Intestinal Kaposiʼs Sarcoma in a Patient With Cirrhosis

Abstract

We present a case of iatrogenic sarcoma or sarcoma associated with immunosuppression related to cirrhosis. Currently, this is second report in the literature of a case of cirrhosis associated with gastrointestinal Kaposi's sarcoma unrelated to liver transplant or HIV infection. The previous case reported was of a 66-year-old male patient diagnosed with alcoholic cirrhosis and portal hypertension syndrome, in whom stomach lesions were identified (1). Our purpose is to inform this infrequent relationship. This was a 66 year old male patient who consulted due to melenas. On admission he was hypotensive, and physical exam findings included edema, ascites and angiomatous lesions on his legs, thighs and palate. An endoscopy and a colonoscopy showed violaceous papular lesions in the duodenum and colon (Image 1), biopsy and immunohistochemistry confirmed Kaposi's sarcoma (Image 2 and 3). The ELISA test for HIV was negative. The patient developed acute liver failure in addition to the chronic failure, with type 1 hepatorenal syndrome. He was not a candidate for liver transplant and died during hospitalization. The true prevalence of Kaposi sarcoma in patients with cirrhosis is still unknown. Most patients with gastrointestinal Kaposi's sarcoma in the variety associated with AIDS are asymptomatic (2), therefore endoscopies carried out for other reasons should be used to study suspicious lesions. The differential diagnosis includes gastrointestinal stromal tumors, angiosarcoma, and fusiform cell melanoma (2). The identification of HHV8 is recommended for all specimens with a fusiform appearance; this marker has a 99% sensitivity and 100% specificity (2). Altered cellular immunity and HHV-8 antibodies have been described in cirrhosis (3), which would also support the role of HHV8 in tumor development. Treatment depends on the epidemiological variant, at the moment no specific treatment has been established in this subgroup of patients.1910_A Figure 1. Flat macular purplish lesion seen in colonoscopy1910_B Figure 2. Biopsy of duodenum Kaposi lesion with immunohistochemistry stain for HHV-8.1910_C Figure 3. Biopsy of duodenum Kaposi lesion with immunohistochemistry stain for CD31.