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Kaposi's Sarcoma: Patients Seen in The Past 8 Years: 83 Cases

Kaposi's sarcoma is a vascular tumor caused by human herpes virus 8. It manifests as multiple skin nodules and lesions and was first described in 1872. It is associated with HIV/AIDS and is more common in men. There are four clinical types including classical, African, transplant-related, and epidemic associated with HIV/AIDS. Treatment involves local modalities like surgery, radiation and chemotherapy or systemic chemotherapy and antiretroviral therapy. Prognosis depends on CD4 count, presence of symptoms, and other opportunistic infections.

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39 views12 pages

Kaposi's Sarcoma: Patients Seen in The Past 8 Years: 83 Cases

Kaposi's sarcoma is a vascular tumor caused by human herpes virus 8. It manifests as multiple skin nodules and lesions and was first described in 1872. It is associated with HIV/AIDS and is more common in men. There are four clinical types including classical, African, transplant-related, and epidemic associated with HIV/AIDS. Treatment involves local modalities like surgery, radiation and chemotherapy or systemic chemotherapy and antiretroviral therapy. Prognosis depends on CD4 count, presence of symptoms, and other opportunistic infections.

Uploaded by

Worku Kifle
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Kaposi’s Sarcoma

Definition: A vascular Tumor associated with


human herpes virus 8 (HHV-8).

•Manifest as multiple nodule in skin or other


organs.
•First described in 1872 by Moritz Kaposi.
•KS remained a rare disease until HIV epidemic.
•Kaposi’s sarcoma is a disease of men (15:1)
Patients seen in the past 8 years: 83 cases
Male 53, and 30 Female
Sex ratio : 2:1
Types of Kaposi’s
Four clinical types have been recognized:
1. Classical Kaposi’s Sarcoma ( 1872)
2. African Kaposi’s Sarcoma (1950)
3.Transplant related KS (1969)
4. Epidemic Kaposi’s Sarcoma (1981)

=> The histological feature is similar


Classical Kaposi’s Sarcoma
 Affect mainly elderly men of Mediterranean or
Jewish origin
 Lesion start usually as reddish nodule on the
lower extremities
 Generally indolent disease (10 to 15 years)
 About 20% die as a direct result of KS
Gastrointestinal or pulmonary involvement
 Many of these patients develop second
malignancy
e.g. Lymphoma
African Kaposi’s Sarcoma
Common malignancy In Central Africa
3 – 9 % of all malignancies
Occur in young men, variable clinical course:
• Indolent to aggressive
• Sex ratio 14:1
• Involve extremities, usually generalized
 It is not associated to immune deficiency
Immunosuppressive treatment
related KS
 Renal transplant, first case reported 1969

The incidence is 150 to 200 times more than general


population

 Some cases regress following stopping,


reducing or changing of immunosuppressant
Epidemic Kaposi’s Sarcoma
 Occurs in 20% of AIDS patients
 The clinical feature resembles transplant
associated KS

Widely disseminated involving the viscera

Rapidly fatal course

 It arise from multiple foci


Staging classification of AIDS related
KS
Staging classification of AIDS associated KS

Good risk (0) Poor risk (1)


(all of the parameters listed) (Any of the parameters listed)

Tumor Small tumor with limited Large tumor burden:


involvement of one or more: Oral
Skin Pulmonary

Oral GI
Lymph node Other visceral invo.

Immune system (I) CD4 >200 /mm3 CD4 cells < 200/ mm3

Systemic Illness (S) No Oppor. inf History of opport. infec


No B symptoms B symptoms
Indications for treatment (Epidemic KS)
1. Pulmonary Kaposi’s Sarcoma
2. Painful nodule or ulcerating foot lesions
3. Function limiting lymph edema
4. Cosmetic
5. Social stigma
Treatment
Two modalities:
1. Local modalities
1.1 Surgery
1.2. Radiotherapy
1.3. Chemotherapy

2. Systemic modality
2.1. Chemotherapy
2.2. Antiretroviral therapy
Local modalities

1. Surgery :
1.1. Curettage
1.2. Cryotherapy
1.3. Surgical excision
In epidemic KS the place for surgical treatment is limited
2. Radiotherapy:
2.1 . Single fraction - 800 cGy
2.2. Multiple fractions:
300-400 cGy x4 = 1200 cGy – 1600 cGy
300cGy x10 = 3000cGy
=> Kaposi’s sarcoma is radiosensitive
3. Chemotherapy:
Intra-lesional injection
Systemic Therapy
I. Chemotherapy
2.1. Single agent
2.2. Combination

II. Antiretroviral
Decreased new AIDS cases with KS
Regression in the size of existing KS lesions
Improve survival
Prognostic factors for epidemic KS

1. CD4 cell count

2. Presence/ absence of systemic symptoms

3. Prior or coexisting opportunistic infection

=> Are also prognostic factors for HIV/AIDS

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