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1.
Rev. ADM ; 77(2): 100-107, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1102211

RESUMO

El sarcoma de Kaposi (SK) es una neoplasia vascular maligna poco frecuente, asociada al virus herpes humano tipo 8. Existen cuatro formas clínicas: clásico, endémico, asociado con inmunosupresión iatrogénica y asociado al VIH/SIDA. Este artículo presenta una revisión de la literatura sobre la epidemiología, la patogénesis, las manifestaciones clínicas y el tratamiento del sarcoma de Kaposi asociado al VIH/ SIDA (SK-VIH/SIDA) a propósito de un caso clínico manejado en la Clínica Académica de Atención Dental. La baja en la incidencia de esta neoplasia da lugar al desconocimiento de sus manifestaciones clínicas. En adición, los pacientes seropositivos suelen no mencionar su padecimiento en la anamnesis, lo cual representa un riesgo tanto para el paciente en su diagnóstico y manejo odontológico como para el odontólogo y el personal clínico con riesgo de contagio (AU)


Kaposi sarcoma (KS) is an uncommon malignant vascular neoplasm, associated with human herpes virus type 8. There are four clinical presentations: classic, endemic, associated with iatrogenic immunosuppression and associated with AIDS. This article presents a review of the literature on epidemiology, pathogenesis, clinical manifestations, treatment and HIV/AIDS-associated Kaposi sarcoma (SK-HIV/AIDS) regarding a clinical case managed at the Academic Center of Dental Care. The decrease in the incidence of this neoplasm, leads to ignorance of its clinical manifestations. In addition, seropositive patients usually don't mention their condition in the anamnesis, which represents a risk for the patients on their diagnosis and the case management as well as for the dentist and the clinical personnel from risk of infection (AU)


Assuntos
Humanos , Masculino , Adulto , Manifestações Bucais , Sarcoma de Kaposi , Infecções por HIV/complicações , Assistência Odontológica para Doentes Crônicos , Sarcoma de Kaposi/diagnóstico por imagem , Controle de Doenças Transmissíveis , Controle de Infecções Dentárias , Terapia Antirretroviral de Alta Atividade , México
2.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(2): 373-377, 2020 Apr 18.
Artigo em Chinês | MEDLINE | ID: mdl-32306025

RESUMO

Kaposi's sarcoma (KS) is an unusual vascular tumor associated with human herpesvirus-8 (HHV-8) infection, which is common in immunosuppressors. Although extremely rare, iatrogenic (drug-related) KS can occur in human immunodeficiency virus (HIV)-negative patients under immunosuppressive therapy. We report a 64-year-old male diagnosed with ulcerative colitis for 1 year. He was treated with methylprednisolone because of an acute severe disease flare. He presented with several popular violet lesions on the body 4 months after steroid therapy. Histological examination of skin biopsies showed Kaposi's sarcoma associated with HHV-8. The skin lesions regressed after steroid withdrawal and chemotherapy. Two key words "Kaposi's sarcoma" and "inflammatory bowel disease" were searched in Wanfang data and CNKI, but no relevant articles were found. Thirty-eight articles in English were retrieved on PubMed with the key words of ("ulcerative colitis" OR "Crohn's disease" OR "inflammatory bowel disease") AND (Kaposi sarcoma). Twenty-five cases of Kaposi's sarcoma related to inflammatory bowel disease (IBD) were reported. Including this case, the majority of 26 Kaposi's sarcoma related IBD patients were male (80.8%, 21/26). The average age was (51.1 ± 16.4) years. Twenty cases were ulcerative colitis and 6 were Crohn's disease. All the patients received immunomodulatory therapy, including glucocorticoid, azathioprine/mercaptopurine, methotrexate, cyclosporin and anti tumor necrosis factor α antibody. Thirteen cases were positive for HHV-8. There were 18 cases involving the distal ileum and colorectum only, 3 cases involving skin only, and 5 cases involving both skin and colorectum at the same time. Overall, the prognosis was good. Three patients only stopped immunosuppressive therapy, 1 received radiotherapy, 1 received chemotherapy, and 20 received surgery. Kaposi's sarcoma could be seen in IBD patients with immunomodulatory therapy. It is very important to distinguish from the skin lesions related to IBD or drug treatment. The adverse reactions of immunomodulatory therapy should not be ignored. In addition, attention should be paid to the cooperation of multi-disciplinary team, which can diagnose and treat rare cases earlier and more accurately.


Assuntos
Colite Ulcerativa , Herpesvirus Humano 8 , Sarcoma de Kaposi , Adulto , Idoso , Doença de Crohn , Humanos , Imunossupressão , Masculino , Pessoa de Meia-Idade
3.
Med Sci Monit ; 26: e920711, 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32148334

RESUMO

BACKGROUND The suicide risk of patients with cancer is higher than the general population. Our research aimed to explore the Surveillance, Epidemiology, and End Results (SEER) database to define incidence and quest risk factors for death of suicide in patients with Kaposi's sarcoma (KS) in the United States (US). MATERIAL AND METHODS We screened KS patients without human immunodeficiency virus status in the SEER database from 1980 to 2016, calculated the standardized mortality ratios of them by comparing the rates with those of the US general population from 1980 to 2016, and identified relevant suicide risk factors by univariable and multivariable logistic regression analyses. RESULTS The suicide rates of KS patients and US general population were 115.31 (110 suicides among 21 405 patients) and 15.1 per 100 000 person-years, respectively, thus the standardized mortality ratio was 7.64 (95% confidence interval [CI], 6.28-9.21). The multivariate analysis showed that black race (versus white race, hazard ratio [HR]: 0.43, 95% CI: 0.21-0.89, P=0.022), advanced age at diagnosis (≥55 years versus 18-44 years, HR: 0.31, 95% CI: 0.14-0.66, P=0.002), and chemotherapy (versus no chemotherapy, HR: 0.60, 95% CI: 0.37-0.96, P=0.032) were protective factors for suicide among KS patients. CONCLUSIONS Clinicians and caregivers can apply our findings to identify KS patients with high suicide risk characteristics (white race, age of 18-44 years, non-chemotherapy) and exert timely interventions during patient diagnosis, treatment, and follow-up to reduce the suicide rate in this population.


Assuntos
Sarcoma de Kaposi/psicologia , Suicídio , Adolescente , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Programa de SEER , Sarcoma de Kaposi/tratamento farmacológico , Estados Unidos , Adulto Jovem
6.
Lancet ; 395(10231): 1195-1207, 2020 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-32145827

RESUMO

BACKGROUND: Optimal treatment regimens for AIDS-associated Kaposi sarcoma, a frequent contributor to morbidity and mortality among people with HIV, have not been systematically evaluated in low-income and middle-income countries, where the disease is most common. In this study, we aimed to investigate optimal treatment strategies for advanced stage disease in areas of high prevalence and limited resources. METHODS: In this open-label, non-inferiority trial, we enrolled people with HIV and advanced stage AIDS-associated Kaposi sarcoma attending 11 AIDS Clinical Trials Group sites in Brazil, Kenya, Malawi, South Africa, Uganda, and Zimbabwe. Eligible participants were randomly assigned (1:1:1) with a centralised computer system to receive either intravenous bleomycin and vincristine or oral etoposide (the investigational arms), or intravenous paclitaxel (the control arm), together with antiretroviral therapy (ART; combined efavirenz, tenofovir disoproxil fumarate, and emtricitabine). The primary outcome was progression-free survival (PFS) at week 48, using a 15% non-inferiority margin to compare the investigational groups against the active control group. Safety was assessed in all eligible treated study participants. The study was registered with ClinicalTrials.gov, NCT01435018. FINDINGS: 334 participants were enrolled between Oct 1, 2013, and March 8, 2018, when the study was closed early due to inferiority of the bleomycin and vincristine plus ART arm, as per the recommendations of the Data and Safety Monitoring Board (DSMB). The etoposide plus ART arm also closed due to inferiority in March, 2016, following a DSMB recommendation. Week-48 PFS rates were higher in the paclitaxel plus ART arm than in both investigational arms. The absolute differences in PFS were -30% (95% CI -52 to -8) for the comparison of paclitaxel plus ART (week 48 PFS 50%, 32 to 67; n=59) and etoposide plus ART (20%, 6 to 33; n=59), and -20% (-33% to -7%) for the comparison of paclitaxel plus ART (64%, 55 to 73; n=138) and bleomycin and vincristine plus ART (44%, 35 to 53; n=132). Both CIs overlapped the non-inferiority margin. The most common adverse events, in 329 eligible participants who began treatment, were neutropenia (48 [15%]), low serum albumin (33 [10%]), weight loss (29 [9%]), and anaemia (28 [9%]), occurring at similar frequency across treatment arms. INTERPRETATION: Non-inferiority of either investigational intervention was not shown, with paclitaxel plus ART showing superiority to both oral etoposide plus ART and bleomycin and vincristine plus ART, supporting its use in treating advanced AIDS-associated Kaposi sarcoma in resource-limited settings. FUNDING: US National Institute of Allergy and Infectious Diseases and National Cancer Institute, National Institutes of Health.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibióticos Antineoplásicos/efeitos adversos , Antineoplásicos Fitogênicos/efeitos adversos , Bleomicina/efeitos adversos , Sarcoma de Kaposi/tratamento farmacológico , Vincristina/efeitos adversos , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , África , Fármacos Anti-HIV/administração & dosagem , Antibióticos Antineoplásicos/administração & dosagem , Antineoplásicos Fitogênicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Antirretroviral de Alta Atividade/métodos , Bleomicina/administração & dosagem , Países em Desenvolvimento , Quimioterapia Combinada , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Feminino , Humanos , Masculino , Paclitaxel/administração & dosagem , Paclitaxel/efeitos adversos , Intervalo Livre de Progressão , Sarcoma de Kaposi/mortalidade , Vincristina/administração & dosagem
7.
Niger Postgrad Med J ; 27(1): 63-66, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32003365

RESUMO

A 35-year-old highly active antiretroviral therapy (HAART)-naïve woman diagnosed 2 years earlier presented with complaints of cough, fever and progressive weight loss of 5 months and skin rashes of 2 months. Clinical examination revealed a chronically ill-looking young woman who was wasted and pale, with purplish flat-topped papules and nodules on the skin of her neck, trunk, forearms and thighs. She also had a single lesion on the hard palate. Chest examination shows reduced breath sounds with crepitations. Sputum acid-fast bacilli were positive, and skin biopsy taken for histology confirmed Kaposi's sarcoma (KS). The patient recovered fully on antiretroviral and antituberculosis therapy without the need for any specific chemotherapy for KS. We report this case to elucidate the role of immune reconstitution as a treatment modality for AIDS-related KS, as well as to point out the possibility of multiple opportunistic conditions coexisting amongst patients with advanced HIV disease.


Assuntos
Síndrome de Imunodeficiência Adquirida , Terapia Antirretroviral de Alta Atividade , Reconstituição Imune , Sarcoma de Kaposi , Tuberculose Pulmonar , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Feminino , Humanos , Nigéria , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/etiologia , Tuberculose Pulmonar/complicações
8.
BMC Infect Dis ; 20(1): 50, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948393

RESUMO

BACKGROUND: Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. METHODS: A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. RESULTS: This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having "fair" or "poor" ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. CONCLUSIONS: In this study, the incidence rate of opportunistic infections among HIV-infected children remained high. Concerning predictors, such as advanced disease stage (III and IV), CD4 count or % below the threshold, "fair" or "poor" ART adherence, and not taking past OI prophylaxis were found to be significantly associated with OIs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções por HIV/complicações , Adolescente , Contagem de Linfócito CD4 , Criança , Pré-Escolar , Estudos de Coortes , Etiópia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia , Fatores Socioeconômicos , Taxa de Sobrevida , Tuberculose/epidemiologia
9.
Artigo em Inglês | MEDLINE | ID: mdl-31967210

RESUMO

A 37-year-old male patient, Fitzpatrick skin phototype IV, a student living in Belem, Amazon region, in 2015 had a confirmed diagnosis of acquired immunodeficiency virus (HIV) infection, but did not initiate antiretroviral treatment at his own option. Three years after the diagnosis, erythematous maculae appeared on the dorsum of the nose with rapid progression to the entire face, with posterior diffuse infiltration and appearance of nodules on the chin and shoulder. In December 2018, the patient presented with exacerbation of the condition with an increase in infiltrated violaceous plaques and disseminated violaceous nodules. A histopathological biopsy of the skin was performed, confirming the diagnosis of angiomatoid proliferation suggestive of Kaposi's sarcoma (KS), with an important dissemination of this disease to the noble organs. In addition, it is important to note that he only started antiretroviral therapy (ART) after the exacerbation of Kaposi (December 2018). In such cases, chemotherapy associated with ART is crucial for the treatment and follow-up of the patient, since Kaposi's sarcoma develops relatively low in patients who do not have immunodeficiency.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/complicações , Sarcoma de Kaposi/etiologia , Neoplasias Cutâneas/etiologia , Adulto , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Humanos , Lamivudina/administração & dosagem , Masculino , Sarcoma de Kaposi/diagnóstico , Tenofovir/administração & dosagem
10.
PLoS Pathog ; 16(1): e1008114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31951641

RESUMO

Infection by Kaposi's sarcoma-associated herpesvirus (KSHV) is necessary for the development of Kaposi's sarcoma (KS), which most often develops in HIV-infected individuals. KS frequently has oral manifestations and KSHV DNA can be detected in oral cells. Numerous types of cancer are associated with the alteration of microbiome including bacteria and virus. We hypothesize that oral bacterial microbiota affects or is affected by oral KS and the presence of oral cell-associated KSHV DNA. In this study, oral and blood specimens were collected from a cohort of HIV/KSHV-coinfected individuals all previously diagnosed with KS, and were classified as having oral KS with any oral cell-associated KSHV DNA status (O-KS, n = 9), no oral KS but with oral cell-associated KSHV DNA (O-KSHV, n = 10), or with neither oral KS nor oral cell-associated KSHV DNA (No KSHV, n = 10). We sequenced the hypervariable V1-V2 region of the 16S rRNA gene present in oral cell-associated DNA by next generation sequencing. The diversity, richness, relative abundance of operational taxonomic units (OTUs) and taxonomic composition of oral microbiota were analyzed and compared across the 3 studied groups. We found impoverishment of oral microbial diversity and enrichment of specific microbiota in O-KS individuals compared to O-KSHV or No KSHV individuals. These results suggest that HIV/KSHV coinfection and oral microbiota might impact one another and influence the development of oral KS.


Assuntos
Bactérias/isolamento & purificação , DNA Viral/genética , Infecções por HIV/microbiologia , Herpesvirus Humano 8/genética , Microbiota , Boca/microbiologia , Sarcoma de Kaposi/virologia , Bactérias/classificação , Bactérias/genética , Estudos de Coortes , Coinfecção/imunologia , Coinfecção/microbiologia , Coinfecção/virologia , Estudos Transversais , DNA Viral/metabolismo , Infecções por HIV/complicações , Infecções por HIV/imunologia , Infecções por HIV/virologia , Herpesvirus Humano 8/isolamento & purificação , Herpesvirus Humano 8/fisiologia , Humanos , Boca/virologia , Filogenia , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/imunologia , Sarcoma de Kaposi/microbiologia
11.
Hum. immunol ; 81(1): 26-31, Jan. 2020. tab, ilus
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1049267

RESUMO

Human gammaherpesvirus 8 (HHV-8) is the etiologic agent of Kaposi's sarcoma (KS), one of the most common cancers in people living with HIV/AIDS. It is believe that the course of both HIV and HHV-8 infection is associated with the imbalance of anti- and/or pro-inflammatory cytokines. Here, we evaluated the IL-6, TNF-α, IL-10, CCL2 and CXCL10 serum concentrations in HIV- and HIV/HHV-8 (without KS) individuals, and in patients with cutaneous or visceral AIDS-KS. Serum concentrations of IL-6, IL-10 and CXCL10 were significantly higher in the AIDS-KS group compared to HIV and HIV/HHV-8 individuals. Similarly, the concentrations of theses cytokines were higher in patients with visceral than in those with cutaneous AIDS-KS. The TNF-α concentration was significantly higher in the HIV group compared to HIV/HHV-8 (with and without KS) individuals, and CCL2 levels did not present significant difference among the groups. The HIV viral load was undetectable in all patients from the HIV and HIV/HHV-8 groups. On the other hand, in the AIDS-KS group, most patients had detectable HIV viral load. In this context, we believe that the cytokine levels in AIDS-KS may be result of a complex interaction between HIV, HHV-8 and immunity


Assuntos
Humanos , Sarcoma de Kaposi , Infecções por HIV , Síndrome de Imunodeficiência Adquirida
12.
J Dermatolog Treat ; 31(2): 183-185, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30897011

RESUMO

Background: Paclitaxel has recently been approved for AIDS-related Kaposi's sarcoma (KS) and there is much interest also in HIV-negative KS.Objective: To assess the safety and effectiveness of intravenous paclitaxel in the treatment of non-HIV-associated KS.Method: A retrospective database analysis of our departmental database in histologically proven, HIV-negative KS.Results: Fifty-eight patients treated with intravenous paclitaxel 100 mg weekly were identified. Among these patients, 11 patients underwent paclitaxel as first-line treatment, whereas 47 received paclitaxel after other types of systemic chemotherapy. Fifty-three (94.6%) patients achieved a partial or a complete remission after a mean of 13.5 infusions. Disease progression was observed in two patients and one patient had a stable disease. Thirty-one (58.5%) of 53 responding patients are still stable after a mean of 19.1 months of follow-up, while 22 (41.5%) patients relapsed after a mean of 14 months. Paclitaxel was repeated in relapsed patients obtaining PR/CR in all cases. Tolerance was good except for one patient who discontinued the treatment because of a severe allergic reaction.Conclusion: Paclitaxel is effective for the treatment of non-HIV-related KS, both as first- and as second-line treatment. It is well tolerated and can be repeated without loss of efficacy.


Assuntos
Antineoplásicos Fitogênicos/uso terapêutico , Paclitaxel/uso terapêutico , Sarcoma de Kaposi/tratamento farmacológico , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma de Kaposi/patologia , Resultado do Tratamento
13.
AJR Am J Roentgenol ; 214(1): W1-W10, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31593515

RESUMO

OBJECTIVE. Imaging plays an important role in the diagnosis and staging of malignancies. Many common lymphoproliferative and other solid tumor malignancies can be viral-related. CONCLUSION. This review discusses the imaging findings that can be associated with common viral-induced malignancies. Knowledge of these imaging presentations can help narrow the differential diagnosis to reach a specific diagnosis through a precise workup and proper management.


Assuntos
Neoplasias/diagnóstico por imagem , Neoplasias/virologia , Viroses/complicações , Neoplasias do Ânus/diagnóstico por imagem , Neoplasias do Ânus/virologia , Linfoma de Burkitt/diagnóstico por imagem , Linfoma de Burkitt/virologia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/virologia , Feminino , Doença de Hodgkin/diagnóstico por imagem , Doença de Hodgkin/virologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/virologia , Masculino , Neoplasias Orofaríngeas/diagnóstico por imagem , Neoplasias Orofaríngeas/virologia , Neoplasias Penianas/diagnóstico por imagem , Neoplasias Penianas/virologia , Sarcoma de Kaposi/diagnóstico por imagem , Sarcoma de Kaposi/virologia , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/virologia
14.
Pediatr Blood Cancer ; 67(3): e28095, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31814291

RESUMO

BACKGROUND: Endothelial cell malignancies are extremely rare in childhood. New identification of genetic abnormalities (WWTR1:CAMTA1 translocation) helps to recognize potential therapeutic targets. Little is known about treatment and outcome of these patients. METHODS: Clinical course, treatment, and outcome in patients with endothelial cell malignancies treated within the Cooperative Weichteilsarkom Studiengruppe (CWS) trials CWS-91, -96, -2002P, and the Soft-Tissue Sarcoma Registry (SoTiSaR) were analyzed (1991-2019). RESULTS: Patients had angiosarcoma (AS) (n = 12), malignant epithelioid hemangioendothelioma (EHE) (n = 16), and kaposiform hemangioendothelioma (KHE) (n = 13). The median age was 5.39 years (range, 0.8-17.34); 33 patients had localized disease (LD), and 8 patients had metastatic disease. Therapy consisted of chemotherapy (CHT) (AS n = 8, EHE n = 9, KHE n = 5), interferon or new agent therapy (EHE n = 5, 2 KHE n = 2), microscopically or macroscopically complete resection (AS n = 3, EHE n = 6, KHE n = 3), and radiotherapy (AS n = 6, EHE n = 2, KHE n = 1). Two patients (KHE) had watch-and-wait strategy resulting in stable disease. Complete remission (CR) was achieved in AS (10/12; 83%), EHE (10/16; 63%), and KHE (5/13; 38%). The five-year EFS and OS for patients with AS was 64% (± 29 CI 95%) and 80% (± 25, CI 95%), with EHE 62% (± 24, CI 95%) and 78% (± 23, CI 95%), with KHE 33% (± 34, CI 95%) and 92% (± 15, CI 95%), respectively. Complete resection was a significant prognostic factor for AS, LD for EHE. CONCLUSIONS: Endothelial cell malignancies in childhood have a fair outcome with multimodal treatment. New treatment options are needed for metastic disease.


Assuntos
Hemangioendotelioma Epitelioide/terapia , Hemangioendotelioma/terapia , Hemangiossarcoma/terapia , Síndrome de Kasabach-Merritt/terapia , Recidiva Local de Neoplasia/terapia , Sistema de Registros/estatística & dados numéricos , Sarcoma de Kaposi/terapia , Sarcoma/terapia , Adolescente , Adulto , Criança , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Hemangioendotelioma/patologia , Hemangioendotelioma Epitelioide/patologia , Hemangiossarcoma/patologia , Humanos , Lactente , Síndrome de Kasabach-Merritt/patologia , Masculino , Recidiva Local de Neoplasia/patologia , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma de Kaposi/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
15.
Oral Dis ; 26(1): 43-52, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31605560

RESUMO

OBJECTIVES: The aim of this study was to investigate the prevalence of oral sarcomas from geographic regions of Brazil. MATERIALS AND METHODS: A cross-sectional study was conducted on biopsies obtained from January 2007 to December 2016 at twelve Brazilian oral and maxillofacial pathology centres. Gender, age, evolution time, clinical aspects, tumour location, tumour size at diagnosis, radiographic aspects and histopathological diagnosis were evaluated. Data were analysed using descriptive statistical methods. RESULTS: From 176,537, a total of 200 (0.11%) oral sarcomas were reported, and the most prevalent were osteosarcomas (74 cases; 37%) and Kaposi's sarcomas (52 cases; 26%). Males were more affected than females at a mean age of 32.2 years old (range of 3-87 years). The most common symptoms were swelling¸ localised pain and bleeding at a mean evolution time of 5.14 months (range <1-156 months). The lesions were mostly observed in the mandible (90 cases; 45%), with a mean tumour size of 3.4 cm (range of 0.3-15 cm). Radiographically, the lesions presented a radiolucent aspect showing cortical bone destruction and ill-defined limits. CONCLUSIONS: Oral sarcomas are rare lesions with more than 50 described subtypes. Osteosarcomas and Kaposi's sarcomas were the main sarcomas of the oral cavity in Brazil.


Assuntos
Neoplasias Bucais/epidemiologia , Sarcoma/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/epidemiologia , Estudos Retrospectivos , Sarcoma de Kaposi/epidemiologia , Adulto Jovem
16.
Virchows Arch ; 476(1): 17-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31463731

RESUMO

The classification of vascular neoplasms continues to evolve as we accumulate more genetic and clinical data, particularly for rare tumor types. Because of tumor rarity, changes to classification schema, overlapping histologic features, and in some cases, lack of morphologic evidence of vasoformation, vascular neoplasms present a diagnostic challenge. Here, we discuss recent developments in our understanding of vascular tumors, with a detailed discussion of epithelioid hemangioma, tufted angioma, kaposiform hemangioendothelioma, composite hemangioendothelioma, pseudomyogenic hemangioendothelioma, epithelioid hemangioendothelioma, and angiosarcoma.


Assuntos
Neoplasias Vasculares/patologia , Proteínas de Ligação ao Cálcio/genética , Hemangioendotelioma/genética , Hemangioendotelioma/patologia , Hemangioendotelioma Epitelioide/genética , Hemangioendotelioma Epitelioide/patologia , Hemangioma/genética , Hemangioma/patologia , Hemangiossarcoma/genética , Hemangiossarcoma/patologia , Humanos , Síndrome de Kasabach-Merritt/genética , Síndrome de Kasabach-Merritt/patologia , Proteínas Proto-Oncogênicas c-myc/análise , Sarcoma de Kaposi/genética , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Transativadores/genética , Neoplasias Vasculares/genética
17.
Int J Infect Dis ; 91: 44-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31740407

RESUMO

OBJECTIVES: We assessed the economic burden of AIDS-defining illnesses (ADIs), which was further stratified by adherence to antiretroviral therapy (ART). METHODS AND MATERIALS: A nationwide longitudinal cohort of 18,234 incident cases with HIV followed for 11years was utilized. Adherence to ART was measured by medication possession ratio (MPR). Generalized estimating equations modeling was used to estimate the cost impact of ADIs. RESULTS: Having opportunistic infections increased the annual cost by 9% (varicella-zoster virus infection) to 98% (cytomegalovirus disease), while the annual costs increased by 26% (Kaposi's sarcoma) to 95% (non-Hodgkin's lymphoma) in the year when AIDS-related cancer occurred. ADIs occurred more frequently in the years with low adherence for ART compared to the high-adherence years (e.g., 0.1≤MPR<0.8 vs. MPR≥0.8, event rate of cytomegalovirus disease 4.03% vs. 0.51%). The annual baseline costs in the years with MPR<0.1, 0.1≤MPR<0.8, and MPR≥0.8 were $250, $4,752, and $8,990 (in 2018 USD), respectively. The economic impact of ADIs in the years with low adherence (MPR<0.1) was larger than that in the high-adherence years (MPR≥0.8) (e.g., MPR<0.1 vs. MPR≥0.8, annual cost increased by 244% vs. 9% when candidiasis occurred). CONCLUSIONS: Adherence to ART may increase the baseline medical costs but mitigate the incidence and economic burden of ADIs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/economia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/economia , Adulto , Fármacos Anti-HIV/uso terapêutico , Candidíase/complicações , Candidíase/economia , Efeitos Psicossociais da Doença , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/economia , Feminino , Humanos , Estudos Longitudinais , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/economia , Masculino , Pessoa de Meia-Idade , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/economia , Infecção pelo Vírus da Varicela-Zoster/complicações , Infecção pelo Vírus da Varicela-Zoster/economia
18.
J Oncol Pharm Pract ; 26(1): 220-223, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30854926

RESUMO

Kaposi sarcoma (KS) is a low-grade mesenchymal angioproliferative disease, mostly observed in immune compromised patients. KS is mostly encountered in HIV-positive or organ transplant patients. The drugs causing immunosuppression have also been associated with KS. Here, we present a KS experience associated with rituximab-based therapy.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Rituximab/efeitos adversos , Sarcoma de Kaposi/induzido quimicamente , Idoso , Humanos , Masculino
19.
São Paulo; s.n; 2020. 50 p. graf, ilus. (BR).
Tese em Português | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP, SESSP-ESPECIALIZACAOSESPROD, Sec. Est. Saúde SP | ID: biblio-1102500

RESUMO

O progresso na área de transplantes de órgãos sólidos é uma tendência observada nos últimos anos, entretanto, apesar do aperfeiçoamento das técnicas cirúrgicas e terapia imunossupressora, complicações clínicas como infecções e episódios de rejeição do enxerto constituem ainda hoje uma das principais causas de morbidade e mortalidade no período pós transplante. Dentre as infecções, àquelas causadas por vírus são as mais frequentes observadas nos transplantados e os membros da família Herpesviridae constituem a principal causa de infecções virais neste grupo de pacientes. O herpesvírus humano tipo 8 (HHV-8), também conhecido como herpesvírus associado ao Sarcoma de Kaposi, é um membro da família Herpesviridae. Existem várias síndromes relacionadas ao HHV-8 e, dentre essas,o Sarcoma de Kaposi (SK) ganha importância. O SK é definido como uma neoplasia de células endoteliais de capilares de origem multicêntrica e foi descrito pela primeira vez em 1872 por Kaposi, um dermatologista húngaro. Existe uma classificação clínico-epidemiológica em 4 formas de Sarcoma de Kaposi: (1) SK clássico, que afeta homens idosos da Europa Oriental e do Mediterrâneo; (2) SK endêmico ou Africano, ocorre em países da África; (3) SK epidêmico ou associado a AIDS; (4) SK iatrogênico, desenvolve-se em pacientes após transplante de órgãos, ocorrendo em 0,2 a 5% dos transplantados renais. Não há dados no Brasil de SK em pacientes transplantados e se há correlação com os esquemas imunossupressores utilizados no pós transplante. Aqui, relatamos dois casos de SK após transplante renal com desfechos diferentes. No primeiro caso, a paciente apresenta-se com SK 11 meses após o transplante e tem cura da doença após a combinação de quimioterapia (QT) com a suspensão da terapia imunossupressora durante a QT, posteriormente retoma o regime imunossupressor com outra droga. No segundo caso, a paciente desenvolve SK 8 anos após o transplante e evolui para óbito após a segunda sessão da QT. A progressão da infecção por HHV-8 para Sarcoma de Kaposi pós transplante (SKPT) ainda precisa ser estudada. Uma vez que o SKPT se desenvolve, pode ser uma doença fatal em receptores de aloenxerto renal, o que alerta sobre a necessidade de se conhecer as formas de apresentação, diagnóstico e manejo nos pacientes transplantados renais


Assuntos
Humanos , Sarcoma de Kaposi , Transplante de Rim , Herpesvirus Humano 8
20.
PLoS Pathog ; 15(12): e1008156, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31790497

RESUMO

Kaposi's sarcoma-associated herpesvirus (KSHV) causes several human cancers, such as Kaposi's sarcoma (KS) and primary effusion lymphoma (PEL). Current treatment options for KSHV infection and virus associated diseases are sometimes ineffective, therefore, more effectively antiviral agents are urgently needed. As a herpesvirus, lytic replication is critical for KSHV pathogenesis and oncogenesis. In this study, we have established a high-throughput screening assay by using an inducible KSHV+ cell-line, iSLK.219. After screening a compound library that consisted of 1280 Food and Drug Administration (FDA)-approved drugs, 15 hit compounds that effectively inhibited KSHV virion production were identified, most of which have never been reported with anti-KSHV activities. Interestingly, 3 of these drugs target histamine receptors or signaling. Our data further confirmed that antagonists targeting different histamine receptors (HxRs) displayed excellent inhibitory effects on KSHV lytic replication from induced iSLK.219 or BCBL-1 cells. In contrast, histamine and specific agonists of HxRs promoted viral lytic replication from induced iSLK.219 or KSHV-infected primary cells. Mechanistic studies indicated that downstream MAPK and PI3K/Akt signaling pathways were required for histamine/receptors mediated promotion of KSHV lytic replication. Direct knockdown of HxRs in iSLK.219 cells effectively blocked viral lytic gene expression during induction. Using samples from a cohort of HIV+ patients, we found that the KSHV+ group has much higher levels of histamine in their plasma and saliva than the KSHV- group. Taken together, our data have identified new anti-KSHV agents and provided novel insights into the molecular bases of host factors that contribute to lytic replication and reactivation of this oncogenic herpesvirus.


Assuntos
Antivirais/farmacologia , Herpesvirus Humano 8/efeitos dos fármacos , Histamina/metabolismo , Sarcoma de Kaposi/virologia , Ativação Viral/efeitos dos fármacos , Avaliação Pré-Clínica de Medicamentos , Herpesvirus Humano 8/fisiologia , Ensaios de Triagem em Larga Escala , Humanos , Receptores Histamínicos/metabolismo , Transdução de Sinais/fisiologia , Ativação Viral/fisiologia , Latência Viral/efeitos dos fármacos , Latência Viral/fisiologia
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