Abstract
IntroductionAlthough the Kaposi sarcoma (KS) is one of the AIDS defining entity and seen in almost one third of HIV infected patients with low CD4 cell counts, it is not uncommon in HIV seronegative persons, but genital KS is rare, particularly in people without risk factors for HIV infection. Isolated penile KS is an unusual manifestation, especially as solitary nodule with ulceration, in HIV seronegative patient.Case presentationWe report such a case of Kaposi sarcoma showing HHV-8 positivity in an elderly male Arabian patient with a delay in prompt diagnosis, but treated successfully with 3 3 years follow-up after limited local surgical excision.ConclusionThe general practitioners, venereologists and urologists should think of KS as a possibility in such lesion and consider early biopsy.
Highlights
The Kaposi sarcoma (KS) is one of the AIDS defining entity and seen in almost one third of HIV infected patients with low CD4 cell counts, it is not uncommon in HIV seronegative persons, but genital KS is rare, in people without risk factors for HIV infection
The classic Kaposi sarcoma usually presents as sporadic cases, more commonly in Mediterranean & East European population, in elderly HIV seronegative people with multiple brownish non-pruritic skin patches, plaques and nodules, usually affecting lower limbs [6], but rare to present as isolated genital solitary lesion, that too in Arabic patient as in our case
Though the CD31 & CD34 immuno-stains recognize the lesion as endothelial origin, the HHV8 antigen immuno- reactivity in the tissue is diagnostic for Kaposi sarcoma [12]
Summary
Though Moritz Kaposi in 1872 described 5 cases of aggressive forms of sarcoma with mortality within 3 years, the incidence rate of Kaposi sarcoma increased with the discovery of HIV during early 1980s and its association with this vascular tumor. As the Kaposi sarcoma is known to be a diverse entity clinically, histopathologically & prognostically with its various forms, early diagnosis and roper treatment is of utmost significance in the management. Our patient of classic KS with rare presentation as isolated penile ulcerative nodule who had initial delay in diagnosis, but received proper management with good response. There was no history of any systemic disease except he has been on diet for glucose intolerance. Local examination revealed an ulcerated firm, reddish brown, slightly tender nodule of 8 mm. Dermatologic examination did not reveal any skin or oral lesions. The initial histopathology report revealed atypical spindle cell proliferation with clear resection margins and advised immunohistochemical studies for final diagnosis. No local recurrence or systemic lesions observed during last three years of follow up
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