scholarly journals Oral Kaposi’s Sarcoma: A Case Report and Literature Review on Treatment Management

2021 ◽  
Vol 6 ◽  
pp. 247275122110363
Author(s):  
Florian M. Thieringer ◽  
Julia Cede ◽  
Katharina Glatz ◽  
Stefan Roehling ◽  
Marcel Stoeckle ◽  
...  
Keyword(s):  
Kaposi's Sarcoma ◽  
Treatment Options ◽  
Symptom Relief ◽  
Disease Onset ◽  
Kaposi’S Sarcoma ◽  
Clinical Staging ◽  
Poor Prognostic Factor ◽  
Oral Manifestation ◽  
Additional Chemotherapy ◽  
Disseminated Disease

Background: Kaposi’s sarcoma is a common malignancy in HIV patients. Oral manifestation of AIDS-associated Kaposi’s sarcoma occurs in up to 65% of HIV/AIDS patients and is a poor prognostic factor. We report the case of a patient with a progressive bulky manifestation of oral Kaposi’s sarcoma. Case Presentation: A 48-year-old male presented with dysphagia due to progressive indolent swelling of the palate. Intraoral inspection revealed an uneven, partially ulcerated, livid mass, approximately 5 cm in diameter, extending antero-posteriorly from the superior vestibulum to the soft palate and across the hard palate, thereby overgrowing remaining teeth and the alveolar arch. Serological testing revealed an HIV infection, and further tests showed HHV8-positivity. The patient underwent surgical debulking of the oral lesions and, following complete remission, received full mouth reconstruction with an implant-supported prosthesis. Conclusions: Understanding the relation of HIV and HHV8-infection in terms of disease onset and clinical presentation is important to increase awareness of oral Kaposi’s sarcoma and ensure subsequent appropriate management of affected patients. Clinical staging represents the most important factor for choosing the optimal treatment. The introduction of combined antiretroviral therapy has proven to be efficient in curing oral Kaposi’s sarcoma, while several additional locoregional treatment options, including debulking surgery, may be necessary for symptom relief or to improve cosmesis. Radiotherapy should be applied restrictively due to potentially severe toxic mucosal reactions, whereas additional chemotherapy must be considered in severe cases that present with widespread disseminated disease. A multidisciplinary approach to the treatment of functionally and aesthetically impairing oral Kaposi’s sarcoma is highly recommended.

scholarly journals Transplant-associated penile Kaposi sarcoma managed with single agent paclitaxel chemotherapy: a case report

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew A. Anderson ◽  
Tracey Ying ◽  
Kate Wyburn ◽  
Peter M. Ferguson ◽  
Madeleine C. Strach ◽  
...  
Keyword(s):  
Kaposi's Sarcoma ◽  
Single Agent ◽  
Lower Extremities ◽  
Kaposi’S Sarcoma ◽  
The Body ◽  
Cutaneous Lesions ◽  
Rare Presentation ◽  
Post Transplant ◽  
Transplant Patients ◽  
Disseminated Disease

Abstract Background Kaposi’s sarcoma is an uncommon complication in renal transplant patients, and typically presents with cutaneous lesions on the lower extremities. Penile involvement has been reported only rarely. Management of cutaneous-limited disease is primarily reduction of immunosuppression and conversion to an mTOR-inhibitor, whereas the treatment of disseminated disease in transplant patients is more variable. Case presentation A 75-year-old male, originally from Somalia, received a deceased-donor kidney transplant for diabetic and hypertensive nephropathy. Seven months post-transplant he presented with lower limb lesions, oedema and bilateral deep vein thromboses. He then developed a fast-growing painful lesion on his penile shaft. A biopsy of this lesion confirmed KS, and a PET scan demonstrated disseminated disease in the lower extremities, penis and thoracic lymph nodes. His tacrolimus was converted to sirolimus, and his other immunosuppression was reduced. He was treated with single agent paclitaxel chemotherapy in view of his rapidly progressing, widespread disease. The penile lesion completely resolved, and the lower extremity lesions regressed significantly. His kidney allograft function remained stable throughout treatment. Conclusion This case illustrates a rare presentation of an uncommon post-transplant complication and highlights the need for a high index of suspicion of KS in transplant patients presenting with atypical cutaneous lesions. It serves to demonstrate that the use of single agent paclitaxel chemotherapy, switch to an mTORi and reduction in immunosuppression where possible produces excellent short-term outcomes, adding to the body of evidence for this management strategy in disseminated Kaposi’s sarcoma.

AIDS-Related Kaposi’s Sarcoma: Evaluation of Potential New Prognostic Factors and Assessment of the AIDS Clinical Trial Group Staging System in the Haart Era—the Italian Cooperative Group on AIDS and Tumors and the Italian Cohort of Patients Naïve From Antiretrovirals

2003 ◽  
Vol 21 (15) ◽  
pp. 2876-2882 ◽  
Author(s):  
Guglielmo Nasti ◽  
Renato Talamini ◽  
Andrea Antinori ◽  
Ferdinando Martellotta ◽  
Gaia Jacchetti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Survival Rate ◽  
Survival Data ◽  
Highly Active Antiretroviral Therapy ◽  
Kaposi's Sarcoma ◽  
Systemic Disease ◽  
Univariate Analysis ◽  
Kaposi’S Sarcoma ◽  
Staging System ◽  
Clinical Staging

Purpose: To assess potential new prognostic factors and to validate the AIDS Clinical Trials Group (ACTG) for AIDS-related Kaposi’s sarcoma (AIDS-KS) staging system in the highly active antiretroviral therapy (HAART) era. Patients and Methods: We collected epidemiologic, clinical, staging, and survival data from 211 patients with AIDS-KS enrolled in two prospective Italian human immunodeficiency virus (HIV) cohort studies. We included in the analysis all patients with the diagnosis of KS made from January 1996, the time at which HAART became available in Italy. Results: In the univariate analysis, survival was not influenced by sex, age, level of HIV viremia at KS diagnosis, HAART at KS diagnosis (HAART-naïve v HAART-experienced), or type of HAART combination. Regarding ACTG classification, the 3-year survival rate was 85% for T0 patients and 69% for T1 patients (P = .007), 83% for S0 patients and 63% for S1 patients (P = .003), and 83% for I0 patients and 71% for I1 patients (P = .06). In the multivariate analysis, only the combination of poor tumor stage (T1) and poor systemic disease (S1) risk identified patients with unfavorable prognosis. The 3-year survival rate of patients with T1S1 was 53%, which was significantly lower compared with the 3-year survival rates of patients with T0S0, T1S0, and T0S1, which were 88%, 80%, and 81%, respectively (P = .0001). Conclusion: In the era of HAART, a refinement of the original ACTG staging system is needed. CD4 level does not seem to provide prognostic information. Two different risk categories are identified: a good risk (T0S0, T1S0, T0S1) and a poor risk (T1S1).

Overview of the Management of AIDS-Related Kaposi's Sarcoma

1996 ◽  
Vol 30 (10) ◽  
pp. 1150-1163 ◽  
Author(s):  
Ashley K. Morris ◽  
Amy Wells Valley
Keyword(s):  
Prognostic Factors ◽  
Combination Chemotherapy ◽  
Kaposi's Sarcoma ◽  
Single Agent ◽  
Prognostic Significance ◽  
Local Therapy ◽  
Kaposi’S Sarcoma ◽  
Interferon Alfa ◽  
Patient Specific ◽  
Disseminated Disease

OBJECTIVE: To review the epidemiology, pathogenesis, clinical presentation, diagnosis, and staging of Kaposi's sarcoma (KS), as well as the current role of local and systemic therapies in the management of AIDS-related KS (AIDS–KS). DATA SOURCES AND STUDY SELECTION: MEDLINE and CANCERLIT searches of the English-language medical literature were conducted. Emphasis was placed on studies published since the onset of the AIDS epidemic in the early 1980s. A manual review of selected bibliographies was also completed. DATA SYNTHESIS: AIDS–KS is a disease with a heterogeneous presentation that affects approximately 20% of patients with AIDS. Although the proportion of AIDS patients developing this disease during the course of their illness is declining, the actual number of AIDS–KS cases is increasing. The etiology of AIDS–KS is not clear, but a sexually transmitted cofactor has been implicated. Recent reports demonstrate that a herpes-like virus may be responsible for the development of KS in patients with and without AIDS. Furthermore, the cellular origin of KS has not been identified and questions remain about whether KS represents a true malignancy. The system used in staging patients with AIDS–KS has changed dramatically since initial therapeutic trials were conducted; this may account for observed differences in outcome among trials. The immunologic status of patients is now included as part of the staging system, since it has prognostic significance. Since specific therapy for AIDS–KS is not curative and does not prolong survival, it should be directed at improving patient cosmesis and palliation of disease-related symptoms. Local therapy, such as radiation, cryotherapy, and intralesional chemotherapy, is recommended for the management of limited disease. Systemic interferon alfa or chemotherapy is indicated for disseminated disease. Interferon alfa is useful in patients with predominantly mucocutaneous disease and is most effective in patients with good prognostic factors, such as absence of B symptoms, no history of opportunistic infections, and a CD4 count of more than 200 cells/mm3. Interferon alfa alone or in combination with zidovudine produces responses in approximately 30% of AIDS–KS patients with good prognostic factors. Single-agent or combination chemotherapy is indicated for rapidly progressive or advanced AIDS–KS. Commonly used agents include doxorubicin, daunorubicin, bleomycin, vincristine, and vinblastine. Responses can be expected in at least 50% of patients treated with single-agent or combination chemotherapy. However, many patients are unable to tolerate the toxicity associated with systemic AIDS–KS therapy. Future research will focus on therapies that target the underlying pathogenesis of this disease. CONCLUSIONS: The optimal therapy for patients with AIDS–KS has not been determined. Treatment is appropriately directed at palliation of disease-related symptoms as no therapy has been unequivocally proven to impact survival. Local therapies should be used in the management of localized disease, while systemic therapy is appropriate for disseminated disease. Interferon alfa is useful in patients with primarily mucocutaneous disease or asymptomatic visceral involvement. Chemotherapy is indicated in patients who have rapidly progressive or advanced disease. Therapy must be individualized according to the patient's disease course and other patient-specific factors.

Human Immunodeficiency Virus–Negative–Associated Lymphangioma-like Kaposi's Sarcoma with Variable Clinical Presentations

2017 ◽  
Vol 107 (5) ◽  
pp. 461-466
Author(s):  
Georgios Kotzias ◽  
Modupe Agunbiade ◽  
Leon Isaac ◽  
Morteza Khaladj
Keyword(s):  
Kaposi's Sarcoma ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Human Herpesvirus ◽  
Kaposi’S Sarcoma ◽  
Vascular Tumors ◽  
Systemic Involvement ◽  
Clinical Appearance ◽  
Herpesvirus Type ◽  
Long Term Treatment

Lymphangioma-like Kaposi's sarcoma (LLKS) is a rare histologic variant of KS. Kaposi's sarcoma is also known as human herpesvirus type 8. The clinical presentation of the LLKS lesion is highly unusual and similar to that of classic KS but with multinodular vascular tumors and lymphedema. We present a 63-year-old native Haitian man with multiple slowly progressive exophytic ulcerated lesions covering more than 60% of his left lower extremity with no systemic involvement. Much confusion surrounded the clinical presentation of these wounds, and we postulated several differential diagnoses. Herein we describe the evaluation, clinical appearance, and progression of LLKS. Due to the rarity of LLKS, treating physicians need to be aware of the clinical presentation and diagnostic criteria of this variant. Despite being incurable, early diagnosis of LLKS can lead to long-term treatment options and a major reduction in symptoms.

HIV protease inhibitors as new treatment options for Kaposi’s sarcoma

2003 ◽  
Vol 6 (4) ◽  
pp. 173-181 ◽  
Author(s):  
Giovanni Barillari ◽  
Cecilia Sgadari ◽  
Elena Toschi ◽  
Paolo Monini ◽  
Barbara Ensoli
Keyword(s):  
Protease Inhibitors ◽  
Kaposi's Sarcoma ◽  
Treatment Options ◽  
Kaposi’S Sarcoma ◽  
Hiv Protease ◽  
Hiv Protease Inhibitors ◽  
New Treatment

scholarly journals A case of Kaposi’s sarcoma of tonsil with profuse bleeding in an HIV-positive patient

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110664
Author(s):  
Dorji Penjor ◽  
Aun Wee Chong
Keyword(s):  
Oral Cavity ◽  
Kaposi's Sarcoma ◽  
Treatment Options ◽  
Kaposi’S Sarcoma ◽  
Pyogenic Granuloma ◽  
Hiv Positive ◽  
Treatment Protocols ◽  
Retroviral Infection ◽  
Emergency Tracheostomy ◽  
Associated Malignancy

Kaposi’s sarcoma is the most common AIDS-associated malignancy. Kaposi’s sarcoma in the oral cavity and oropharynx present as a macular, papular, or nodular lesion on the palate, gingiva, or tongue which may look pink, reddish, or purplish. Kaposi’s sarcoma of the tonsils is relatively less common compared with other sites in the oral cavity and oropharynx. We report a case of Kaposi’s sarcoma of tonsil with profuse bleeding requiring emergency tracheostomy to protect the airway followed by tonsillectomy to control the bleeding. Our initial diagnosis was hemangioma or a pyogenic granuloma. The patient tested positive for a retroviral infection and the histopathology report was compatible with Kaposi’s sarcoma. Antiretroviral therapy and radiotherapy were given after stabilizing the patient. Kaposi’s sarcoma of tonsils is relatively uncommon and it is unusual to cause profuse bleeding. Various treatment options are available but there are no standard treatment protocols. Treatments options depend on the site, size, stage, and immune status of the patient.

scholarly journals Diode laser as local treatment for oral Kaposi's sarcoma in HIV young patient: a case report

2021 ◽  
Vol 27 (2) ◽  
pp. 31
Author(s):  
Niccolò Lombardi ◽  
Elena Varoni ◽  
Laura Moneghini ◽  
Giovanni Lodi
Keyword(s):  
Diode Laser ◽  
Highly Active Antiretroviral Therapy ◽  
Kaposi's Sarcoma ◽  
Treatment Options ◽  
Local Treatment ◽  
Human Herpesvirus ◽  
Invasive Procedure ◽  
Kaposi’S Sarcoma ◽  
Surgical Excision ◽  
Highly Active

Introduction: Kaposi's sarcoma (KS) is a malignant mucocutaneous neoplasm caused by human herpesvirus 8 (HHV-8). Four types of KS exist and, in each of them, the patient could develop skin and visceral lesions. Surgical excision, radiotherapy, intralesional chemotherapy and systemic chemotherapy are widely accepted as treatment options. Observation: The aim of this paper is to present diode laser as minimally invasive procedure in management of oral KS. We report here a case of multiple oral lesions of acquired immunodeficiency syndrome (AIDS)-associated KS, which has been solely treated with diode laser. Discussion: There is no bibliography on local treatment of oral KS with diode laser and this clinical case appears to be the first regarding this technique. Conclusion: This conservative approach, in association with highly active antiretroviral therapy (HAART), is safe and effective, shows fewer side effects than chemotherapy, radiotherapy and surgical excision and may be evaluated as potential treatment for oral KS.

Kaposi's sarcoma in the acquired immune deficiency syndrome: a proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee.

1989 ◽  
Vol 7 (9) ◽  
pp. 1201-1207 ◽  
Author(s):  
S E Krown ◽  
C Metroka ◽  
J C Wernz
Keyword(s):  
Immune Deficiency ◽  
Clinical Trials ◽  
Kaposi's Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Immune Deficiency Syndrome ◽  
Acquired Immune Deficiency Syndrome ◽  
Deficiency Syndrome ◽  
Response To Treatment ◽  
Clinical Staging ◽  
Acquired Immune Deficiency

The availability of uniform and precise criteria for disease evaluation, response to treatment, and clinical staging of Kaposi's sarcoma (KS) in individuals with the acquired immune deficiency syndrome (AIDS) would facilitate therapeutic trials in patients with this neoplasm. Recently, a group of oncologists conducting clinical trials in patients with AIDS-associated KS as part of a cooperative group established by the National Institute of Allergy and Infectious Diseases (NIAID) drafted such criteria. The criteria take into account the unique problems associated with the evaluation of patients with a disseminated cutaneous neoplasm in the setting of a systemic virus infection associated with immune deficiency. The recommendations include a standardized format for documenting the extent of KS on initial and subsequent evaluations, response definitions that include assessments of lesion nodularity and tumor-associated edema in addition to more traditional methods for evaluating tumor response, and a new staging system that includes extent of tumor, immune status, and other AIDS-related disease manifestations, akin to the tumor-node-metastasis (TNM) system used to stage other tumors. The adoption of standardized criteria for the evaluation of KS should prove useful for group trials and for other investigators involved in the treatment of this disease.

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