肝肾联合移植术后并发Kaposi’s肉瘤(附1例报告)

目的 :探讨器官移植受者并发Kaposi’s肉瘤的发生率、原因及诊治。 方法 :回顾分析 1例肝肾联合移植术后合并Kaposi’s肉瘤患者的临床诊治经过。 结果 :患者于术后 17个月起病 ,首发症状为腹膜后淋巴结肿大 ,随后出现腹股沟淋巴结肿大及腹部红褐色斑丘疹 ,经病理活检确诊 ,CsA减量联合小剂量化疗 ,起病半年死亡。结论 :Kaposi’s肉瘤是器官移植受者的常见并发症 ,发病常与免疫抑制过度及HHV - 8病毒感染有关 ,诊断依赖于组织病理学检查 ,予小剂量化疗及减少免疫抑制剂的用量 。

26例新疆Kaposi’s肉瘤放射治疗的疗效分析

目的:探讨Kaposi’s肉瘤(KS)放射治疗剂量与疗效的关系。方法:26例Kaposi’s肉瘤患者共有66个照射野,按总剂量不同分为三组,<40Gy组,40Gy～45Gy组,46Gy～52 Gy组。采用加速器X线,电子线或混合射线常规分割照射,每周5次,每次2Gy。结果:本组66个照射野总的客观缓解率(CR+PR)66.7%,其中<40Gy组为41.7%,40Gy～45Gy组为81.8%,46Gy～52Gy组为80.6%。40Gy～45Gy组与46Gy～52Gy组疗效优于<40Gy组,差异具有统计学意义(P<0.05)。放射性皮炎随着剂量的增加而加重,<40Gy组Ⅲ°～Ⅳ°放射性皮炎发生率8.3%,40Gy～45Gy组为27.3%,46Gy～52Gy组为77.4%,46Gy～52Gy组Ⅲ°～Ⅳ°放射性皮炎发生率明显高于40Gy～45Gy和<40Gy组(P<0.001),但皮损局部消炎处理后基本可痊愈。26例患者5例KS患者死于其他疾病,1例患者死于皮肤及肺部感染,其余20例患者带瘤存活。结论:Kaposi’s肉瘤是一种放射治疗敏感的恶性肿瘤,常规分割照射剂量40Gy～52Gy为宜。

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.

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.

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.

Kaposi’s Disease (KS) in a Senegalese Child Living with HIV

Kaposi’s Disease or Kaposi’s Sarcoma (SK ) is a multifocal malignant proliferation induced by viral growth factors, including interleukin 6 of human herpes virus type 8 (HHV8). We describe four forms of this disease who poses a real public health problem in East and Central Africa. The purpose of our observation was to report a rare condition in a Senegalese HIV-positive child. It was an 11-year-old girl from a region in central Senegal. She was an orphan of both parents, tested and monitored since the age of 5 for HIV infection 1. She was on the 1st line protocol. Due to a lack of support and good observance, she was referred to us at the age of 11 for follow-up in our structure in the suburbs of Dakar. The initial follow-up assessment showed a very low CD4 count and a very high viral load. Before the lack of clinical and immune-virological response, a genotypic resistance test was performed and showed immunological and virological failure. The initial development was marked by the appearance of lesions which were highly suggestive of Kaposi’s disease. She was on 2nd line treatment. The histopathological aspect of cutaneous biopsy was very suggestive of Kaposi’s disease. The subsequent course after ART and bleomycin treatment was clinically marked by regression of skin lesions. Virologically, it was marked by a fall in the viral load. Immunologically there was a gradual recovery of CD4 levels which came back to normal. Our observation demonstrates that absence of effective antiretroviral therapy for HIV increases the risk to develop Kaposi’s sarcoma.

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.

Kaposi’s肉瘤的放射治疗

目的：探讨Ｋａｐｏｓｉ肉瘤的发展现律，临床特点及疗效。材料与方法：１９８５－１９９２年间新疆医学院肿瘤医院收治７例。维吾尔族６例，哈萨克族１例。除１例病变起始左股部有腹股沟淋巴结受累外，余６例无淋巴结及内脏受侵。用ｘ线或６０Ｃｏ治疗，射野超过病灶边缘２ｃｍ－３ｃｍ，每日１．８－２．０Ｇｙ，每周５次，总剂量２３－５７ＧＹ。结果：首发于上肢４例，２～６年后向对侧上肢及双下肢远端扩散，进展相对较快。首发于下肢３例，内有２例经８－１１年时沿同侧肢体远端扩散，１例侵及上肢，病程较慢。尽管起病部位不同，是终仍为向心性发展，生存２年以上７／７例，４年以上５／５例，５年以上４／４例。结论：本病病程较长，疗效判断也相应长；对放射线治疗有效，减症剂量１０－２９Ｇｙ，病变消失量２８－５７Ｇｙ。

肾移植后并发Kaposi’s肉瘤一例报告

肾移植后并发Ｋａｐｏｓｉ’ｓ肉瘤一例报告马素兰，李文竹，黎启祥我院于１９９４年１２月收治１例肾移植后并发Ｋａｐｏｉ’ｓ；肉瘤报告如下。患者，男，５４岁．因尿毒症于１９８９年８月及１９９２年１１月两次肾移植术后长期应用三联免疫抑制剂：环孢素Ａ、强的松、...

经典型Kaposi's肉瘤1例

患者男,68岁,因右小腿反复起紫蓝色结节13年,组织病理符合经典型Kaposi's肉瘤。

Kaposi’s肉瘤的病因探究

Kaposi，s肉瘤（Kaposi＇s sarcoma，KS）是一种特发性的恶性血管瘤，机体感染该病所表现出的临床症状与其分型密切相关。遗传因素、病毒感染、细胞因子、免疫低下等是致病的重要因素。近年来的研究表明，疱疹病毒8（human herpesivirus 8，HHV8）的发生与Kaposi’s肉瘤的发生密切相关，除了性传播方式以外．吸血节肢动物可能在该疾病的传播方面有一定的作用。该文从Kaposi’s肉瘤的定义及分型、病因及发病机制两个方面进行阐述，并介绍近年来吸血节肢动物在该病传播中的作用。

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.

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.

Chest neoplasms with infectious etiologies

A wide spectrum of thoracic tumors have known or suspected viral etiologies.Oncogenic viruses can be classified by the type of genomic material they contain.Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease,lymphoid granulomatosis,Kaposi's sarcoma,Castleman's disease, recurrent respiratory papillomatosis,lung cancer,malignant mesothelioma,leukemia and lymphomas.Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8,human papillomavirus,Simian virus 40,human immunodeficiency virus,and Human T-lymphotropic virus.Imaging findings,epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.

Regulation of Wnt/β-catenin signaling by herpesviruses

The Wnt/β-catenin signaling pathway is instrumental in successful differentiation and proliferation of mammalian cells. It is therefore not surprising that the herpesvirus family has developed mechanisms to interact with and manipulate this pathway. Successful coexistence with the host requires that herpesviruses establish a lifelong infection that includes periods of latency and reactivation or persistence. Many herpesviruses establish latency in progenitor cells and viral reactivation is linked to host-cell proliferation and differentiation status. Importantly, Wnt/β-catenin is tightly connected to stem/progenitor cell maintenance and differentiation. Numerous studies have linked Wnt/β-catenin signaling to a variety of cancers, emphasizing the importance of Wnt/β-catenin pathways in development, tissue homeostasis and disease. This review details how the alpha-, beta-, and gammaherpesviruses interact and manipulate the Wnt/β-catenin pathway to promote a virus-centric agenda.

The Role of Human Herpesvirus 8 Molecular Characterization in the Management of HIV Infected Patients Diagnosed with Malignancies Associated with Its Infection

Despite the progress has been reached with Human herpesvirus 8 (HHV-8) research, there are gaps in the knowledge of viral induced oncogenesis. The aim of the present study was to identify possible associations between HHV-8 subtypes, HHV-8 loads and clinical manifestations of HIV infected patients diagnosed with different malignancies associated with HHV-8 infection. Forty six HIV-1 infected individuals diagnosed with different HHV-8 associated diseases were studied [37 epidemic Kaposi’s sarcoma (KS), 3 pleural effusion lymphoma (PEL);5 peripheral lymphadenopathies (PL);1 Hodgkin’s lymphoma (HL);1 non Hodgkin’s lymphoma (NHL)]. HHV-8 loads were determined by quantitative real time PCR (qRT-PCR) whilst HHV-8 subtypes were determined by open-reading frame (ORF)-K1 gen genotyping. HHV-8 subtypes B, A, C, A5 and E were exhibited by 31.8%, 23.4%, 19.1%, 17% and 8.5% of the studied patients, respectively. The median HHV-8 viral load did not differ between subtypes (p > 0.05) but HHV-8 viral loads were significantly higher in PEL than in epidemic KS lesion or lymph nodes (p = 0.04). Subtype B was detected in 60% of patients with B cell lymphoma (NHL, PEL and HL) whereas subtype E was only detected in patients with epidemic KS diagnosis. Our data suggest that HHV-8 DNA quantification instead of subtype identification could be used as a surrogate marker for monitoring its infection, not only in epidemic KS patients but also in HIV infected individuals with lymphoproliferative disorders.

Maxillofacial sarcomas: a ugandan epidemiological survey

We reviewed the case notes of 203 patients who were treated for sarcomas of the oral and maxillofacial region over a period of 5 years. There were 98 male cases (mean age 31.4 ± 12.8 years) and 105 female cases (mean age 29.3 ± 10.4). Kaposi’s sarcoma accounted for 82.8% cases, and rhabdomyosarcoma 6.9% followed by osteosarcoma and chondrosarcoma at 2.5% each. Except for Kaposi’s sarcoma, surgery in combination with radiotherapy and/or chemothe- rapy was the main stay of treatment. Survival data was not available for most of our patients.