Case of metastatic kaposi sarcoma successfully treated with anti-PD-1 immunotherapy.

INTRODUCTION: Kaposi sarcoma (KS) is an angioproliferative malignancy associated with HHV-8. It is mostly observed in patients affected by HIV and/or chronic immunosuppression, while classic KS without underlying immunosuppression are relatively rare. Systemic chemotherapy is used for advanced diseases, although there is no consensus in treatment algorithms. With the demonstration of PD-1 expression in KS, immune-checkpoint-inhibitors (ICI) emerged as possible treatment options. Notwithstanding, the data of ICIs is limited to case reports/series. Herein, we present a case of advanced classic KS, which has been treated successfully with nivolumab. CASE REPORT: 82-year-old male patient was investigated for erythematous lesions on thigh. Punch biopsy lead to KS diagnosis. Abdominal CT showed lymphadenopathies in the inguinal region. After radiotherapy follow-up, patient had shown vertebral & gastric metastases. Because of the PSA elevation patient was diagnosed with prostatic adenocarcinoma. Metastases were investigated for origin. The lesions showed no uptake in Ga-68 PET-CT, therefore accepted as KS metastases. Patient rejected chemotherapy options and consented to immunotherapy trial.Management and outcome: Nivolumab was initiated 3 mg/kg bi-weekly with 12-dose protocol. After nivolumab patient wellbeing is improved and control endoscopy shown no metastases. With these findings patient has been assessed as complete response. DISCUSSION: ICI on KS is still a blurred option to be included in standard regimens; but progressive understanding of PD-1 expression and its role in disease progression may be a milestone for further treatment algorithms on KS. Besides good efficacy, tolerability of ICIs could be helpful patients with comorbidities precluding the use of chemotherapy.

Examination versus subjective nasal obstruction in the evaluation of the nasal septal deviation.

BACKGROUND: Nasal septal deviation (NSD) is a frequent complaint among patients in an otolaryngology clinic. The prevalence of NSD varies in different populations and NSD classification schemes are complex. METHODS: We aimed to determine the prevalence of NSD in a population of Turkish young males using a new NSD classification method that we developed. We compared the results with patients' complaints. All patients underwent two nasal examinations, which were performed using a nasal speculum with and without administration of vasoconstrictor agents. Inferior Concha Hypertrophy (ICH) was evaluated in the first examination and NSDs were scored during the second examination. All findings were recorded according to our classification scheme. Severity of nasal obstruction was subjectively evaluated by using a visual analogue scale (VAS). RESULTS: We found a significant association between prevalence of NSD and nasal injuries, but there was no association between the mode of delivery and prevalence of NSD. Surprisingly, about 30 % of the participants with NSD had no complaint of nasal obstruction. Although most of the participants in the study had no severe nasal obstruction complaint, we found an association between NSD presence and patient's VAS. CONCLUSION: NSD is very frequent in the Turkish population and most often related to trauma; however, its effect on patient quality of life varies.