1/64. Epstein-Barr virus-associated intravascular lymphomatosis within Kaposi's sarcoma in an AIDS patient.Intravascular lymphomatosis (IL) is an unusual neoplasm characterized by multifocal proliferation of lymphoma cells exclusively within the blood vessels. We report here a patient with acquired immunodeficiency syndrome (AIDS) and disseminated Kaposi's sarcoma. A 233-bp amplification product of HHV-8 was detected in the dna extracted from specimens of Kaposi's sarcoma at different sites by polymerase chain reaction (PCR). At autopsy, the vessels within the Kaposi's sarcoma were dilated and filled with atypical large mononuclear cells. No such feature was seen in the vessels of non-Kaposi's sarcomatous regions. Immunohistochemically, the spindle cells of Kaposi's sarcoma were positive for CD31 (endothelial cell marker). The intravascular tumor cells were positive for CD45 (leukocyte common antigen) but negative for others, including chloroacetate esterase, CD45-RO (UCHL-1, Pan-T), CD3, CD43, CD20 (L26, Pan-B), CD30 (Ki-1), immunoglobulin heavy chains and light chains, CD56 (natural killer cell antigen), and CD31. Monoclonal rearrangement of immunoglobulin heavy chain gene was detected in the dna extracts from fresh tissue of Kaposi's sarcoma by PCR, which indicated that the lymphoma cells within the Kaposi's sarcoma were of monoclonal B cell origin. in situ hybridization revealed that EBER-1 transcripts were present in the lymphoma cells of IL but not in the spindle cells of Kaposi's sarcoma. To the authors' best knowledge, this is the first instance of IL in an AIDS patient with direct evidence of EBV association.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
2/64. Gastro-intestinal Kaposi's sarcoma, with special reference to the appendix.Kaposi's sarcoma (KS) of the gastro-intestinal tract is a common disease in the AIDS setting, although it is often asymptomatic. In this paper we wish to highlight the occurrence of gastro-intestinal KS with appendiceal involvement. Two of the patients presented with features of acute appendicitis, and KS of the appendix was not suspected at the time of surgery. In the remaining patient KS of the appendix was part of generalised gastro-intestinal involvement. It is important to remember that KS can cause appendicitis by producing a submucosal nodule that abuts into the lumen and thereby causes obstruction. KS of the gastro-intestinal tract may therefore masquerade as 'simple' appendicitis, or indeed remain asymptomatic.- - - - - - - - - - ranking = 1keywords = tract (Clic here for more details about this article) |
3/64. Coexistent gastric MALT lymphoma and Kaposi sarcoma in an hiv positive patient.A 47 year old hiv positive male presented with haematemesis and epigastric pain. A gastrectomy was performed for intractable bleeding. The cause of the haematemesis proved to be a Kaposi sarcoma of the stomach which had resulted in mucosal ulceration. Several other smaller foci of Kaposi sarcoma were also present. Coexistent with the Kaposi sarcoma was a dense lymphoid infiltrate with lymphoid follicles and reactive germinal centres. Centrocyte-like cells caused marked effacement and destruction of gastric glands with the formation of lymphoepithelial lesions, typical of a MALT lymphoma. These cells were of B cell lineage and some expressed the hiv antigen, p24. Follicular dendritic cells and macrophages within germinal centres were also p24 positive. immunohistochemistry and in situ hybridisation did not detect Epstein-Barr virus. Although helicobacter pylori was not identified by light microscopy in the sections sampled, this does not preclude its possible role, with other cofactors such as hiv, in the causation of the MALT lymphoma.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
4/64. Kaposi's sarcoma of the pancreas mimicking pancreatic cancer in an hiv-infected patient. Clinical diagnosis by detection of HHV 8 in bile and complete remission following antiviral and cytostatic therapy with paclitaxel.BACKGROUND: diagnosis of pancreatic cancer is usually made by endoscopic retrograde cholangiopancreatography (ERCP) and corresponding findings in computed tomography (CT) or magnetic resonance imaging. Kaposi's sarcoma, a frequent tumor in individuals with a late-stage hiv infection, can be located in the gastrointestinal tract and cause identical symptoms to carcinoma of the same site. A close correlation of this tumor to human herpes virus 8 (HHV 8) has been known for several years and there are reports of successful antiproliferative therapy. methods: Aspirated pancreatic juice and bile was investigated for the presence of HHV 8 by polymerase chain reaction. The clinical course of the patient under antiviral therapy and treatment with paclitaxel was studied. RESULTS: A 47-yr-old hiv-infected man with a history of Kaposi's sarcoma of skin and lungs caused by obstructive jaundice in the years before was admitted. ERCP showed a typical double-duct sign and CT revealed a tumorous infiltration of the pancreatic head, highly suspicious for pancreatic adenocarcinoma. A mutation of the ki-ras gene could be ruled out and molecular analysis of bile identified HHV 8 by PCR. Intensive antiviral therapy, including foscarnet and treatment with paclitaxel led to a complete remission within 8 m.o. CONCLUSION: Kaposi's sarcoma of the pancreas possibly mimics pancreatic cancer in hiv-infected subjects. diagnosis may be made by identification of HHV 8 in pancreatic juice or bile, and successful clinical outcome is possible by intensive antiviral and cytostatic treatment with paclitaxel.- - - - - - - - - - ranking = 18.780987921937keywords = gastrointestinal tract, tract (Clic here for more details about this article) |
5/64. Common head and neck manifestations of AIDS.head and neck manifestations of acquired immunodeficiency syndrome (AIDS) can involve the skin, ear, upper aerodigestive tract, and neck. Several head and neck manifestations of AIDS may be the only initial sign of this disease process and therefore primary-care physicians and otolaryngologists must be able to recognize and understand the management of these lesions. Cystic enlargement of the parotid gland and Kaposi's sarcoma are increasingly being encountered in the head and neck exam of hiv-infected patients. An example of each of these disease processes is presented with full discussion about the various treatment methods.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
6/64. A report of two non-AIDS associated Kaposi's sarcoma in malaysia.Kaposi's sarcoma is an uncommon cutaneous neoplasm seen classically in elderly males of East European or Jewish extract. It has been known to be endemic in sub-Saharan africa for many years. Numerous cases had been described in patients on long-term immunosuppressive therapy and in patients living with acquired immunodeficiency syndrome (AIDS). In spite of the increasing number of organ transplant recipients and people living with AIDS. Kaposi's sarcoma remains rare in asia. We report two cases seen in Johor, malaysia.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
7/64. rehabilitation considerations of prosthetic fittings for Kaposi's sarcoma amputees.PURPOSE: We report on cutaneous limb manifestations of Kaposi's sarcoma and the secondary infection of these lesions that necessitated five lower-limb amputations. METHOD: The cases are briefly described and prosthetic adaptations in respect to pressure, traction and sweating on the skin are considered. RESULTS: All four patients ambulated initially; one lady died, the double amputee stopped walking owing to the excessive physical demand, and two patients ambulate freely. CONCLUSION: Special considerations to the cutaneous/prosthesis interface are necessary in order to provide these patients with optimal ambulatory ability.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
8/64. Classic Kaposi sarcoma presenting as rapidly growing nodules.Classic Kaposi sarcoma (KS) is a sporadic disease that usually affects persons older than 50 years, with a distinct male predominance. Although classic KS has a protracted, indolent course, there appears to be a rare disseminated fulminant type. This report describes a case of classic KS, presenting as a very rapid enlargement and dissemination of skin lesions, without evidence of human immunodeficiency virus (hiv) infection or involvement of other internal organs.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
9/64. Classic Kaposi's sarcoma associated with human herpesvirus 8 infection in a 13-year-old male: a case report.PURPOSE: Classic Kaposi's sarcoma (KS) is rare in children. Although its etiology is not fully understood, human herpesvirus 8 (HHV-8) is present in the angiogenic lesions. We report an hiv-negative, 13-year-old patient of Sicilian descent with HHV-8-associated classic KS to facilitate the diagnosis and treatment of this entity in children. EXPERIMENTAL DESIGN: dna was extracted from the skin specimen of the patient and analyzed via PCR assay and Southern blot hybridization for HHV-8 dna. The amplified HHV-8 dna was cloned, sequenced, and compared with the prototype HHV-8-KS330/BAM. RESULTS: The patient presented with purpuric lesions on the distal lower extremities and the tip of his nose, associated with thrombocytopenia and leukopenia, suggesting an immune-mediated cytopenia. While on prednisone, he developed marked vascular proliferation in the groins. biopsy of the skin lesions showed KS, and HHV-8 was detected in the tissues by PCR. sequence analysis of the amplified dna was homologous to the prototype HHV-8-KS330/BAM. His HHV-8 strain was the A subgroup, the type associated with Mediterranean classic KS. Stopping prednisone and treatment with IFN-alpha and IgG resulted in regression of the groin lesions. CONCLUSIONS: This report emphasizes the importance of recognizing classic KS in children and avoiding immunosuppressive therapies in indolent classic KS. The diagnostic and therapeutic strategies were effective and well tolerated.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
10/64. Disseminated manifestation of Kaposi's sarcoma in newly diagnosed AIDS in an african female.BACKGROUND: Kaposi's sarcomas are the most frequent malignancies in patients with AIDS and there is increasing evidence of an association with human Herpesvirus 8 (HHV-8). A reconstitution of the immune response due to different regimens of highly active antiretroviral therapy (HAART) is the most important step in treatment of Kaposi's sarcomas. Local treatment options include the topic application of alitretionin (9-cis-retinoic acid) as a gel, cryotherapy with liquid nitrogen and intralesional vinblastine, as well as local laser or low-dose X-ray treatment. A systemic chemotherapy can be taken under consideration in selected cases with clinical significant visceral lesions or aggressive sarcomatous behavior with anthracyclines, taxanes, as well as an immunomodulatory treatment with alpha Interferon. CASE REPORT: The case of an african emigrant is described. Hospitalized due to recurrent fever and diarrhea, the diagnosis of AIDS was quickly established. The physical examination revealed multiple nodular, painless skin lesions suspicious of Kaposi's sarcoma. The diagnosis was confirmed histologically, later on also in bronchial and duodenal biopsies due to the atypical subepithelial vessels with slit-like appearance and prominent endothelia. CONCLUSIONS: Cutaneous lesions in patients with dark skin colour may be unfamiliar to European physicians. In patients with hiv-infection, nodular skin lesions should lead suspicion to Kaposi's sarcoma. If this diagnosis is established, it should be clarified, if other locations (e.g.: intestine, respiratory tract) are involved, too.- - - - - - - - - - ranking = 0.5keywords = tract (Clic here for more details about this article) |
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