Non-AIDS-related Kaposi’s sarcoma:A single-institution experience

AIM:To evaluate the outcomes and potential prognostic factors in patients with non-acquired immunodeficiency syndrome(AIDS)-related Kaposi’s sarcoma(KS).METHODS:Patients with histologically proven non-AIDS-related KS treated with systemic chemotherapy were included in this retrospective analysis.In some cases,the human herpes virus 8 status was assessed by immunohistochemistry.The patients were staged according to the Mediterranean KS staging system.A multivariable model was constructed using a forward stepwise selection procedure.A P value<0.05 was considered statistically significant,and all tests were two-sided.RESULTS:Thirty-two cases were included in this analysis.The average age at diagnosis was 70 years,with a male/female ratio of approximately 2:1.Eighty-four percent of the cases had classic KS.All patients received systemic chemotherapy containing one of the following agents:vinca alkaloid,taxane,and pegylated liposomal doxorubicin.Ten patients(31.5%)experienced a partial response,and a complete response was achieved in four patients(12.4%)and stable disease in sixteen cases(50%).Two patients(6.2%)were refractory to the systemic treatment.The median progression-free survival(PFS)was 11.7 mo,whereas the median overall survival was 28.5 mo.At multivariate analysis,the presence of nodular lesions(vs macular lesions only)was significantly related to a lower PFS(hazard ratio:3.09;95%CI:1.18-8.13,P=0.0133).CONCLUSION:Non-AIDS-related KS appears mostly limited to the skin and is well-responsive to systemic therapies.Our data show that nodular lesions may be associated with a shorter PFS in patients receiving chemotherapy.

Genotypic analysis on the ORF-K1 gene of human herpesvirus 8 from patients with Kaposi's sarcoma in Xinjiang,China

Human herpesvirus 8 （HHV-8） is thought to be essential for the development of all forms of Kaposi＇s sarcoma （KS）. HHV-8 DNA is present virtually in all KS tumor biopsy samples. Genes at both ends of the HHV-8 genome have been shown to vary considerably. Seven major molecular subtypes of HHV-8 were defined based on the amino acid sequence of the open reading frame K1 （ORF-K1）, generally known as A, B, C, D, E, F, and Z. Most strains collected worldwide were clustered into two subtypes （A and C）. Here, the K1/VRI region of HHV-8 was amplified by nested PCR in 22 （81.48%） of 27 cases from Xinjiang Uygur Autonomous Region, a province in northwestern China. Phylogenetic analysis on the basis of the K1/VR1 amino acid sequence indicated that the majority of these KS patients were infected by subtype C HHV-8 （n = 18, including 15 belonging to the C2 group）, and several by subtype A （n = 4, including 3 being the A1 group）. This is the first report of subtype A HHV-8 in China. Furthermore, the correlations between different forms and lesions of KS and different subtypes of HHV-8 were analyzed. The findings showed that subtype A HHV-8 resulted in significantly more frequent mucosal KS lesions than subtype C. However, there was no obvious correlation between different forms of KS and different subtypes of HHV-8.

Kaposi’s sarcoma manifested as lower gastrointestinal bleeding in a HIV/HBV-co-infected liver cirrhosis patient: A case report

BACKGROUND Kaposi’s sarcoma(KS)is one of the most common cancers in human immunodeficiency virus(HIV)-positive patients and leads to a high prevalence of morbidity and mortality.It usually appears as cutaneous or mucous lesions.Patients with visceral KS are asymptomatic and clinically silent.As the disease advances,patients may progress from a normal condition to exhibiting severe symptoms.CASE SUMMARY A 27-year-old man presented with a 2-mo history of fever,bearing-down pain,and rectal bleeding.His hepatitis B virus DNA level was 2.7×107 IU/mL.Abdominal computed tomography(CT)indicated liver cirrhosis.Before he was admitted to our hospital,he was diagnosed with HIV infection.His CD4 count was 24 cells/μL.Pelvic cavity CT suggested a thickened rectum wall accompanied by multiple enlarged lymph nodes.The patient was initially treated as having haemorrhoidal varices with bleeding,telbivudine for anti-hepatitis B virus treatment,and antibiotics for anti-infection.After half a month of treatment,the patient felt that his lower lumbus ache and bearing-down pain had not improved,and a colonoscopy was conducted.The result revealed a rectal mass that was histologically confirmed as KS with rectal spindle cells that were positive for cluster of differentiation 117(CD117),CD34,human herpes virus 8,and CD31.He was administered systemic chemotherapy with 36 mg/d liposomal doxorubicin six times.The patient experienced no sign of lower gastrointestinal bleeding again.CONCLUSION This case highlights the diagnosis of primary KS with lower gastrointestinal bleeding in HIV-positive patients,which means visceral KS could not be excluded.The gold standard relies on colonoscopy and biopsy findings.

The effect of ABV regimen on CD4 lymphocyte count in patients with advanced HIV related Kaposi’s sarcoma

Objective: The combination of highly active antiretroviral therapy (HAART) and chemotherapy with ABV regimen (doxorubicin, bleomycin and vincristine) is a promising approach for the treatment of advanced HIV-related Kaposi's sarcoma (KS). Here we analyzed the relationship between the CD4 lymphocyte cell count and the clinical response to chemotherapy. Methods: The 176 HIV infected patients with advanced KS who failed to respond to prior HAART were selected. All these patients were then preceded to chemotherapy with ABV regimen which was administered at 3 weekly intervals for 6 cycles. For each patient CD4 cell count was done before starting chemotherapy and after finishing 6 cycles of chemotherapy. The difference of CD4 cell counts pre chemotherapy and post chemotherapy was compared with the clinical progress of the patients after 6 cycles of chemotherapy. Results: The overall clinical remission was shown in 93.7% patients. Progressive disease (PD) and no change in clinical condition (NC) was shown in 6.3% patients. The increase in CD4 cell count post chemotherapy was found in 89.8% patients and the decrease in CD4 cell count was seen in 10.2% patients. The difference of the mean CD4 cell counts for patients in group CR + PR (complete relief + partial relief) before and after chemotherapy was highly significant. The difference of the mean CD4 cell counts for patients in group NC + PD before and after chemotherapy was not significant. The difference in CD4 cell counts in CR + PR and NC + PD groups before and after chemotherapy was highly significant. Conclusion: The HIV related KS patients on HAART benefit from the chemotherapy as it increases the CD4 cell count and it has positive impact on clinical remission of KS.

Facial nerve palsy, headache, peripheral neuropathy and Kaposi's sarcoma in an elderly man

We present a case of an elderly man, who initially presented with right facial nerve palsy, ipsilateral headache, elevated erythrocyte sedimentation rate(ESR) and no fever. A presumptive diagnosis of giant cell arteritis was made and the patient was treated with highdose steroids. A temporal artery biopsy was negative. Several months later, while on 16 mg of methylprednisolone daily, he presented with severe sensorimotor peripheral symmetric neuropathy, muscle wasting and inability to walk, uncontrolled blood sugar and psychosis. A work-up for malignancy was initiated with the suspicion of a paraneoplastic process. At the same time a biopsy of the macular skin lesions that had appeared on the skin of the left elbow and right knee almost simultaneously was inconclusive, whereas a repeat biopsy from the same area of the lesions that had become nodular, a month later, was indicative of Kaposi'ssarcoma. Finally, a third biopsy of a similar lesion, after spreading of the skin process, confirmed the diagnosis of Kaposi's sarcoma. He was treated with interferon α and later was seen in very satisfactory condition, with no clinical evidence of neuropathy, normal muscle strength, no headache, normal electrophysiologic nerve studies, involution of Kaposi's lesions and a normal ESR.

Intestinal Kaposi's sarcoma may mimic gastrointestinal stromal tumor in HIV infection

Diffuse intestinal Kaposi＇s sarcoma shares macroscopic and histopathologic features with gastrointestinal stromal tumors. Correct diagnosis may pose a clinical challenge. We describe the case of a young HIV-1-infected African lady without advanced immunodeficiency, who presented with a diffuse spindle cell tumor of the gut. Initial diagnosis was of a gastrointestinal stromal tumor, based on endoscopy and histopathology. Further evaluation revealed evidence for human herpesvirus 8 （HHV8） and the diagnosis had to be changed to diffuse intestinal Kaposi＇s sarcoma. Antiretroviral triple therapy together with chemotherapy was commenced, and has led to the rapid remission of intestinal lesions. With a background of HIV infection, the presence of HHV8 as the causative agent of Kaposi＇s sarcoma should be determined, as distinct treatment is indicated.

Angiogenesis,Kaposi’s Sarcoma and Kaposi’s Sarcoma-associated Herpesvirus

Tumor angiogenesis is the uncontrolled growth of blood vessels in tumors,serving to supply nutrients and oxygen,and remove metabolic wastes. Kaposi’s sarcoma (KS),a multifocal angioproliferative disorder characterized by spindle cell proliferation,neo-angiogenesis,inflammation,and edema,is associated with infection by Kaposi's sarcoma-associated herpesvirus (KSHV). Recent studies indicate that KSHV infection directly promotes angiogenesis and inflammation through an autocrine and paracrine mechanism by inducing pro-angiogenic and pro-inflammatory cytokines. Many of these cytokines are also expressed in KS lesions,implicating a direct role of KSHV in the pathogenesis of this malignancy. Several KSHV genes are involved in KSHV-induced angiogenesis. These studies have provided insights into the pathogenesis of KS,and identified potential therapeutic targets for this malignancy.

Diagnostic value of endothelial markers and HHV-8 staining in gastrointestinal Kaposi sarcoma and its difference in endoscopic tumor staging

AIM: To clarify the diagnostic values of hematoxylin and eosin (HE), D2-40, CD31, CD34, and HHV-8 immunohistochemical (IHC) staining in gastrointestinal Kaposi's sarcoma (GI-KS) in relation to endoscopic tumor staging. METHODS: Biopsy samples (n = 133) from 41 human immunodeficiency virus-infected patients were reviewed. GI-KS was defined as histologically negative for other GI diseases and as a positive clinical response to KS therapy. The receiver operating characteristic area under the curve (ROC-AUC) was compared in relation to lesion size, GI location, and macroscopic appearances on endoscopy. RESULTS: GI-KS was confirmed in 84 lesions (81.6%). Other endoscopic findings were polyps (n = 9), inflammation (n = 4), malignant lymphoma (n = 4), and condyloma (n = 2), which mimicked GI-KS on endoscopy. ROC-AUC of HE, D2-40, blood vessel markers, and HHV-8 showed results of 0.83, 0.89, 0.80, and 0.82, respectively. For IHC staining, the ROC-AUC of D2-40 was significantly higher (P < 0.05) than that of HE staining only. In the analysis of endoscopic appearance, the ROC-AUC of HE and IHC showed a tendency toward an increase in tumor staging (e.g. , small to large, patches, and polypoid to SMT appearance). D2-40 was significantly (P < 0.05) advantageous in the upper GI tract and for polypoid appearance compared with HE staining. CONCLUSION: The diagnostic value of endothelial markers and HHV-8 staining was found to be high, and its accuracy tended to increase with endoscopic tumor staging. D2-40 will be useful for complementing HE staining in the diagnosis of GI-KS, especially in the upper GI tract and for polypoid appearance.

Splenic Kaposi’s sarcoma in a human immunodeficiency virusnegative patient:A case report

BACKGROUND Kaposi’s sarcoma(KS)is a malignancy that usually affects the skin of the lower extremities,and may involve internal organs.It originates from the vascular endothelium.It is well known that the development of KS is associated with human herpes virus 8(i.e.HHV8)infections.Sporadic KS cases have mainly been found in Africa.Isolated splenic KS in Asia has rarely been reported.We present here a case of KS primarily involving the spleen in a human immunodeficiency virus(HIV)-negative Chinese patient.CASE SUMMARY A 50-year-old male patient was admitted to hospital due to abdominal distension and discomfort,reduced food intake and weight loss.Medical examination revealed that the patient had moderate anemia,a low platelet count,slight fatty liver and a huge mass in the spleen.Spleen lymphoma was considered.An anti-HIV test was negative.The whole spleen was surgically excised.The final pathological diagnosis was nodular stage spleen KS,and the patient underwent total splenectomy.He recovered well and was discharged from hospital 12 d after surgery.Two weeks later,the patient developed liver metastasis and died within 1 mo after surgery.CONCLUSION KS is difficult to diagnose and pathological examination is necessary.KS has a poor prognosis and should be diagnosed and treated early to improve survival.

Mathematical Model of Classical Kaposi’s Sarcoma

In this paper, the global properties of a classical Kaposi’s sarcoma model are investigated. Lyapunov functions are constructed to establish the global asymptotic stability of the virus free and virus (or infection) present steady states. The model considers the interaction of B and progenitor cells in the presence of HHV-8 virus. And how this interaction ultimately culminates in the development of this cancer. We have proved that if the basic reproduction number, R0 is less than unity, the virus free equilibrium point, ε0, is globally asymptotically stable (GAS). We further show that if R0 is greater than unity, then both the immune absent and infection persistent steady states are GAS.

Treatment of Kaposi’s Sarcoma by Combination of Zinc Sulfate and Propranolol

Kaposi’s sarcoma (KS) in Iraq has been reported as sporadic cases of elderly of Iraqi population but after exposure to depleted uranium radiation in early 1991, the frequency of the disease is increasing appearing in younger age with more wide spread and aggressive in nature. There is no satisfactory oral treatment to control this disease. The aim of the present work is to record a new regime of therapy using oral zinc sulfate and oral propanolol. Four patients with wide spread Kaposi’s sarcoma (KS) were treated with oral and topical zinc sulfate solution and oral propranolol. The duration of treatment was between 6 - 12 months and the response started few weeks and was obvious after one month. Most old lesions were resolved leaving post inflammatory hyperpigmentation and few lesions appeared during course of treatment.

14例Kaposi肉瘤临床与病理分析

目的：为了提高对Ｋａｐｏｓｉ肉瘤临床病理特征的认识，减少误诊和漏诊。方法：对１４例Ｋａｐｏｓｉ肉瘤进行了光镜观察。结果：病变主要发生在皮肤，呈多发性，最常累及四肢远端。病变由血管裂隙、肉瘤样间质、血管外红细胞溢出及含铁血黄素沉着所构成。结论：在同一病变中存在裂隙状血管、肉瘤样梭形细胞增生及血管外红细胞溢出与含铁血共素沉着是早期诊断及与纤维母细胞性病变和其他血管源性肿瘤区别的关键。

肾移植受者并发Kaposi肉瘤的诊治和预防

目的：探讨同种异体肾移植受者并发Ｋａｐｏｓｉ肉瘤的诊治和预防。方法：回顾分析我院７７３例肾移植受者中４例Ｋａｐｏｓｉ肉瘤的诊治经过。结果：肾移植术后Ｋａｐｏｓｉ肉瘤的发生率为０５２％，占同期所发生的各类恶性肿瘤的３６４％，发生时间分别为术后３、７、１４、２１个月，首发症状为咽喉痛、咽部异物感伴吞咽困难者２例，双下肢对称性多发紫红色斑丘疹并下肢水肿者２例，均经病理检查确诊。治愈２例。结论：应提高对肾移植受者并发Ｋａｐｏｓｉ肉瘤的认识，强调尽早行组织学检查，确诊后立即减少或停用免疫抑制剂。

维吾尔族Kaposi’s肉瘤患者组织中KSHV-vFLIP表达水平与患者临床特征相关性

目的探讨维吾尔族卡波西肉瘤(Kaposi’s sarcoma,KS)患者皮损组织内KSHV-vFLIP基因表达水平与临床特征的相关性。方法选取29例维吾尔族卡波西肉瘤患者和12例血管瘤(hemangioma)患者、11例健康对照患者皮损石蜡包埋组织,反转录-聚合酶链反应(RT-PCR)分析KSHV-vFLIP基因mRNA表达水平。结果 KS患者KSHV-vFLIP基因表达水平(4.436±0.508)显著高于健康对照组(1.145±0.112,P<0.05),其中斑块型组KSHV-vFLIP基因表达水平(8.104±2.225)显著高于结节型组(3.971±0.371,P<0.05)和斑片组(2.774±0.867,P<0.05)。而KS组(4.436±0.507)与血管瘤组(6.343±0.949)差异无统计学意义(P>0.05),且HIV携带组(3.739±0.816)与非HIV携带组(4.618±0.604)差异无统计学意义(P>0.05)。结论在维吾尔族卡波西肉瘤患者组织中,KSHV-vFLIP基因表达水平与瘤体体积正相关。

艾滋病相关型Kaposi肉瘤1例

患者男,32岁。口腔上颚出现褐色增生物、面颈部及阴茎出现褐色斑块和结节4个月,周身乏力3个月。皮损组织病理示:真皮血管扩张,充血明显,部分呈出芽状生长,间质内可见小灶性梭型细胞。血清抗HIV抗体阳性;RPR(-);球蛋白52.2g/L;免疫全项:CD4:12细胞/μL;CD8:430细胞/μL;CD4/CD8:0.03;β微球蛋白6.4mg/L;A/G:0.7;WBC:1.4×109/L,L:0.5×109/L。诊断:艾滋病相关型Kaposi肉瘤。

经典型Kaposi,s肉瘤放射治疗加生物治疗

目的 分析了 8例Kaposi,s肉瘤 (KS)的临床特点和放疗加生物治疗的疗效。方法 采用6 0 钴或加速器 χ线和电子线混合射线常规分割照射 ,总量 36～ 6 1Gy。生物疗法包括LAK细胞和干扰素、免疫核糖核酸。结果 除例 1放疗后 2个月死于糖尿病、例 6失访外 ,其余均获长期生存。生存 1年以上 6 /8,3年以上 4 /8,5年以上 2 /8。结论 放射线治疗对KS有效 ,较晚期根治剂量以 5 0Gy左右为宜 ,同时加生物治疗可能可以提高疗效。

Kaposi肉瘤组织内人疱疹病毒8型的K14.1基因型研究

目的:确定人疱疹病毒8型K14.1基因等位基因型在Kaposi肉瘤中的分布,及与Kaposi肉瘤临床分型的关系。方法:使用酚-氯仿-异戊醇法对32例Kaposi肉瘤石蜡包埋组织进行病毒DNA提取,使用PCR法扩增K14.1基因片段,然后确定其等位基因型。结果:32例中有27例人疱疹病毒8型感染为阳性,阳性率为84.38%,其中5例艾滋病相关型KS患者HHV-8感染均为阳性,感染率100%;在分析的27例HHV-8病毒株中,24例为P等位基因型(包括5例艾滋病相关型KS患者皮损),3例为M等位基因型(均来自经典型KS)。结论:本研究中,Kaposi肉瘤感染的人疱疹病毒8型的K14.1等位基因型以P等位基因型为主。

艾滋病并Kaposi肉瘤的X线胸片表现及其诊断价值

目的:探讨艾滋病(AIDS)最常见的相关性恶性肿瘤Kaposi肉瘤(KS)的胸部X线表现及其诊断价值。材料和方法:回顾性分析经临床和病理确诊为AIDS并发KS胸部侵犯的24例胸部X线平片的表现,对其X线表现进行分析并评估其诊断价值。结果:AIDS并发KS的胸部X线表现为间质型网织结节影(6/24例),片块状阴影(5/24例),肺门增大增浓和纵隔影增宽(10/24例),胸腔积液和心包积液(6/24例),机会性感染(6/24例),特异性感染(2/24例)。X线平片无明显异常发现(5/24例)。结论:AIDS并发KS的表现多种多样,诊断需紧密结合临床。

经典型Kaposi肉瘤CD164,c-myc的检测

目的探讨差异表达基因在经典型Kaposi肉瘤(KS)中的作用,为揭示KS的发病机制提供新的思路。方法采集经典型KS肿瘤组织、来源于同一患者的正常皮肤组织及血清。运用巢式PCR检测是否感染了人类8型疱疹病毒(HHV-8)。利用抑制性差减杂交(SSH)技术分析KS肿瘤组织差异基因表达谱。结果患者HHV-8检测阳性,在KS肿瘤组织中差异表达的基因28条,包括基因CD164,c-myc。结论基因CD164,c-myc在KS发病机制中可能发挥一定作用,此作用可能与HHV-8病毒感染存在一定的关系。

新疆地区经典型Kaposi肉瘤患者血清性激素及外周血白细胞受体水平变化与临床意义探讨

目的探讨新疆地区经典型Kaposi肉瘤患者血清性激素及外周血白细胞受体水平变化与临床意义。方法选取2010年5月至2020年6月新疆医科大学第一附属医院诊治的经典型Kaposi肉瘤患者85例纳入肉瘤组,另选取同期体检的健康者59例纳入对照组。检测肉瘤组和对照组外周血睾酮(T)、雌二醇(E_(2))及白细胞雄激素受体(AR)、雌激素受体(ER)水平,分析以上指标与肉瘤组临床病理特征的关系。结果肉瘤组外周血E_(2)、ER水平低于对照组,差异具有统计学意义(P<0.05);肉瘤组外周血E_(2)、ER水平在性别、组织病理分期、皮损面积大小方面比较,差异具有统计学意义(P<0.05)。结论新疆经典型Kaposi肉瘤患者外周血E_(2)、ER水平降低,且可能与患者性别、肿瘤组织病理分期及皮损面积有关。