characteristics of the lesion

Unilateral presentation of pseudo-Kaposi's acroangiodermatitis--a diagnostic and therapeutic challenge.

INTRODUCTION: Acroangiodermatitis is a rare skin disease characterised by hyperplasia of pre-existing vasculature due to venous hypertension from severe chronic venous stasis. Clinical appearance of this condition is often similar to Kaposi sarcoma and is creating serious differential diagnostic difficulties. CASE REPORT: A patient with acroangiodermatitis was presented and the differential diagnosis discussed. Examination of the patella of the affected area showed grayish-blue to brown infiltrates and reduced elasticity, located in the supra- and infrapatellar regions. Clinically, Kaposi's sarcoma was suspected. Histopathologically there were acanthosis and compact hyperkeratosis. The underlying papillary dermis showed fibrosis and edema. A subepidermal lobular vascular proliferation with hemosiderin deposition was also noted. This consisted of multiple newly formed capillaries, featuring small blood vessels with dilated, rounded lumina. Serologies for HIV and Borrelia burgdorferi were negative, as was a HHV-8 PCR in lesional tissue. Doppler analysis of the vessels of the extremities showed chronic venous insufficiency, insufficiency of v. perforantes, insufficiency of the Cockett II-III. No deep thromboses in the area of the shank and thigh were found. Initially, treatment consisted of clindamycin 600 mg 3 times per day, intravenously, during a 2-week period. After that the treatment was continued with prednisolone, 30 mg daily in combination with furosemide 40 mg/day, as well as lymph drainage and adequate compression therapy. The consequent clinical improvement allowed the patient to be discharged from the clinic. CONCLUSION: The most important differential diagnostic marker in distinguishing between acroangiodermatitis and Kaposi sarcoma seems to be the confirmation of the presence of genetic material of HHV-8 in the affected skin areas in patients with Kaposi sarcoma.

Human herpes virus-8 serology and DNA analysis in recipients of renal allografts showing Kaposi's sarcoma and their respective donors.

Kaposi's sarcoma (KS) developed among 11 of 416 renal allograft recipients transplanted between 1985 and 2000. Only 3 among 364 Caucasian recipients developed KS, while it affected 8 of 52 Black patients, all of whom had been born in African countries (P <.001). All patients had their immunosuppression reduced; two also received daunorubicin and one received electrotherapy. Three patients developed accelerated renal allograft dysfunction, probably due to the reduced immunosuppression. Remission of KS was observed in seven patients, while lesions stabilized or improved partially in the other four. After resuming dialysis 2 of 11 patients died; both were in KS remission. Human herpes virus-8 (HHV-8) serology and DNA analysis was evaluated in sera obtained from seven donors: all were negative. Conversely, among eight sera collected pretransplant from the nine living recipients, HHV-8 IgG was detected in six and DNA was present in one. HHV-8 IgG was expressed in all patients (9/9) at some point posttransplant; DNA was detected in three patients. Therefore, the robust ethnic predisposition to KS was associated with a high pretransplant prevalence of HHV-8 among African recipients. Although some seroconversions were detected posttransplant, there was no evidence for donor-to-recipient transmission.

Sarcoma de kaposi del tracto gastrointestinal como primera manifestación de SIDA

Ilustramos el caso de un paciente de 40 años de edad, sexo masculino, homosexual, con sarcoma de kaposi gastrointestinal sin lesiones cutáneas como primera manifestación de SIDA, quien presentaba lesión en el dorso de la lengua de aspecto polipoide y violácea asociada a pólipos rectales. Se realizaron estudios de vías digestivas altas y colon enema de doble contraste los cuales evidenciaron lesiones nodulares son umbilicación central y compresiones extrínsecas en la mayor parte del tracto gastrointestinal. Se confirmó diagnostico de sarcoma de kaposi mediante biopsia de las lesiones.El reporte de este caso único quiere ilustrar la presentación radiológica del sarcoma de Kaposi en el tracto gastrointestinal sin compromiso cutáneo y como primera manifestación de SIDA.

Total body hyperthermia in the treatment of Kaposi's sarcoma in an HIV positive patient.

The effect of prolonged exposure to heat on the HIV has had limited exploration. This is the report of a 33-year-old white man with positive tests for HIV and multiple lesions of Kaposi's Sarcoma. The patient was exposed to total body hyperthermia of 42 degrees C for two hours. Three months following hyperthermia the patient feels improved. The lesions of Kaposi's Sarcoma have markedly regressed, and the T4 lymphocyte count has risen from 5 per cc to 330 per cc. HIV cultures (blood) remain negative. These data would indicate this modality of therapy has altered the progression of disease in this patient.

The value of barium enema and colonoscopy in patients infected with HIV.

Double contrast barium enema (DCBE) and colonoscopy were prospectively compared with rigid sigmoidoscopy, rectal biopsy and microbiological examination in the analysis of stool specimens in 58 HIV-1-infected patients with diarrhoea (more than three liquid motions/day for greater than 1 month). In 26 patients no cause for the diarrhoea was found. In 17 patients the cause of diarrhoea was microbiological, and in 19 rectal histology provided a specific diagnosis. In all these patients sigmoidoscopic appearances were abnormal except in those with Cryptosporidium alone. Colonoscopy provided additional information in only one individual, with cytomegalovirus ulcers of the transverse colon. DCBE was abnormal in only seven cases (cytomegalovirus in three, Kaposi's sarcoma in two, Giardia lamblia in two) and in no case provided additional information. A combination of stool microbiology and rectal histology gave a sensitivity of 97% with a positive predictive value of 100%. The sensitivities of DCBE and colonoscopy with histology were low (16 and 62%, respectively) although the specificity for each test was high, with high positive predictive values. We conclude that neither barium enema nor colonoscopy add usefully to rigid sigmoidoscopic biopsy and stool microscopy in HIV-positive patients with diarrhoea.

Kaposi's sarcoma of the bowel--presenting as apparent ulcerative colitis.

Persistent diarrhoea with mucus-production developed in a 37 year homosexual man, and an initial diagnosis of ulcerative colitis was made after barium enema examination and rectal biopsy. The patient later developed cutaneous lesions which proved to be Kaposi's sarcoma, and the bowel lesion was also subsequently shown to be Kaposi's sarcoma. This tumour occurred as a manifestation of the acquired immune deficiency syndrome (AIDS). The patient was treated with alpha interferon, with partial regression of the skin lesions, but progression of the bowel tumour. Because of severe bowel symptoms, including episodes of subacute intestinal obstruction, the localised bowel disease was treated with radiotherapy. In view of the increasing incidence of AIDS, a diagnosis of Kaposi's sarcoma must be considered in homosexual men presenting with persistent diarrhoea, for which no infectious cause can be demonstrated.

Alimentary tract involvement in Kaposi sarcoma: radiographic and endoscopic findings in 25 homosexual men.

An outbreak of Kaposi sarcoma has recently occurred among young homosexual men. It differs from the classic form in its virulence and preponderance of systemic manifestations. Twenty-five homosexual men with a mean age of 37 and biopsy-proven Kaposi sarcoma received extensive gastrointestinal evaluations. Twelve patients (48%) had evidence of gastrointestinal involvement by radiography and/or endoscopy. Lesions were found in the larynx, oropharynx, esophagus, stomach, duodenum, and colon. Radiographically they ranged from minimally elevated submucosal lesions, some with central ulceration, to polypoid defects. Abdominal CT was obtained in 18 patients, 11 of whom showed abnormalities. Of those with abnormal CT, 50% had retroperitoneal adenopathy. The gastrointestinal radiographic findings with endoscopic correlation in this unusual group of patients is discussed.