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Kaposi's Sarcoma
Aka: Kaposi's Sarcoma, Kaposi Sarcoma, Multiple Idiopathic Hemorrhagic Sarcoma
- Epidemiology
- Highest frequency in HIV homosexual or bisexual men
- Middle aged to elderly white males
- Young Black patients in Africa
- Extremely uncommon in women and children
- Incidence
- Was more common (48%) early in the HIV epidemic
- Now only seen 18% of HIV cases in homosexual or bisexual men
- Pathophysiology
- Endothelial tumor
- Usually multicentric
- Involves the skin and visceral organs
- Very rarely involves the brain
- May be caused by an enteric sexually transmitted agent
- Associated with Human Herpes Virus 8
- Risks
- More common in those with oral or anal sexual contacts
- Symptoms
- Lesions typically non-pruritic
- Initial: Painless
- Later: Lesions can become large and painful
- Signs: Cutaneous lesions
- Pigmented (violaceous)
- Red-blue/purple or bluish-brown Plaques and Nodules
- Flush with skin or raised strawberry-like Plaques
- Lesions enlarge, coalesce and may bleed
- Can involve any area of the skin
- Especially common on the soles of the feet
- Rarely affects the palms of the hands
- Biopsy differentiates from
- Bacillary Angiomatosis
- Cutaneous cryptococcus
- Signs: Intraoral disease
- Intraoral disease present at time of diagnosis: 50%
- Higher risk of gastrointestinal involvement
- Signs: Gastrointestinal involvement (Usually asymptomatic)
- Dysphagia
- Gastric outlet obstruction
- Gallbladder
- Signs: Pulmonary involvement
- Rapidly fatal if not treated
- Usually symptomatic
- Non-productive cough
- Bronchospasm
- Dyspnea
- Pleural Effusion in 20-50% cases at diagnosis
- Pleural Fluid negative for Kaposi's Sarcoma
- Transudative or exudative
- Chest XRay
- Reticulonodular Pulmonary Infiltrates
- Much coarser than with Pneumocystis carinii
- Normal gallium scan
- Bronchoscopy
- Characteristic endobronchial lesions
- Biopsy usually avoided secondary to bleeding
- Management: General
- No treatment is curative!
- Slow the progression of systemic disease
- Manage local or regional problems
- Management: Medications
- Chemotherapy
- Cytotoxic drugs (Indicated for widespread disease)
- Doxorubicin
- Vinblastine
- Vincristine
- Bleomycin
- Interferon alpha
- Better with Less extensive cutaneous lesions
- Better if no edema or visceral disease
- Radiation Therapy
- Control Lymphedema
- Control painful or necrotic bulky tumors
- Surgical Resection
- Indicated for local complications
- Cryotherapy or Liquid Nitrogen
- Indicated to ablate single lesions