Oral Kaposi Research Articles

Classic Kaposi's Sarcoma (non-hiv-associated) of oral cavity: a case report

Kaposi’s sarcoma (KS) is a locally aggressive multicentric mucocutaneous malignant neoplasm. The aim of this article is to report and discuss the immunohistochemical profile of a rare case of classic primary Oral Kaposi’s sarcoma presenting on the hard palate of a female patient which was non-HIV and was not immunocompromised.

Angiopoietin‐2 is expressed in oral Kaposi's sarcoma

Kaposi's sarcoma (KS) persists today as a highly prevalent vascular cancer, often found in HIV patients. Studies have shown that angiopoietin 2 (Ang2), a pro-angiogenic protein, is involved in the pathogenesis of this tumor. However, expression of this protein has not been investigated in oral KS lesions. Thus, we aimed to investigate the expression of Ang2 in samples of oral KS. Immunohistochemistry was used to evaluate Ang2 expression in 14 oral KS cases, with degrees of expression being analyzed in a semi-quantitative manner. In addition, clinical information such as age, gender, race, tumor location, size, color, and appearance, as well as HIV status, was collected and included in the analysis. All patients were white males, mostly HIV-positive, with a mean age of 40years. Clinically, the lesions were dark red/blue/purple masses, ranging from 1 to 2.5cm in diameter, found in various locations such as the tongue, palate, and gingiva. Expression of Ang2 was noted in 72% (10/14) of the samples. Of these, 10% showed weak expression, 60% moderate, and 30% strong expression. Our results indicate that Ang2 is expressed in oral KS and, consistent with results from previous studies, show that Ang2 may contribute to the pathogenesis of this lesion.

Imaging Findings in AIDS-related Oral Kaposi's Sarcoma.

Kaposi's sarcoma (KS) is one of the most common diseases in patients with acquired immunodeficiency syndrome, but is rarely encountered in dental practice in Japan. We encountered a case of oral KS (OKS) presenting in the hard palate, gingiva, and tongue in a 41-year-old man. We report the results of imaging, including computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT in this case. The process leading to an imaging diagnosis of OKS is discussed, emphasizing the importance of collating clinical, laboratory, pathological, and radiological findings. The present results suggest that mapping of accurate tumors is very important in cases of OKS, and that multiple or bilateral manifestations, ill-defined margins, osteolysis, and swollen lymph nodes, in particular, need to be taken into account.

Acquired Immunodeficiency Syndrome Revealed by Oral Kaposi’s Sarcoma

Introduction Kaposi’s Sarcoma (KS), being first described in 1872 [1], is an unusual vascular neoplasm that most likely arises from endothelial cells, with some evidence of lymphatic origin. Different clinical and epidemiological variants have been identified. Lesions of KS typically manifests as bluish-purple macules and plaques on the skin, particularly of the face and lower extremities. Oral mucosa, lymph nodes and visceral organs may be affected, sometimes without cutaneous involvement.

Bouche et infections virales

Exclude herpes infection in the presence of acute oral ulcers of unknown origin, particularly in patients in poor general condition. Remember that asymptomatic HSV-1 shedding in saliva may result in an oral-genital transmission. Perform an anogenital examination and a screening for other sexually transmitted diseases when oral warts are diagnosed. Search for immunosuppression and monitor the patient (screening for a potential associated carcinoma) when there is rapid growth of oral warts. Consider all the clinical signs (systemic, skin, other mucosa, immunity...) when a patient has an enanthem or oral ulcerations. Ask for a HIV test when an oral Kaposi's sarcoma, a hairy leukoplakia or major aphthae are diagnosed.

Quantification of oral palatine Langerhans cells in HIV/AIDS associated oral Kaposi sarcoma with and without oral candidiasis.

Langerhans cells (LCs) are effective antigen-presenting cells that function as "custodians" of mucosa, modifying the immune system to pathogen entry, and tolerance to self-antigen and commensal microbes. A reduction in number of LCs in human immunodeficiency virus (HIV)-positive individuals may predispose to local mucosal infections. To quantitatively determine the number of oral mucosal LCs in HIV/acquired immunodeficiency syndrome HIV/acquired immunodeficiency syndrome (AIDS) associated oral Kaposi sarcoma (KS) with/without oral candidiasis (OC) and to define in situ interrelationships between the cells, OC, and HIV infection. Thirty-two periodic acid-Schiff. (PAS) stained histologic sections of palatal HIV/AIDS associated KS with intact oral epithelium were examined for Candida and divided into two groups: . (1) KS coinfected with Candida and. (2) KS noninfected with Candida. Sections were immunohistochemically stained with CD1a. The standard length of surface epithelium was measured and number of positively stained LCs counted per unit length. Control cases included non-Candida infected palatal mucosa overlying pleomorphic adenoma. (PA) and oral mucosa infected with Candida in otherwise healthy individuals. LC number per unit length of surface epithelium was statistically significantly greatest in uninfected PA mucosa and lowest in KS coinfected with Candida (P = 0.0001). A statistically significant difference was also noted between uninfected PA mucosa and non-Candida infected KS (P = 0.0014), in KS coinfected with Candida and non-infected KS (P = 0.0035), between OC and PA (P = 0.0001), and OC and KS coinfected with Candida (P = 0.0247). LC numbers are significantly reduced in oral tissues of HIV/AIDS infected patients by Candida infection when compared to oral tissues without.

Co-Infection of Cytomegalovirus in Oral Kaposi's Sarcoma: A Case Report

Co-Infection of Cytomegalovirus in Oral Kaposi's Sarcoma: A Case Report

Diagnostic challenges of oral and cutaneous Kaposi's sarcoma in resource-constrained settings.

Kaposi's sarcoma (KS), caused by HHV-8, is the most frequent HIV-associated malignancy worldwide and remains a major scourge in Sub-Saharan Africa. KS is also endemic in much of Africa. There is a risk of misdiagnosis based solely on clinical appearance and haematoxylin and eosin (H&E) staining, especially with other reactive and neoplastic vascular proliferations which occur in the mouth. This study examined oral and cutaneous biopsies from clinically diagnosed lesions of KS in Kenya, using histopathology supplemented with immunohistochemistry (IHC) and polymerase chain reaction (PCR) for HHV-8 as confirmation of diagnosis. Biopsies of 49 lesions (28 oral, 21 cutaneous) previously diagnosed as 'KS' were re-examined by H&E staining and IHC targeting HHV-8 LANA-1. Positive controls were sections from embedded BCBL-1 cell lines. Negative controls were from three different HHV-8-negative biopsies. Confirmation of HHV-8 immunohistochemistry was sought by PCR and by determining the HHV-8 ORFK1 subtype. Whilst most cases were confirmed, 12 oral and 4 cutaneous lesions displayed clinical and histological features of KS but were negative to HHV-8 IHC. These oral lesions were re-diagnosed as pyogenic granulomata (n = 6), deep mycosis (n = 1), inflamed mucosa (n = 2) or 'uncertain but not KS' (n = 3). Whilst PCR is usually helpful in differentiating HHV-8 disease, all samples were HHV-8 PCR positive, with identical sequences, suggesting cross-contamination of samples in the original pathology laboratories. HHV-8 IHC is essential for the correct diagnosis of KS, but due to the high level of contamination in resource-poor settings, PCR is inadvisable.

Phenotypic Variability of Candida Species in Patients of Oral Lichen Planus and its Therapeutic Implications

DESMOPLASTIC KAPOSI SARCOMA A NEWLY RECOGNISED ORAL MUCOSAL VARIANT Belinda Kathleen Bunn, Willie Van Heerden, Department of Oral Pathology and Oral Biology, University of Pretoria, South Africa Objective: To distinguish desmoplastic Kaposi sarcoma (DKS) from other morphological variants of oral Kaposi sarcoma (OKS) and to investigate the possibility of a pathogenetic link to IgG-related disease. Study Design: Fourteen cases of DKS were reviewed and the clinicopathological features summarised. Immunohistochemical staining for SMA, IgG and IgG4 was performed. Results: Distinctive features of DKS include:

Mucocutaneous manifestations and the relationship to CD4 lymphocyte counts among Turkish HIV/AIDS patients in Istanbul, Turkey.

Dermatologic findings differ among countries but no sufficient data about Turkish HIV-infected patients exist in the literature. Therefore, our aim in this study was to document the dermatologic manifestations and their relationships with CD4 cell counts among HIV/AIDS patients visiting our clinic for the first time in Istanbul, Turkey. A retrospective analysis of 306 HIV/AIDS patients (260 men, mean age: 38.3 years) was done in a tertiary hospital in Istanbul from January 2006 to September 2012. Information on age, sex, transmission routes, socioeconomic and educational status, CD4 counts, and dermatologic findings was collected retrospectively from medical records. Our analyses revealed at least 1 dermatologic disease in 111 of the 306 (36.2%) patients. Mean CD4 count of the patients was 393.64 cells/mm3 (range: 4-1270 cells/mm3). Oral candidiasis (12.4%), herpes zoster (5.9%), dermatophytosis (5.4%), hyperpigmentation (5.2%), and folliculitis (4.6%) were the most common skin problems. Statistically significant correlation (P < 0.05) with low CD4 cell counts was found for oral candidiasis, folliculitis, herpes zoster, hyperpigmentation, xerosis, and Kaposi's sarcoma. Dermatologic manifestations in this study were identical to those described in most studies from Asia, and there were more manifestations as the HIV infection progressed and immune functions declined.

Association between oral candidiasis and low CD4+ count among HIV positive patients in Hoima Regional Referral Hospital.

BackgroundThe aim of this study was to determine the prevalence of Human Immune Virus (HIV) related oral lesions and their association with Cluster of Differentiation 4 (CD4+) count among treatment naïve HIV positive patients.MethodsThis was a descriptive and analytical cross sectional study. Participants were 346 treatment naïve HIV positive adult patients. These were consecutively recruited from Hoima Regional Referral hospital between March and April 2012. Data collection involved interviews, oral examinations and laboratory analysis.ResultsA total of 168(48.6%) participants had oral lesions. The four commonest lesions were oral candidiasis (24.9%, CI = 20.6-29.7%), melanotic hyperpigmentation (17.3%, CI = 13.7-21.7%), kaposi sarcoma (9.3%, CI = 6.6-12.8%) and Oral Hairy Leukoplakia (OHL) (5.5%, CI = 3.5-8.4%). There was significant association between oral candidiasis and immunosuppression measured as CD4+ less than 350 cells/mm3 (OR = 2.69, CI = 1.608-4.502, p < 0.001). Oral candidiasis was the only oral lesion significantly predictive of immunosuppression (OR = 2.56, CI = 1.52-4.30, p < 0.001) with a Positive Predictive Value (PPV) of 48.2%, Negative Predictive Value (NPV) of 74.3%, 38.1% sensitivity and specificity of 81.4%.ConclusionOral candidiasis can be considered as a marker for immunesuppression, making routine oral examinations essential in the management of HIV positive patients.

OI0345 Oral squamous cell carcinoma and epithelial dysplasia in HIV-infected individuals

HIV-infected individuals are at increased risk of oral cavity Kaposi sarcoma and non-Hodgkin lymphoma. However, it is suggested this patient population may also be at increased risk of oral cavity squamous cell carcinoma (OSCC). It remains unclear whether this is secondary to known risk factors (such as smoking and alcohol) or relates to HIV-specific factors, such as coinfection with human papillomavirus or Candida species, or the use of highly active antiretroviral therapy (HAART).

Oral Kaposi’s sarcoma in immunosuppressed patients – report of cases

Kaposi sarcoma is a vascular neoplasm composed of endothelium-lined vascular spaces and spindle-shaped cells. It often manifests with multiple vascular nodules on the skin and other organs. Kaposi sarcoma is rare in HIV negative patients and it is associated with HHV-8 infection. There are four types: classic, endemic, iatrogenic and HIV-associated. Patients with HIV/AIDS are also at increased risk of developing Kaposi sarcoma. Objective: The aim of this article is to present two cases of Kaposi sarcoma in the hard palate of HIV/AIDS male patients. Case report and Conclusion:Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with bluish, smooth, firm, nonpulsatile macule or nodule in the region of the hard palate. Development of Kaposi sarcoma in the oral cavity also has prognostic implications for untreated HIV patients, who are found to have higher death rates than patients affected only by cutaneous disease.

Short-Chain Fatty Acids from Periodontal Pathogens Suppress Histone Deacetylases, EZH2, and SUV39H1 To Promote Kaposi's Sarcoma-Associated Herpesvirus Replication

Periodontal pathogens such as Porphyromonas gingivalis and Fusobacterium nucleatum produce five different short-chain fatty acids (SCFAs) as metabolic by-products. We detect significantly higher levels of SCFAs in the saliva of patients with severe periodontal disease. The different SCFAs stimulate lytic gene expression of Kaposi's sarcoma-associated herpesvirus (KSHV) dose dependently and synergistically. SCFAs inhibit class-1/2 histone deacetylases (HDACs) and downregulate expression of silent information regulator-1 (SIRT1). SCFAs also downregulate expression of enhancer of zeste homolog2 (EZH2) and suppressor of variegation 3-9 homolog1 (SUV39H1), which are two histone N-lysine methyltransferases (HLMTs). By suppressing the different components of host epigenetic regulatory machinery, SCFAs increase histone acetylation and decrease repressive histone trimethylations to transactivate the viral chromatin. These new findings provide mechanistic support that SCFAs from periodontal pathogens stimulate KSHV replication and infection in the oral cavity and are potential risk factors for development of oral Kaposi's sarcoma (KS). About 20% of KS patients develop KS lesions first in the oral cavity, while other patients never develop oral KS. It is not known if the oral microenvironment plays a role in oral KS tumor development. In this work, we demonstrate that a group of metabolic by-products, namely, short-chain fatty acids, from bacteria that cause periodontal disease promote lytic replication of KSHV, the etiological agent associated with KS. These new findings provide mechanistic support that periodontal pathogens create a unique microenvironment in the oral cavity that contributes to KSHV replication and development of oral KS.

Oral Kaposi's Sarcoma in HIV Patients: Report of Two Cases

Oral Kaposi's Sarcoma in HIV Patients: Report of Two Cases

Human herpes virus-8 in human immunodefi ciency virus/ acquired immunodefi ciency syndrome - associated oral Kaposi’s sarcoma

Human herpes virus-8 (HHV-8), now called Kaposi’s sarcoma-associated herpes virus (KSHV), as a probable causative agent of Kaposi’s sarcoma (KS) was putforth when it was first detected in KS specimens in 1994. Since then, many investigators have confirmed the association of HHV-8 and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) - associated KS. This study was done to review the original research aimed at assessing the presence of HHV-8 in HIV/AIDSassociated oral KS and other oral lesions.

Knowledge and Attitudes about HIV/AIDS of Students in H.P. Government Dental College and Hospital, Shimla, India

The purpose of this cross-sectional survey was to assess the knowledge and attitudes towards patients with HIV/AIDS among dental students in H.P. Government Dental College, Shimla, India. In November 2011, a survey was conducted of all the dental students of the college using a forty-five-item, self-administered questionnaire. The total mean knowledge score was 68.3 percent (good knowledge). The mean knowledge score was statistically higher in the clinical group than in the preclinical group. A majority of the students were aware of the association between HIV and oral candidiasis (89.1 percent), major aphthous (83.2 percent), and Kaposi's sarcoma (68.9 percent). Only 4.9 percent had professional attitudes about treating patients with HIV/AIDS. Male students had significantly fewer negative attitudes and higher positive attitudes than female students. The overall attitude score was significantly higher in the clinical group than in the preclinical group. Although a majority of the students had good knowledge, there were some inadequacies in their knowledge; those were more frequently seen in the preclinical students. It is important that dental students, as future dentists, develop not only the necessary practical skills but also knowledge and attitudes that will prepare them to treat patients with HIV/AIDS.

Gender differences in oral manifestations among HIV-infected Brazilian adults

The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearing house criteria. A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39-13.36)]. These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.

Regression of oral Kaposi’s sarcoma after combination antiretroviral therapy

A 32-year-old homosexual Caucasian male presented withan asymptomatic lesion in the right maxilla that he noticed6 monthsearlier.Hispastmedicalhistoryrevealeduntreatedhuman immunodeficiency virus (HIV) seropositivity detec-ted3 yearsearlier.Bloodteststakenatpresentationrevealeda high viral load (5.12 log10–131,300 copies/ml) and a lowCD4-T cell count (39 cells/mm

Expression of PROX‐1 in oral Kaposi's sarcoma spindle cells

The histogenesis of neoplastic spindle cells of Kaposi's sarcoma is still uncertain, but some studies consider it a lymphatic vessel differentiation. Prox-1 is a nuclear transcription factor that plays a major role during embryonic lymphangiogenesis, and it has been considered a specific and sensitive lymphatic endothelial cell marker. The aim of this study was to determine the expression of Prox-1 in oral Kaposi's sarcoma comparing the results with oral benign vascular tumors including capillary hemangiomas and pyogenic granulomas. Expression of Prox-1 and HHV-8 was evaluated by immunohistochemistry in 30 oral Kaposi's sarcoma, 5 oral capillary hemangiomas, and 10 oral pyogenic granulomas. The labeling index was expressed as the percentage of positive cells for each case studied. Statistical comparison was performed using the Wilcoxon-Mann-Whitney rank sum test. Twenty-eight (93.3%) and 30 oral Kaposi's sarcoma cases were positive for Prox-1 and HHV-8, respectively, while all oral benign vascular tumors were negative for these markers. The number of Prox-1 and HHV-8 oral Kaposi's sarcoma-positive cells increased significantly from patch/plaque to nodular histological stages. The expression of Prox-1 in the neoplastic spindle cells supports the view of a lymphatic differentiation in oral Kaposi's sarcoma. Prox-1 may also be involved in the pathogenesis of oral Kaposi's sarcoma as the number of positive spindle cells increased progressively from patch to nodular stages and could be eventually useful as an additional diagnostic tool for differential diagnosis between oral Kaposi's sarcoma and benign oral vascular lesions.