Gastric Kaposi's Sarcoma Research Articles

S2566 Concurrent CMV Colitis and Gastric Kaposi Sarcoma in AIDS Patient Presenting as Watery Diarrhea

S2566 Concurrent CMV Colitis and Gastric Kaposi Sarcoma in AIDS Patient Presenting as Watery Diarrhea

2764 An Unusual Presentation of Gastric Kaposi's Sarcoma

INTRODUCTION: Kaposi sarcoma (KS) is a low grade angioproliferative tumor. AIDS-related KS is the most common and aggressive form of KS. The prevalence of AIDS-related KS is up to 30%. Skin is the most commonly affected organ in 78% of cases, The gastrointestinal (GI) tract is the most commonly affected extracutaneous site, and often asymptomatic. In advanced cases, patients may present with GI bleeding, diarrhea, protein-losing enteropathy, intussusception, or perforation. Although only 20% of KS patients experience GI symptoms, some studies have found that up to 80% of KS patients have GI lesions at autopsy. With the advent availability of HARRT therapy, the incidence of Kaposi sarcoma has decreased dramatically. Our objective is to present an unusual presentation of Kaposi sarcoma and its endoscopic findings leading to the diagnosis of KS, to share how endoscopy can be used as a tool for diagnosing and assessing the GI involvement in KS. CASE DESCRIPTION/METHODS: A 35-year-old African American male with HIV, syphilis, and hepatitis B complains of swelling of his legs and scrotum for 2 months. Physical examination revealed abdominal distension, bilateral lower extremity edema, and one skin nodule on his right foot. Laboratory studies revealed Hgb 8.7 g/dL, MCV 95.3 fL/cell, WBC 7500/cmm, CD4 count < 80 cells/uL, and albumin 1.4 g/dL. CT imaging revealed significant abdominal ascites (Figure 1). The patient underwent paracentesis removing 3.5 L of milky fluid. Fluid culture, gram stain and cytology were negative. Given the ascites and hepatitis history, an esophagogastroduodenoscopy (EGD) was completed in evaluating for possible esophageal varices. EGD revealed a nodular fungating lesion that extends diffusely from the gastric body into the duodenal bulb and sweep (Figures 2 and 3). Biopsy revealed cylindrical cells positive for HHV-8, confirming the diagnosis of gastric Kaposi's sarcoma (KS). Immunohistochemical analysis of the skin nodule biopsy confirmed KS. Computed tomography scan of the chest was consistent with pulmonary metastases. Patient is being treated with HAART and will be started on chemotherapy. DISCUSSION: KS is a rare neoplasm, and an AIDS-defining illness in HIV patients. About 40-51% of HIV patients with cutaneous KS will develop gastrointestinal KS, which is typically asymptomatic until growth is extensive enough to cause abdominal pain. This case illustrates the importance of endoscopic evaluation in HIV patients for early detection of gastrointestinal involvement of KS.

Gastric Kaposi Sarcoma Discovered in a Immunocompromised Renal Transplant Patient

Kaposi sarcoma (KS) is an angioproliferative tumor associated with human herpesvirus 8. Lesions in the gastrointestinal tract (GI) are the most common extracutaneous location and can even occur in the absence of cutaneous lesions. They are often clinically silent; however, patients can present with abdominal pain, nausea, vomiting, anemia, GI bleeding and, in rare cases, mechanical obstruction, intussusception, and perforation. The purpose of this case study is to share a case of a gastric KS to help illustrate the clinical presentation and endoscopic description of this rare finding. A 61-year-old male post renal transplant for end state renal disease was admitted to the hospital from clinic secondary to worsening anasarca and lethargy. His vitals were stable upon presentation and laboratory evaluation revealed acute kidney injury with a Creatinine of 2.5 (baseline of 1.5) and acute anemia with hemoglobin at 6.8 (baseline of 13). GI was consulted with concern of occult GI bleeding for which an esophagogastroduodenoscopy (EGD) and colonoscopy was performed. On EGD, a large 3x3cm friable mass was found in the gastric antrum thought to be a contributing cause of the patient's anemia. Pathology demonstrated positive CD31 and CD34 staining confirming the vascular origin of the tumor. Further assessment revealed spindle cell proliferation and confirmatory immunohistochemical testing for human herpes virus 8 latent nuclear antigen consistent with a diagnosis of gastric KS. His colonoscopy incidentally demonstrated a diminutive tubular adenoma and a small lipoma. After further work-up, including negative HIV testing, it was felt that the patient's presentation was a result of his immunosuppression from his renal transplant. Oncology was consulted who did not feel chemotherapy was indicated. His tacrolimus was reduced and he was taken off his mycophenolate mofetil. He was discharged home with close follow up with his nephrologist and primary care provider. Although rare, the GI tract is the most common extracutaneous site involved in KS. Endoscopic appearance of KS lesions includes cratered, ulcerated, flat, polypoid/nodular masses. It is usually associated with immunosuppression. Treatment should be focused on reconstitution of the patient's immune system and joint decision making with oncology. Endoscopic examinations are often useful for assisting in therapeutic decision-making and evaluating therapy outcomes.2635 Figure 1. Approximately 3 x 3cm large friable mass in right gastric antrum representing Kaposi sarcoma.

Rare Photograph of Endoscopic View of Gastric Kaposi Sarcoma with Concurrent Candidasis in an HIV Aids Patient

Rare Photograph of Endoscopic View of Gastric Kaposi Sarcoma with Concurrent Candidasis in an HIV Aids Patient

Gastric Kaposi's sarcoma simulating gastric lymphoma during endoscopic ultrasound examination.

Gastric Kaposi's sarcoma simulating gastric lymphoma during endoscopic ultrasound examination.

Refractory Nausea and Vomiting Due to Gastric Kaposi Sarcoma in an HIV-infected Patient

Refractory Nausea and Vomiting Due to Gastric Kaposi Sarcoma in an HIV-infected Patient

Kaposi Sarcoma of the eyelid as an initial manifestation of AIDS

Kaposi sarcoma (KS) is a multifocal systemic disease that originates in the vascular endothelium related to Human Herpes Virus 8 (HHV-8). In the early 1980s the first series of cases of disseminated Kaposi Sarcoma in HIV infected patients were reported. However, with the advent of highly active antiretroviral therapy (HAART) since 1997, these cases are less frequently observed by clinicians. We report the case of a 40-year-old woman, presenting with two asymptomatic purpuric nodules localized in the superior and inferior left eyelids, occluding the palpebral fissure, which were present for 4 months prior to presentation. The eyelid nodules were determined to represent KS, but there were no additional cutaneous lesions. Pulmonary and gastric KS involvement was documented. Antiretroviral therapy was initiated along with pegylated liposomal doxorubicin. The nodules gradually disappeared and her immune status eventually improved. Ocular and periorbital involvement of KS associated with HIV-1 infection as the initial clinical manifestations is a rare advent. This case is important as it illustrates that disseminated KS was not to be predicted by the number or the extension of cutaneous lesions.

Upper gastrointestinal Kaposi's sarcoma in HIV-infected patients: ten years of endoscopy observation at a single Brazilian center

Kaposi's sarcoma (KS) is the most common neoplasm among HIV-infected individuals. The frequency of involvement of KS in the gastrointestinal (GI) tract and the associated epidemiological, immune, endoscopic, and histopathological features in HIV-infected patients, were evaluated in this study. A review of the medical and endoscopy reports of 1428 HIV-infected patients, who had undergone upper GI endoscopy at the Endoscopy Service, Clinical Hospital, Faculty of Medicine of Ribeirão Preto between January 1999 and June 2009, was performed. Clinical, epidemiological, immunological, endoscopic, and histological data were collected. Twenty-seven (1.9%) patients were diagnosed with GI KS. Patients were predominantly male (81.5%). Sexual activity was the main route of HIV transmission (81.5%). Cutaneous involvement was noted in 21 patients (78%). Fifteen patients (55%) received highly active antiretroviral therapy for a mean duration of 12.6 weeks (range 2-52 weeks) before endoscopy. GI lesions were mainly found in the stomach (55%). Analysis of the immunohistochemical methods HHV8 LNA-1, CD31, and CD34 for the diagnosis of gastric KS indicated high agreement (kappa=0.63, 95% confidence interval 0.32-0.94). There was no relationship between CD4 levels (p=0.34) or HIV viral load (p=0.99) and HHV8 LNA-1 positivity in gastric KS. GI KS is an infrequent finding in patients with HIV infection. Among those with GI KS, 80% had concomitant skin lesions. Immunohistochemical methods for CD31, CD34, and LNA-1 were important tools in the diagnostic assessment of lesions suggestive of KS in the GI tract. Further studies are required to confirm these data, and the need for routine endoscopic investigation of the GI tract in HIV-infected patients with cutaneous KS should be assessed.

Gastric and Peritoneal Involvement of Human Herpes Virus 8 Related Kaposi Sarcoma in a Patient with Acquired Immunodeficiency Syndrome

Kaposi's sarcoma (KS) is one of the most frequent neoplastic diseases in patients infected with human immunodeficiency virus (HIV). The authors report the case of a 40-year-old male with ascites, peripheral edema and peritoneal carcinomatosis secondary to a gastric KS related to human herpes virus type 8 (HHV-8). The patient had severe immunodeficiency, with a TCD4+ count of 86 cells/µl and newly diagnosed acquired immunodeficiency syndrome. His clinical condition rapidly deteriorated, with multiorgan failure, and he died without the possibility of initiating antiretroviral therapy or chemotherapy. To the authors’ knowledge, carcinomatosis is a rare feature in KS.

Sirolimus for the Treatment of Kaposi Sarcoma After Renal Transplantation: A Series of 10 Cases

The incidence of Kaposi sarcoma (KS) has substantially increased among immunocompromised patients, suggesting a role for immunosuppressive drugs. The aim of this study was to evaluate the incidence, features, and outcome of KS among 307 kidney transplantation patients at our center between January 1994 and June 2010. During the study period, the 10 patients who developed KS (3.25%) showed a mean age at transplantation of 35.8 ± 8.7 years (range, 22 to 49 years). The mean interval between transplantation and occurrence of KS was 24.7 ± 21.36 months (range, 6 to 64 months). The mean time of antithymocyte globulin induction was 9.5 days (range, 6 to 13 days). KS was restricted to the skin in 7 cases, among which, one presented with associated Hodgkin lymphoma. Visceral involvement (one lung and one colon) was observed in two cases. One patient presented with a gastric KS without skin lesions. Immunosuppressive treatment was reduced, then withdrawn in three cases, resulting in regression of KS a few weeks later, but with graft loss requiring hemodialysis at 1, 3 and 4 months. Among the remaining 7 cases, we stopped mycophenalate mofetil (MMF) and switched from calcineurin inhibitors to sirolimus. Allograft function remained stable after the switch. Only one patient who already had allograft dysfunction due to biopsy-proven chronic allograft nephropathy. Deteriorated progressively, undergoing hemodialysis at 2 years after KS diagnosis. In conclusion, we observed a relatively high incidence of KS among our cases. The introduction of sirolimus resulted in complete regression of KS lesions with preserved graft function.

Peritoneale Splenose 26 Jahre nach traumatischer Milzruptur - seltene Differenzialdiagnose eines submukösen Magentumors - Fallbericht und Literaturübersicht

Differential diagnoses of subepithelial gastric masses include benign (leiomyoma, lipoma, haemangioma, lymphangioma, neurogenic tumours, glomus tumour) and malignant (leiomyosarcoma, gastric Kaposi's sarcoma, metastases) neoplastic lesions, gastrointestinal stromal tumours (GIST) and lesions of non-neoplastic origin (heterotopic pancreatic tissue, intramural pseudocysts, intramural haematoma). Occasionally, however, suspected gastric wall tumours are caused by extragastral lesions that are not always easily distinguished from genuine gastric wall lesions by endoscopy or radiological imaging. We report the case of a 77-year-old patient undergoing laparoscopy for suspected gastric GIST in our institution in whom splenectomy had been performed 26 years prior to presentation due to traumatic splenic rupture. The tumour revealed to be ectopic splenic tissue located at the parietal peritoneum of the ventral abdominal wall, thereby fulfilling the definition of splenosis. Epidemiology, pathogenesis, diagnostics and therapy of splenosis are discussed in the context of a review of the relevant literature.

Gastric Kaposiʼs Sarcoma

Purpose: Kaposi's sarcoma is an uncommon neoplasm that occasionally involves the gastrointestinal tract in immunosuppressed individuals. Although skin lesions are the usual presentations, visceral lesions are common in organ transplant recipients and involve the gastrointestinal tract. The gastrointestinal tract is involved in approximately 40 percent of patients with KS at initial diagnosis and in up to 80 percent at autopsy. Methods: Chart review and review of the available literature using Medline and bibliographies of published articles. Results: A 30-year-old man with medical history of HIV, not on HAART, presented with nodular, velvety skin lesions on face, arms and legs. Biopsy of the skin lesion was suggestive of AIDS-related Kaposi's sarcoma. A CT scan of the chest, abdomen and pelvis showed thickening of the stomach wall and the colon at the hepatic flexure. EGD performed subsequently revealed hemorrhagic confluent nodules in the body of the stomach, biopsies of which showed spindle cells with positive staining for human herpes virus 8, suggestive of gastric Kaposi's sarcoma. Colonoscopy was unremarkable. Patient was subsequently started on HAART therapy along with intralesional injection of skin lesions with vinblastine. Conclusion: The gastrointestinal lesions in Kaposi's sarcoma may be asymptomatic as in our patient or cause one or more of the following symptoms: weight loss, abdominal pain, nausea/vomiting, upper or lower GI bleeding or diarrhea. Systemic cytotoxic chemotherapy should be administered in the presence of widespread skin involvement and symptomatic visceral involvement.Figure: Hemorrhagic confluent nodules in the body of the stomach.Figure: Spindle cells seen on gastric biopsy.

Primary gastric Kaposi's sarcoma presenting first with upper gastrointestinal bleeding and abdominal pain: A case report

Kaposi's sarcoma (KS) is the most common tumour among human immunodeficiency syndrome (HIV) infected individuals, but its involvement of the gastrointestinal tract was reported long before the acquired immunodeficiency syndrome (AIDS) epidemic. Although most cases of gastrointestinal KS are asymptomatic, advanced lesions may occasionally result in a severe life-threatening haemorrhage that requires immediate treatment. Endoscopy, with biopsy of suspicious lesions is necessary to make the diagnosis and is recommended in all HIV antibody positive patients with persistent upper gastrointestinal symptoms.We describe a patient with primary gastrointestinal involvement by KS who presented first with upper gastrointestinal bleeding and abdominal pain and no other stigmata. Afterwards, the diagnosis of an HIV infection was made.South African Gastroenterology Review Vol. 6 (1) 2008: pp. 5-7

Evolution of Human Herpesvirus Type 8-associated Gastric Kaposi's Sarcoma Following Corticosteroid Treatment for Asthma

The association of gastric Kaposi's sarcoma (KS) with human herpesvirus type 8 (HHV-8) may be found in immunosuppressed patients such as those with AIDS or transplant recipients. A 64-year-old man with a 2-year history of corticosteroid treatment was admitted due to the impression of chronic obstructive pulmonary disease with secondary infection. Abdominal fullness and tarry stool led to the performance of panendoscopy, which revealed two hypertrophic gastric mucosal lesions. These lesions had transformed into a large polyp 2 months later. KS was not diagnosed until a third endoscopic biopsy was performed. The polyp further transformed into a flattened, elongated tumor within a month. The patient died from acute cardiopulmonary insufficiency 4 days after radical gastrectomy. Polymerase chain reaction study identified HHV-8 in all biopsied specimens and resected tumor lesions. Immunostaining further demonstrated the virus in the tumor cells. Both of these methods seemed more sensitive in diagnosing KS than histologic examination of small biopsied specimens. This case suggests the existence of a relationship between gastric KS and HHV-8 infection.

Complete response of an HIV negative gastric Kaposi’s sarcoma (KS) patient with peritoneal carcinomatosis by liposomal daunorubicin treatment

We report the first case of an HIV negative patient with gastric Kaposi's sarcoma (KS) and peritoneal carcinomatosis in whom a complete response (CR) was obtained after liposomal daunorubicin administration. The patient presented with epigastric pain and hematemesis. Upper gastric endoscopy with multiple biopsies showed gastric involvement by KS. The whole physical examination and the thoraco-abdomino-pelvic CT scans showed no other localization. A total gastrectomy was performed. Histological examination confirmed the diagnosis of KS with involvement of regional lymph nodes and peritoneal lesions. Six cycles of liposomal daunorubicin were given. Post-treatment coelioscopic control was normal. The patient received another six adjuvant cycles of liposomal daunorubicin. The patient is in complete remission six months after the end of treatment. Liposomal daunorubicin is a promising treatment in the non HIV patient with visceral KS.

Inferior vena cava filters for HIV infected patients with pulmonary embolism and contraindications to anticoagulation

Objectives: To describe the mode of presentation, interventions, and outcome of HIV infected patients with pulmonary embolism and a contraindication to anticoagulation, who were treated with a bird's nest filter....

Gastrointestinal diseases associated with HIV infection

A clinical studies were carried out on gastrointestinal diseases associated with HIV infection. During the 6 years between January 1993 and December 1998, 71 HIV infected cases visited to Yokohama Municipal Citizen's hospital, and 26 of them developed gastrointestinal complications during the course of their illness. They consisted of 24 males and 2 females, with the mean age of 44.7 years and the medial value of 42.5 years. Of the 26 patients, 21 were Japanese, and the remaining 5 were Southeast Asian. The mean CD4 count was 143/microliter and the medial value was 32/microliter at the time of development of complications. Gastrointestinal complications were esophageal candidiasis in 6 patients, cytomegalovirus (CMV) gastritis and gastric Kaposi's sarcoma in 1 patient each, amebiasis in 8 patients, infectious colitis in 11 patients, and asymptomatic pathogen carriers in 3 patients. Esophageal and gastric complications were common in patients with low count of CD4, and endoscopy was useful for diagnosis. Amebiasis developed even in patients with normal CD4 and was common in males with experience in homosexual contact. It seems that homosexual contact acquire not only HIV infection but also Entamoeba histolytica through sexual contact. Protozoan and acid-fast bacteria were detected at high rate in patients with infectious colitis and asymptomatic pathogen carriers. Besides food-born infections, imported infections were seen in foreign and Japanese patients who had traveled abroad. The gastrointestinal diseases associated with HIV infections for the most part were opportunistic infections or tumors but imported, food-born, and sexually transmitted infections were also observed. It seems necessary to take into consideration of varying background of patients in the treatment of gastrointestinal diseases associated with HIV infections.