Sarcoma de kaposi en pacientes vih: a proposito de dos casos / Kaposi´s sarcoma in hiv patients: regarding two case report

RESUMEN: El Sarcoma de Kaposi es unaneoplasia de origen vascular,asociado obligadamente al virus Herpes Humano tipo 8. Presenta manifestaciones cutáneas en primer lugar, mucosas, ganglionares y viscerales. Puede evolucionar de forma leve con lesiones cutáneas, hasta casos fulminantes con compromiso sistémico, en caso de no realizar tratamiento. Existen múltiples opciones terapéuticas, las cuales se definen según el compromiso de la enfermedad y la afectación del paciente por su patología de base.El diagnóstico se basa en la sospecha clínica y se confirma con una biopsia histopatológica. El sarcoma de Kaposi corresponde a la neoplasia más frecuente en los pacientes con VIHse encuentraprincipalmente en hombres homosexuales. En este artículo se presentan dos pacientes con VIH con diagnóstico de Sarcoma de Kaposi y se realiza una breve revisión de la bibliografía.

ABSTRACT: Kaposi´s sarcoma is a vascular origin neoplasm, obligatory associated with Human Herpes Virus 8. It presents cutaneous manifestations at a first place, mucous, ganglionic and viscerals. It may present a mild presentation with cutaneous manifestations, up to fulminant cases with systemicinvolvement,in case of not being treated. There are a number of therapeutic options, defined by the state of the illness and the involvement of the patient due to the primary pathology. The diagnosis is based on the clinical suspicion and it is confirmed by a histopathological biopsy. Kaposi´s sarcomais the most frequent neoplasm in patients with HIV, being more frequently in homosexual men. In this article two HIV patients with Kaposi´s sarcoma diagnosis are exposed and a brief revision of the literature is done.

Sarcoma de Kaposi por dosis altas de esteroides / Kaposi´s sarcoma due to high dose of steroids

Se describe el caso clínico de una paciente de 42 años de edad, quien necesitó tratamiento reiterado con prednisona y a partir de entonces comenzó a presentar lesiones cutáneas en ambas piernas. Luego de ser valorada por especialistas en reumatología y dermatología fue remitida al Servicio de Angiología, donde se le realizó biopsia (con el uso de la coloración de hematoxilina-eosina), cuyos resultados fueron compatibles con un sarcoma de Kaposi, atribuible al suministro de esteroides.

The case report of a 42 years patient is described who needed repeated treatment with prednisone and from that time on she began to present cutaneous lesions in both legs. After being evaluated by reumatology and dermatology specialists, she was referred to the Angiology Service, where a biopsy was taken (with the use of the hematoxylin-eosine stain) which results were compatible with a Kaposi´s sarcoma, attributable to steroids supply.

Sarcoma de Kaposi en conjuntiva bulbar / Kaposi´s sarcoma in bulbar conjunctiva

Paciente masculino de 29 años de edad, raza blanca, soltero, profesor universitario, con antecedentes de padecer crisis de epilepsia tratado con fenitoína y actualmente controlado, menciona que desde hace aproximadamente 4 semanas comenzó con ojo rojo y molestias oculares del ojo derecho, por lo cual acudió a su área de salud donde fue tratado como cuadro de conjuntivitis. No mostró mejoría alguna, sino empeoramiento del cuadro clínico, y observó un enrojecimiento ocular intenso en el ángulo interno de dicho ojo que se fue extendiendo, acompañado de ligera fotofobia. Por la tórpida evolución del cuadro decidió acudir a nuestra institución por lo cual fue remitido a la Consulta de Oculoplastia. También refirió que desde hacía dos meses había presentado anorexia, dificultad al comer, así como pérdida de peso, por lo cual se decidió comenzar estudio y tratamiento. Se decidió realizar la resección de la masa tumoral en conjuntiva bulbar y se envió para estudio anatomopatológico. El resultado fue compatible con un sarcoma de Kaposi(AU)

A twenty-nine years-old male Caucasian patient, single and university professor, with a history of epilepsy treated with fenitoin and managed at present. He stated that 4 weeks ago approximately, he began feeling ocular discomfort in addition to reddened eye, so he went to his health area where he was treated as a conjunctivitis case. No improvement occurred, the clinical picture worsened and there was intensive ocular reddening in the internal angle of the eye that extended and mild photofobia. Because of the rapid profession of the clinical picture, he decided to go to our institution where he was referred to the Oculoplasty Service. He also said that he had been suffering anorexia, difficulties to eating and weight loss two months ago. It was then decided to start the study and treatment of this case. First, the tumor mass from the bulbar conjunctiva was resected and then sent to anatomical pathological study service. The result was compatible with Kaposi´s sarcoma diagnosis(AU)

Tres variedades de sarcoma de Kaposi con compromiso gastrointestinal / Three varieties of Kaposi’s sarcoma with gastrointestinal involvement

Se presentan casos de 4 pacientes adultos con 3 variedades de sarcoma de Kaposi: epidémico (asociado con infección por virus de inmunodeficiencia humana), iatrogénico (en paciente con inmunosupresión crónica y en un hombre con cirrosis alcohólica) y clásico (en paciente anciana sin inmunosupresión conocida); todos ellos presentaron compromiso gastrointestinal. Se hace una breve revisión de esta enfermedad.

This article presents the cases of four adult patients with three varieties of Kaposi’s sarcoma: epidemic, associated with human immunodeficiency virus infections; iatrogenic, associated with chronic immune suppression (and in this case in a man with alcoholic cirrhosis); and classic, occurring in elderly patient without previously known immunosuppression. All four cases had gastrointestinal involvement. A brief review of the disease is included.

Sarcoma de Kaposi. Una revisión / Kaposi's sarcoma

El Sarcoma de Kaposi es un tumor vascular de la piel, más frecuente en hombres mayores de 50 años, de larga evolución y baja mortalidad. Cada día cobran mayor interés los elementos epidemiológicos, como su relación con el SIDA (aumento de incidencia en jóvenes y niños, con una agresividad no habitual) y con la inmunosupresión en pacientes transplantados. Se atribuye una fuerte relación del Herpesvirus 8 como uno de los factores etiopatogénicos, y el tratamiento se ha reorientado en base a estos, pero aún no existe una terapia 100 por ciento eficaz.

A bibliographic review was done on Kaposi's sarcoma with the purpose of updating this topic, mainly in relation to its etiopathogenic aspects and therapeutic behavior. Kaposi's sarcoma is a vascular tumor of the skin, most frequently seen in men over 50 years, which develops throughout many years, rarely causing death. Its epidemiological elements have greater significance each day, such as its relation to AIDS and immunosuppresion in kidney transplants, as well as other organs.In the past years it has been observed worldwide in young patients, even children, with an unusual aggressiveness, more lesions and dissemination in the body, due to its relation to AIDS. A strong relation to Herpesvirus 8 is considered as one of the etiopathogenic factors, and treatment has been changed accordingly, but there is no 100 percent effective therapy.

Manifestaciones clínicas y evaluación diagnóstica en el Sarcoma de Kaposi / Clinical features and diagnostic evaluation in Kaposi´s sarcoma

El Sarcoma de Kaposi (SK) es una causa de compromiso respiratorio en el VIH/SIDA, que clásicamente ha indicado un pronóstico desfavorable. Esta definición está modificándose,según la extensión y alcance de los tratamientos actuales con antiretrovirales (HAART). Se exponen los rasgos clínicos y los recursos diagnósticos empleados en dos pacientesasistidos en nuestro hospital universitario. Las lesiones mucocutáneas generalizadas, los patrones característicos de tomografía computada de alta resolución (TCAR) junto a los hallazgos fibrobroncoscópicos (FBC) son descriptos en ambos casos. Se discuten los diagnósticos diferenciales para neoplasias e infecciones oportunistas, con la correspondiente revisión bibliográfica.

Kaposi´s sarcoma (KS) is considered one of the most severe manifestations related to lung involvement in HIV/AIDS. Present therapy with HAART has modified the incidence and prognosis of Kaposi´s sarcoma. However, KS is still a prevalent condition in HIV/AIDS patients. Clinical features, diagnostic patterns from High Resolution Computed Tomography (HRCT), and bronchofibroscopy findings are described in two patients.Differential diagnosis for main conditions in the AIDS clinical context (malignant neoplasm, opportunistic infections) is discussed with a review of previous reports.

Sarcoma de Kaposi associado a corticoterapia sistêmica / Kaposi sarcoma associated with systemic corticosteroid therapy

Sarcoma de Kaposi é uma neoplasia angioproliferativa de origem mesenquimal com acometimento cutâneo frequente. Encontra-se relacionado a doenças infecciosas ou a condições que envolvam imunossupressão. O objetivo deste trabalho é descrever um caso de sarcoma de Kaposi disseminado iatrogênico, em paciente usuária crônica de corticosteroide. Embora, atualmente, o sarcoma de Kaposi seja relacionado principalmente à síndrome da imunodeficiência adquirida, é importante destacar seu comportamento crescente como malignidade oportunista em pacientes em uso de imunossupressores, particularmente, corticosteróide

Kaposi’s sarcoma is a mesenchymal angioproliferative neoplasm with frequent cutaneous involvement. It is related to infectious diseases or conditions involving immunosuppression. The aim of this paper is to describe a case of disseminated iatrogenic Kaposi’s sarcoma in a female patient under corticosteroid therapy. Although currently Kaposi’s sarcoma is related primarily to the Acquired Immunodeficiency Syndrome, it is important to highlight its growing presence as an opportunistic malignancy in patients taking immunosuppressive drugs, particularly corticosteroids

Sarcoma de Kaposi: a propósito de un caso clínico, actualización del tema / Kaposi 's sarcoma: a case report, update on the topic

El sarcoma de Kaposi (KS por sus siglas en inglés) es una enfermedad similar al cáncer. Se relaciona con la infección del VIH, y se presenta en estadios avanzados de la enfermedad, afectando el 20% de las personas con VIH que no toman medicamentos antirretrovirales. En Pinar del Río existe una baja incidencia de infección por VIH/SIDA. Dada la infrecuencia del Sarcoma de Kaposi se presenta un caso. Paciente de 50 años de edad, que después de un cuadro de dolor en epigastrio comienza con lesiones en la piel similares a hematoma en resolución, con centro más oscuro y nodular, que toman prácticamente todo el cuerpo. El paciente presenta ligera pérdida de peso, pero no prurito, no fiebre, no lesiones en mucosa oral. Se determinó Hb: 112g/l Hto: 0.34l/l Leucocitos: 4.4x10(9)/l. Se encontró aumento de células mononucleares en el diferencial con linfopenia asociada; velocidad de sedimentación, colesterol, transaminasas, función renal y proteínas totales, normales, pero trombocitopenia moderada, acido úrico elevado. En el aspirado medular aparece predominio de linfocitos atípicos, con depresión relativa de las series hematopoyéticas. Gastroscopia, negativa. Biopsia de piel: Compatible con Sarcoma de Kaposi. VIH: tres exámenes durante el estudio con tiempo de intervalo entre ellos 3 meses desde el inicio resultaron negativos. Último examen viral a los 7 meses de iniciado el estudio (positivo) con Western Blot.

Kaposi´s Sarcoma (KS) is a cancer-like disease. It is most frequent related to HIV infection, present in late stages of the disease and affecting 20 % of HIV infected people having no Highly Active Antiretroviral Therapy (HAART). Since in Pinar del Rio Province a low incidence rate of HIV/AIDS is observed , Kaposi´s Sarcoma is very infrequent. A 50 year-old male who after presenting an epigastralgia suffers from hematoma-like skin lesions, in resolution and when palpated the darker center was nodular. These lesions take practically the whole body, observing loss of weight, no fever, no itching, no oral mucosa lesions. Determining Hb: 112 g/l, Hto; 0.34/L, Leukocytes: 4.4 x 4x10(9)/l, increase of mononuclear cells, associated to lymphopenia, but erythrocyte sedimentation rate, seric cholesterol, transaminases, kidney function and total proteins were normal. Moderated thrombocytopenia and high levels of uric acid were observed. In the bone marrow aspiration atypical lymphocytes and relative depression of the hematopoietic series prevailed. Gastroscopy was negative. Skin biopsy: Compatible with Kaposi´s Sarcoma. HIV: three exams during the study at 3 months intervals being negative from the beginning. The last viral examination carried out at 7 months after the beginning of the study resulted positive when Western Blot technique was used.

A Case of Gastric Kaposi's Sarcoma Successfully Treated with VP-16 / 대한소화기내시경학회지

Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. However, extracutaneous lesions are common and the gastrointestinal tract is often involved. Gastric Kaposi's sarcoma is usually asymptomatic, but may cause massive gastrointestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodules. In Korea, only one case of gastric Kaposi's sarcoma had been reported until now. A case of gastric Kaposi's sarcoma treated with VP-16 (etoposide) is here in reported with the endoscopic findings before and after chemotherapy.

Pseudo - Kaposi's Sarcoma Associated with Deep Vein Thrombosis / 대한피부과학회지

Pseudo-kaposi's sarcoma is a vasoproliferative disorder that may resemble Kaposi's sarcoma, clinically and histologically. In most cases, it has been associated with congenital or iatrogenic arteriovenous fistula and chronic venous insuffiency. We present a 36-year-old male patient with pseudo-Kaposi's sarcoma caused by a deed vein thrombosis in the absence of any detectable underlying etiologic factors.

Pseudo - Kaposi' s Sarcoma Developing After Placement of A - V Fistula for Hemodialysis / 대한피부과학회지

Pseudo-Kaposis sarcoma is a self-limited process associated with vascular malformations, without the neoplastic character of real Kaposis sarcoma. In most cases, it has been associated with an underlying congenital arterial venous fistula and chronic venous insufficiency, We present a case of Pseudo-Kaposis's sarcoma developing after plagment of arteriovenous fistula for hemodialysis in a patient wiith chronic renal failure and review cases reported in articles.

A Case of Conventional Kaposi' s Sarcoma / 대한피부과학회지

Convcntional Kaposi's sarcorna is distinguished frorn AIDS-associated Kaposi's sarcorna.. The authors report a case of 65 year-old male who presented with a nodular type of conventional Kaposi's sarcoma. The result of the serum antibody test against HTLV-3 in this patient was negative. Trial with b-interferon administered systemically and by local injection showed favorable results. Following 4 weeks of treatment, the tumor masses had markedly decreased in size. The authors suggest that b-interferon treatment for this patient was effectivc.