Diagnosis Of Kaposi's Sarcoma Research Articles

Kaposi sarcoma in HIV Patients: Case study and literature review

Introduction: Kaposi sarcoma (KS), a malignancy originating from endothelial cells and linked to human herpesvirus 8 (HHV-8), disproportionately affects individuals with human immunodeficiency virus (HIV). Despite decreased incidence in high-income countries due to antiretroviral therapy, KS remains a significant concern in sub-Saharan Africa. This article presents a case study of an HIV-positive patient treated exclusively with radiation therapy and provides a comprehensive literature review on KS management. Case Presentation: A 46-year-old HIV-positive patient, under well-controlled infection, exhibited nodular skin lesions, hyperpigmentation, and lymphedema primarily on the lower left limb. Histological analysis confirmed the diagnosis of KS. The patient underwent radiation therapy (36 Gy in 12 sessions) with subsequent topical imiquimod. Nine months post-treatment, no nodular lesions were observed, indicating a positive response. Conclusion: In the antiretroviral era, radiation therapy emerges as a crucial loco-regional treatment in the multimodal management of epidemic KS. With a focus on controlling disease within irradiated areas, excellent response rates and acceptable toxicity levels highlight the efficacy of this approach.

Clinicopathologic Characterization of Kaposi Sarcoma on the Foot and Ankle: Analysis of 11 Patients Seen in Our Clinics.

Kaposi sarcoma (KS) has multiple clinical variants, and most frequently presents on the lower extremities. Anti-human immunodeficiency virus (HIV) therapy has significantly reduced the incidence of KS. However, KS is still prevalent in both HIV-infected and HIV-uninfected patients. This case series analysis aims to reveal the clinical presentations, differential diagnosis, and treatment options of KS on the foot and ankle. Eleven cases of KS involving the foot and ankle were retrieved from our patient database, and their clinicopathologic features were analyzed. All patients were men, aged 29 to 85 years. Two types of KS were found: classic and acquired immunodeficiency syndrome-associated epidemic. The average ages of classic and epidemic KS were 65.7 and 41.8 years, respectively. Clinically, three patients manifested multiple erythematous or deep violaceous, or blue-violaceous macules on either the dorsal or plantar surfaces of both feet. Eight patients showed exophytic, pyogenic granuloma-like nodules on the plantar surface, heels, and toes. Histologically, all KSs had uniform intervening fascicles of elongated spindle cells with slit-like vascular spaces filled with red blood cells and immunoreactivity with human herpesvirus-8. The patients were treated according to HIV infection status. Human immunodeficiency virus-infected patients were treated with anti-HIV therapy after primary surgical excision or biopsy. Human immunodeficiency virus-negative patients were treated with either surgical excision, Mohs surgery, or a combination of surgical excision and local radiotherapy according to individual patient clinical presentation. Kaposi sarcoma is still prevalent in both HIV-infected and HIV-uninfected patients with a variety of clinical presentations. Biopsy, with histologic evaluation, in combination with immunohistochemistry is essential for the differential diagnosis. The patient should be treated according their clinical manifestation, staging, comorbidity, and immune function.

A case report : 34 y.o male with incidental histopathological findings of Kaposi sarcoma without clinical history of human immunodeficiency virus (HIV)

Introduction: Kaposi sarcoma is a rare and challenging case especially in immunosuppressed patients that frequently doesn’t have specific manifestation. It usually caused by human herpes virus 8 virus infection and male patient with multiple lesion has high mortality rates. The aim of this study is to report 34 y.o Male with incidental histopathological findings of kaposi sarcoma without clinical history of Human Immunodeficiency Virus (HIV). Methodology: Descriptive study of the case report type, whose data were obtained from the patient's medical record. Result: This paper will report 34-year-old young adult male with clinically diagnosed with poroma and differential diagnosis of squamous cell carcinoma and pyogenic granuloma. The clinical sign was multiple skin lesion appear on his right nose and thumb in the last 6 months. The nodules are solitary with oval shape, erythema, firm borders and the nodule surface covered with brownish-yellow squama. In addition, imaging examination suspicious for soft tissue mass. The biopsy was performed, and histopathological finding exhibit a tumor mass consists of Kaposi sarcoma. Discussion: Furthermore, after pathological report revealed the diagnosis of Kaposi sarcoma then a provider-initiated HIV testing and counseling (PITC) examination is carried out and the test result showed reactive for HIV infection. So that, patient concluded to have predisposition of HIV infection with Kaposi sarcoma and treated for antiretrovirals (ARV), chemotherapy and routine clinical follow up. Conclusion : Kaposi sarcoma is a rare cancer caused by infection with the human herpesvirus 8 (HHV8). These lesions are often found in immunosuppressed patients such as HIV sufferers characterized by vascular proliferation. Through the incidental findings of Kaposi's sarcoma in patients who are not clinically suspected of having HIV, clinicopathological correlation is highly recommended. Therefore, the purpose of this writing can be a strong reference so that clinicians are more thorough in reviewing clinical patients and more detailed physical examinations.

Prevalence, Incidence, and Predictors of Kaposi Sarcoma-Associated Herpesvirus Infection Among Young Men Who Have Sex With Men in the Southern United States.

Kaposi sarcoma (KS) continues to cause substantial morbidity and mortality in populations at risk in the southern United States. Utilizing biospecimens from the Houston site of the Young Men's Affiliate Project, 351 men who have sex with men had blood tested for KS-associated herpesvirus (KSHV) IgG. Seroprevalence, seroconversion between time points, and demographic and clinical correlates were measured. KSHV prevalence was 36.7% and incidence was 8.9 per 100 person-years. Furthermore, prevalence and incidence were higher among Black individuals, people living with HIV, and those with a history of syphilis. Further research on KSHV risk may improve health disparities in KS diagnosis and outcomes.

BI11 Cutaneous presentation of Kaposi sarcoma following allogeneic haematopoietic stem cell transplantation for myeloma

Abstract Iatrogenic Kaposi sarcoma (KS) is a relatively frequent occurrence following solid-organ transplants (0–5%), in part due to prolonged immunosuppression. However, its occurrence after haematopoietic stem cell transplantation (HSCT) is rare, with only 15 cases described in the literature. We report a case of KS presenting in the skin of a patient who had received a matched unrelated donor allogeneic HSCT for IgG kappa myeloma. A 55-year-old HIV-negative white man with myeloma underwent an allogeneic HSCT from a matched, unrelated donor following conditioning chemotherapy with fludarabine–melphalan and antithymocyte globulin. Post-transplant, he was maintained on ciclosporin as graft-versus-host disease (GVHD) prophylaxis. On day 14 post-transplant, he developed a widespread eczematous eruption that rapidly evolved into an erythroderma; a skin biopsy was consistent with acute GVHD. He was managed with superpotent topical steroids and a 5-day course of oral prednisolone. He began extracorporeal photopheresis (ECP) on day 33 post-transplant, having failed to respond adequately to systemic steroids. He also completed four cycles of rituximab. Ciclosporin was stopped by day 130 post-transplant. He had completed 14 cycles of ECP by day 139 post-transplant, with resolution of cutaneous GVHD; however, he had developed a rapidly growing solitary dusky-red nodule on his right neck that was excised due to diagnostic uncertainty. Histology revealed a dermal haemorrhagic exophytic vascular tumour composed of lobules and sheets of epithelioid cells with an eosinophilic cytoplasm and pleomorphic nuclei. Immunoperoxidase staining was negative for S100, MNF-116 and AE1/AE3. The same cells were strongly and diffusely positive for the vascular markers CD31, CD34 and ERG. The lesional cells were positive for human herpesvirus (HHV)-8 confirming a diagnosis of Kaposi sarcoma. He subsequently developed a second lesion on his left forearm, despite being off all immunosuppression. A repeat bone biopsy confirmed that he remains in morphological remission from his myeloma. Positron emission tomography–computed tomography has not identified extracutaneous disease. KS following HSCT is rare, but it can be fatal. Skin lesions are the dominant clinical presentation. HHV-8 has an important role in the pathogenesis, and transplant-related KS may occur secondary to reactivation of the virus as a result of significant immunosuppression following HSCT. However, it could also occur as primary infection or be transmitted with donor cells. The outcome of KS after HSCT is variable. A watch and wait strategy can be applied if immune recovery is expected. In our patient, it developed 5 months after HSCT; shortly after immunosuppression had been tapered, he remains well and will be closely monitored for further suspicious lesions.

Effectiveness and safety of conventional systemic treatments in classical and endemic Kaposi sarcoma: A multicentric retrospective study of 110 patients.

e21584 Background: Apart from post-transplant Kaposi sarcoma (KS), 2 major subtypes of non-HIV-related KS are described: classical Kaposi sarcoma (CKS) in patients originated from Mediterranean countries and endemic KS (EKS) in patients of sub-Saharan Africa origin. Some patients with aggressive EKS or CKS require systemic treatments among which liposomal anthracycline (LA), taxanes and, to a lesser extent, low dose interferon (LDI) are generally recommended as first lines. Recently, anti-PD1 have shown promising results in an early phase II trial. At the dawn of a turning point in therapeutic era, we aim to map the effectiveness and safety of the main conventional systemic treatments usually available in KS. Methods: We performed a national multicentric retrospective study including all patients receiving a systemic treatment for a histologically proven KS between January 1st 2013 to July 1st 2019. HIV infected patients and patients treated with immunosuppressive drugs were excluded. Overall response was defined as a decrease of more than 50% of lesion area and serious adverse events encompassed grade 3 and 4 toxicity. Results: A total of 110 patients were included. Sixty-nine had CKS (62.7%) and 41 had EKS (37.2) with a median age at diagnosis of 69 (IQR: 57-77) and 41 years (37-59) (p = 0.011), respectively. At the time of diagnosis, EKS was associated with greater systemic involvement compared with CKS (36.6% vs 14.9%, p = 0.017). First-line therapy was initiated within a median of 13.8 months (2.9-43) after KS diagnosis. The 3 main regimens were taxanes (27.3%), LA (19.1%) and LDI (19.1%) with response rates of 82.8%, 80% and 52.6% (p = 0.063), respectively. The cumulative incidence of a second line of treatment in the first 2 years of follow-up was 49.5% (CI95% 38.7-59.4), without significant difference according to the different regimens. Toxicity, regardless of grade, was reported more frequently with LDI (55.3%) and taxanes (47.8%) than with LA (30.4%) (p = 0.035). Poor tolerability led to discontinuation of LDI more frequently than LA (OR = 4.17, p = 0.048), without difference for taxanes. There was no difference in serious adverse events between the 3 main regimens. CKS and EKS didn’t differ regarding overall response rate or time to next treatment regardless of treatment regimens. However, response rates tended to decrease as the lines went on for EKS (from 77.5% in 1st to 33.3% in 3rd line, p = 0.005), in contrast to CKS who maintained a sustained response, with more frequent systemic involvement (56% vs 25.4%, p = 0.002) during EKS course. Conclusions: Herein, we highlight LA, taxanes and LDI are safe and effective treatments for non-immunodeficient KS. Furthermore, EKS differed from CKS, occurring in younger patients, with more frequent systemic involvement and response loss through therapeutic lines, emphasizing the need to evaluate new agents in this form of KS.

A description of Kaposi sarcoma risk factors and outcomes in HIV-positive and HIV-negative patients at a tertiary care medical center from 2005 to 2020.

Kaposi sarcoma (KS) is a low-grade vascular malignancy caused by human herpesvirus-8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV). There are four established subtypes of KS, which are described by unique risk factors, presentation, and disease course. A "non-epidemic" variant to describe HIV-negative men who have sex with men (MSM) is emerging as a fifth subtype. We retrospectively examined patients with KS at an academic medical center in central Ohio, USA. To our knowledge, this is the first US-based report to describe KS risk factors and outcomes in the context of HIV status. Data were extracted from patient charts including demographic information, history at time of KS diagnosis, and information about KS disease course. HIV-positive and HIV-negative patients were grouped into established categories. HIV-negative patients who did not fit an existing subtype were described as "Unclassified-KS-Type." Demographic characteristics for AIDS-KS patients in our cohort match established trends in this subtype, such as male, MSM, and younger age at diagnosis compared to HIV-negative patients. Most Unclassified-KS-Type patients fit well into the emerging "non-epidemic KS" subtype. These patients are described as healthy, middle-aged, HIV-negative MSM with lower extremity lesions. This descriptive report provides an updated view of KS risk factors and outcomes to improve detection and treatment in dermatology.

LAMP-enabled diagnosis of Kaposi's sarcoma for sub-Saharan Africa.

Kaposi's sarcoma (KS) is an endothelial cancer caused by the Kaposi's sarcoma-associated herpesvirus (KSHV) and is one of the most common cancers in sub-Saharan Africa. In limited-resource settings, traditional pathology infrastructure is often insufficient for timely diagnosis, leading to frequent diagnoses at advanced-stage disease where survival is poor. In this study, we investigate molecular diagnosis of KS performed in a point-of-care device to circumvent the limited infrastructure for traditional diagnosis. Using 506 mucocutaneous biopsies collected from patients at three HIV clinics in Uganda, we achieved 97% sensitivity, 92% specificity, and 96% accuracy compared to gold standard U.S.-based pathology. The results presented in this manuscript show that LAMP-based quantification of KSHV DNA extracted from KS-suspected biopsies has the potential to serve as a successful diagnostic for the disease and that diagnosis may be accurately achieved using a point-of-care device, reducing the barriers to obtaining KS diagnosis while increasing diagnostic accuracy.

Diagnosis of Kaposi’s sarcoma

Kaposi’s sarcoma has a picture reminiscent of several skin conditions, so further testing is needed to show the diagnosis of Kaposi’s sarcoma. Lymphatic endothelium cells infected with KSHV or human herpesvirus 8 form the basis of Kaposi’s sarcoma (KS), a multicentric tumor (HHV-8). These macules and plaques might be purple, reddish-blue or dark brown-black in color. KS is distinguished by this look.” Inflamed, ulcerated nodular lesions are common. They are neither unpleasant or uncomfortable, and the overlying skin or underlying tissues seldom die as a result of them. The gold standard examination in establishing the diagnosis of KS is histopathology. Several techniques that can be used for histopathological tissue retrieval are punch biopsy, shave biopsy, excision biopsy and incision biopsy. Immunohistochemical examination can also be performed to rule out the differential diagnosis. Immunohistochemical examination that we can do is with LANA-1, CD 34, CD 31, D2-40. Diagnosis of Kaposi’s sarcoma is difficult to diagnose only from a clinical picture, so similar diagnoses, i.e. histopathological and immunohistochemical examinations, are required.

Spurious Presentation of Pulmonary Kaposi Sarcoma as Unresolved Pneumonia Led to Fatal Outcome.

Acquired immunodeficiency syndrome (AIDS)-associated Kaposi sarcoma (KS) is an angioproliferative neoplasia caused by infection with human herpesvirus 8 (HHV-8). It typically presents with mucocutaneous involvement, but it can be disseminated. Initial presentation with primarily pulmonary KS is rare. We present a case of a 32-year-old male with untreated human immunodeficiency virus (HIV) diagnosed 1 year before presentation who developed progressively worsening cough and shortness of breath for 6 months. He was hospitalized twice and treated for unresolved pneumonia in an outside hospital. The patient concomitantly developed purplish nodules on his face, then the upper trunk, back, chest, and thighs bilaterally that gradually increased in size and number. Histopathology findings from skin lesions were consistent for KS. Bronchoscopy found multiple erythematous plaques throughout the tracheobronchial tree with telangiectasias and inflammation suggestive of pulmonary KS. His imaging findings and positive serum HHV-8 polymerase chain reaction (PCR) were consistent with disseminated KS. He started antiretroviral therapy (ART) to treat his HIV infection, followed by liposomal doxorubicin chemotherapy. But both ART and chemotherapy were interrupted due to adherence and insurance issues. The patient was readmitted with acute respiratory failure requiring mechanical ventilation with multiple vasopressors that led to the patient's demise. The late recognition of KS diagnosis and delayed treatment can lead to worse outcomes.

Clinical, Dermoscopic, Ultrasonographic, and Histopathologic Correlations in Kaposi's Sarcoma Lesions and Their Differential Diagnoses: A Single-Center Prospective Study.

(1) Background: Kaposi's sarcoma (KS) is an angioproliferative neoplasm typically appearing as angiomatous patches, plaques, and/or nodules on the skin. Dermoscopy and ultrasonography have been suggested as an aid in the diagnosis of KS, but there is little evidence in the literature, especially regarding its possible differential diagnoses. Our aim is to describe and compare the clinical, dermoscopic, and ultrasonographic features of KS and KS-like lesions. (2) Methods: we conducted a prospective study on 25 consecutive patients who were first referred to our tertiary care center from January to May 2021 for a possible KS. (3) Results: 41 cutaneous lesions were examined by means of dermoscopy, Doppler ultrasonography, and pathology, 32 of which were KS-related, while the remaining 9 were lesions with clinical resemblance to KS. On dermoscopy, a purplish-red pigmentation, scaly surface, and the collarette sign were the most common features among KS lesions (81.3%, 46.9%, and 28.1%, respectively). On US, all 9 KS plaques and 21 KS nodules presented a hypoechoic image. Dermoscopic and Doppler ultrasonographic findings of KS-like lesions, such as cherry angioma, venous lake, glomus tumor, pyogenic granuloma, and angiosarcoma were also analyzed. (4) Conclusions: dermoscopy and Doppler ultrasonography can be useful to better assess the features of KS lesions and in diagnosing equivocal KS-like lesions.

PULMONARY KAPOSI SARCOMA WITH ASSOCIATED RECURRENT CHYLOTHORAX

SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: AIDS related Kaposi Sarcoma (KS) is an endothelial malignancy associated with HHV8 infection. It is the most common malignancy in patients with AIDS. Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Here we present a case of recurrent chylothorax leading to diagnosis of pulmonary KS by pleural biopsy.CASE PRESENTATION: 40-year-old male with HIV/AIDS on HAART therapy and KS was referred for pleural effusion. He was previously treated with Doxil for gastrointestinal KS, but stopped due to neutropenia. He had persistent shortness of breath and occasional night sweats. A thoracentesis was performed, and fluid studies were consistent with a chylothorax. He had a recurrent pleural effusion two months later, and he underwent right sided pleuroscopy with pleural biopsies, talc pleurodesis, and tunneled pleural catheter placement. Diffuse hemorrhagic lesions throughout the right lung, and a raised plaque like lesion along the parietal pleura were seen during pleuroscopy. Biopsy of the parietal pleural was consistent with metastatic KS. He will discuss treatment with his oncologist.DISCUSSION: Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Thoracoscopy is usually not needed to diagnose pulmonary KS as it should only affect visceral pleura. As in this case, thoracoscopy is typically used to assist with patient's symptoms and rule out other causes of an effusion. This is a rare case of KS causing chylothorax requiring thoracoscopy and biopsies for diagnosis.CONCLUSIONS: Here we present a case of pulmonary KS with accompanying chylothorax. This is not a typical presentation or path to diagnosis for pulmonary KS.Reference #1: Cherian S, Umerah OM, Tufail M, et al. Chylothorax in a patient with HIV-related Kaposi's sarcoma. BMJ Case Reports CP2019;12:e227641.Reference #2: Ramos A, Granado J, et al. Pulmonary Kaposi Sarcoma - An atypical clinical presentation. International Journal of Infectious Disease. 2022;115:185-188.Reference #3: Pandya K, Lal C, et al. Bilateral Chylothorax with Pulmonary Kaposi's Sarcoma. Chest. 1988;94(6):1316-1317.DISCLOSURES: No relevant relationships by Harshesh AminNo relevant relationships by Yanglin GuoNo relevant relationships by John HeneganNo relevant relationships by Rachel MullinsNo relevant relationships by Randolph Ross SESSION TITLE: Pneumothorax, Chylothorax, and Pleural Effusion Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: AIDS related Kaposi Sarcoma (KS) is an endothelial malignancy associated with HHV8 infection. It is the most common malignancy in patients with AIDS. Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Here we present a case of recurrent chylothorax leading to diagnosis of pulmonary KS by pleural biopsy. CASE PRESENTATION: 40-year-old male with HIV/AIDS on HAART therapy and KS was referred for pleural effusion. He was previously treated with Doxil for gastrointestinal KS, but stopped due to neutropenia. He had persistent shortness of breath and occasional night sweats. A thoracentesis was performed, and fluid studies were consistent with a chylothorax. He had a recurrent pleural effusion two months later, and he underwent right sided pleuroscopy with pleural biopsies, talc pleurodesis, and tunneled pleural catheter placement. Diffuse hemorrhagic lesions throughout the right lung, and a raised plaque like lesion along the parietal pleura were seen during pleuroscopy. Biopsy of the parietal pleural was consistent with metastatic KS. He will discuss treatment with his oncologist. DISCUSSION: Pulmonary KS is uncommon and rarely causes pleural effusions, particularly chylothorax. Thoracoscopy is usually not needed to diagnose pulmonary KS as it should only affect visceral pleura. As in this case, thoracoscopy is typically used to assist with patient's symptoms and rule out other causes of an effusion. This is a rare case of KS causing chylothorax requiring thoracoscopy and biopsies for diagnosis. CONCLUSIONS: Here we present a case of pulmonary KS with accompanying chylothorax. This is not a typical presentation or path to diagnosis for pulmonary KS. Reference #1: Cherian S, Umerah OM, Tufail M, et al. Chylothorax in a patient with HIV-related Kaposi's sarcoma. BMJ Case Reports CP2019;12:e227641. Reference #2: Ramos A, Granado J, et al. Pulmonary Kaposi Sarcoma - An atypical clinical presentation. International Journal of Infectious Disease. 2022;115:185-188. Reference #3: Pandya K, Lal C, et al. Bilateral Chylothorax with Pulmonary Kaposi's Sarcoma. Chest. 1988;94(6):1316-1317. DISCLOSURES: No relevant relationships by Harshesh Amin No relevant relationships by Yanglin Guo No relevant relationships by John Henegan No relevant relationships by Rachel Mullins No relevant relationships by Randolph Ross

S2598 Gastric Kaposi Sarcoma Presenting as Acute Upper Gastrointestinal Hemorrhage in a Heart Transplant Patient

Introduction: Kaposi sarcoma (KS), a multifocal neoplasm of lymphatic cells, occurs more often in organ transplant patients, and its pathogenesis is related to use of immunosuppressive (IS) medications. Acute gastrointestinal hemorrhage due to KS is exceedingly rare and has never been reported in a heart transplant patient. We report a case of KS presenting as gastrointestinal hemorrhage in a heart transplant patient whose bleeding resolved with supportive care and treatment of his underlying KS. Case Description/Methods: A 63-year-old man originally from Sudan with a history of non-ischemic cardiomyopathy requiring heart transplant on IS presented with melena and acute anemia. Medical history included cutaneous KS of the right leg diagnosed 1 year following transplant previously treated with paclitaxel and in clinical remission. He was treated with intravenous proton-pump inhibitor and blood transfusions. EGD showed a patch of nodular mucosa on the lesser curvature of the stomach. Pathology of the nodule showed dilated capillaries with spindle cells in the lamina propria, and staining for human herpesvirus-8 (HHV-8) was positive in the spindled cells, supporting a diagnosis of recurrent KS. He had no further bleeding, hemoglobin stabilized, and he was discharged. He was resumed on paclitaxel for recurrent KS after discharge and had no further bleeding (Figure 1). Discussion: We report a case of KS presenting with GI bleeding in a patient on chronic IS following heart transplant. While GI bleeding from KS has been reported in renal transplant recipients, this is the first such report we are aware of in a heart transplant patient. The GI tract is a common site of visceral involvement in KS, and presentation can include vomiting, diarrhea, and occult blood loss. Overt GI bleeding in KS is rare. Endoscopic appearance varies from flat lesions to polypoid or nodular growths, and histopathology shows spindle cells positive for HHV-8. Management of GI bleeding in KS depends on severity, and in less severe cases, the role of endoscopy is to confirm the visceral spread of KS with biopsy. Thereafter, management includes IS reduction and chemotherapy for refractory disease. Though KS is a rare cause of overt GI bleeding, it should be considered in patients with immunodeficiency or on chronic IS, and biopsy for suspicious lesions should be performed to confirm diagnosis.Figure 1.: Lesser curvature gastric nodule.

Kaposi's sarcoma in people living with HIV/aids in a public referral hospital in Peru.

Kaposi's sarcoma (KS) is the most frequent cancer in people living with HIV. Research on this condition is scarce in the region, therefore, this article aimed to describe the demographic, clinical and therapeutic characteristics of patients with HIV who developed KS at the Cayetano Heredia Hospital between 2000 and 2018. A total of 129 KS cases were identified, with a median age of 33 years, predominantly males with 92% (119/129), and mostly men who have sex with men (MSM). The median time from HIV diagnosis to KS diagnosis was five months, associated with a CD4 lymphocyte count of 64 cells/μL (IQR: 33-185) at KS diagnosis. Cutaneous involvement was the most common presentation; however, at least half also had the visceral form.

Cancer in patients with and without HIV infection in the national cancer registry of Rwanda.

As antiretroviral therapy (ART) has been widely scaled up in Rwanda, life expectancies among people with HIV (PWH) have increased. With increasing viral suppression, AIDS-defining cancers (ADCs) typically decrease; however, as the PWH population ages, non-AIDS-defining cancers (NADCs) will be expected to increase. The aim of this study was to compare cancer diagnoses between PWH and patients without HIV in Rwanda and to describe the changes in the number and types of cancer over time. Retrospective cohort study. Rwanda National Cancer Registry (RNCR) recorded the HIV status, primary site, and morphological description for cancer diagnoses from 2007 to 2018. Descriptive analyses were carried out by cancer group (HIV+ and HIV-). A portion of patients whose HIV status was unknown (63%) were excluded from the present analysis. Among the 20 258 cases registered in the Registry, there were 1048 PWH and 6359 HIV- individuals. The proportion of ADCs were significantly higher in the PWH group compared to those without HIV ( P < 0.001). Among PWH, there was a longitudinal increase in NADCs and a decrease in ADCs ( P < 0.001) over time. Among the ADCs in the PWH group, there was a significant decline in Kaposi sarcoma cases over time. The study demonstrates a decreasing frequency of ADCs driven by declines in Kaposi sarcoma diagnoses and an increased frequency of NADCs among PWH in Rwanda over time. These findings support a need for focusing early detection and management efforts on NADCs, as they begin to play a larger role in the disease processes that affect the aging PWH population.

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study.

Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support. Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.

Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial.

IntroductionMost Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings.MethodsInterventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped‐wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within‐clinic correlations.ResultsA total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post‐intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66–3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11–273%), p = 0.02) post‐intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33–3.24], p = 0.001). Post‐intervention, non‐significant decreases in 90‐day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38–1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85–2.20], p = 0.20) were estimated.ConclusionsKS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90‐day return rates or survival.

Kaposi’s sarcoma management from a plastic surgery perspective

Aim of the study Kaposi's sarcoma (KS) is a low-grade angioproliferative tumor arising from endothelial cells and associated with Human Herpes Virus 8 infection. Although there are considerable number of patients referred for surgical excision, the plastic surgery literature on KS is exceptionally scarce. In this study, it was aimed to emphasize the differences in the management of Kaposi's Sarcoma and help to understand the importance of a multidisciplinary approach, accordingly the sake of choosing the ideal treatment method for each lesion. Materials and methods Thirty patients who were operated with the diagnosis of KS between March 2015 and January 2020 were included. Preoperative HIV tests and detailed whole-body examinations of the patients were performed. As a surgical method, for lesions with sizes ranging from 0.5 * 1 cm to 2 * 3 cm, excisions were made over the deep skin fascia by placing a margin between 0.5-1 cm, considering the anatomical location and elasticity of the skin. Results Primary repair was performed in 23 patients (40 lesions) and 12 lesions of 8 patients were repaired with a skin graft. In four patients the repair was performed with local skin flaps. In a patient with a lesion on the finger, the defect that occurred after the excision of the lesion was repaired with a pedicled regional flap. Conclusions One-stage surgical excision of the lesions provides remarkable advantages, compared to the therapies such as radiotherapy, laser, or chemotherapy which require several administrations.

Telling the story of intersectional stigma in HIV-associated Kaposi's sarcoma in western Kenya: a convergent mixed-methods approach.

IntroductionThe experience of stigma can be multifaceted for people with HIV and cancer. Kaposi's sarcoma (KS), one of the most common HIV‐associated cancers in sub‐Saharan Africa, often presents with visible skin lesions that may put people at risk for stigmatization. In this way, HIV‐associated KS is unique, as people with KS can experience stigma associated with HIV, cancer, and skin disease simultaneously. The aim of this study is to characterize the intersectionality of HIV‐related, cancer‐related and skin disease‐related stigma in people living with HIV and KS.MethodsWe used a convergent mixed‐methods approach nested within a longitudinal study of people with HIV‐associated KS in western Kenya. Between February 2019 and December 2020, we collected quantitative surveys among all participants and conducted semi‐structured interviews among a purposive sample of participants. Quantitative surveys were adapted from the abridged Berger HIV Stigma Scale to assess overall stigma, HIV‐related stigma, cancer‐related stigma, and skin disease‐related stigma. Qualitative data were coded using stigma constructs from the Health Stigma and Discrimination Framework.ResultsIn 88 semi‐structured interviews, stigma was a major barrier to KS diagnosis and treatment among people with HIV‐associated KS. Participant's stories of stigma were dominated by HIV‐related stigma, more than cancer‐related or skin disease‐related stigma. However, quantitative stigma scores among the 117 participants were similar for HIV‐related (Median: 28.00; IQR: 28.0, 34.0), cancer‐related (Median: 28.0; IQR: 28.0, 34.8), and skin disease‐related stigma (Median: 28.0; IQR: 27.0, 34.0). In semi‐structured interviews, cancer‐related and skin disease‐related stigma were more subtle contributors; cancer‐related stigma was linked to fatalism and skin‐related stigma was linked to visible disease. Participants reported resolution of skin lesions contributed to lessening stigma over time; there was a significant decline in quantitative scores of overall stigma in time since KS diagnosis (adjusted β = –0.15, p <0.001).ConclusionsThis study highlights the role mixed‐method approaches can play in better understanding stigma in people living with both HIV and cancer. While HIV‐related stigma may dominate perceptions of stigma among people with KS in Kenya, intersectional experiences of stigma may be subtle, and quantitative evaluation alone may be insufficient to understand intersectional stigma in certain contexts.

Treatments for AIDS/HIV-related Kaposi sarcoma: A systematic review of the literature.

Treatment guidelines are not well established in AIDS-related Kaposi sarcoma (KS). We aim to review the evidence on efficacy of treatments for AIDS-related Kaposi sarcoma. We searched the Cochrane Library, PubMed, and Embase Database from date of database inception till July 2020. Randomized controlled trials reporting intervention consisting of any type of treatment compared to control/placebo to a different treatment modality or different combination of treatment/treatment doses with a diagnosis of AIDS-related KS are selected. Primary outcomes were response rates defined as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Secondary outcomes were cosmesis and adverse outcomes such as pain and erythema. Thirteen out of 536 articles met our eligibility criteria. Three studies reported the efficacy of chemotherapy, two studies looked at different doses of radiotherapy regimes, and three studies compared different antiretroviral therapy (ART) and chemotherapy regimens. Other studies reported topical therapies such as alitretinoin gel, IM862, and bHCG injection which showed varied efficacies. Lack of standardization classification of disease activity and clinical outcomes and treatment modalities precluded meaningful comparison of studies. The evidence of efficacy of any particular intervention is overall varied and there was insufficient evidence to recommend any particular intervention. We have provided an overview of treatments for KS but larger studies need to be carried out to verify the efficacy of treatment options reported in the literature.