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Aggressive behavior of classical Kaposi's sarcoma and coexistence with angiosarcoma
Giovanni Gambassi1, Roberto Semeraro, Vincenzo Suma
1Centro Medicina Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, 8, 00168 Rome, Italy. giovanni_gambassi@rm.unicatt.it
Summary
Classical Kaposi's sarcoma can be a rapidly progressing, malignant tumor, even without HIV. Aggressive skin lesion spread indicates potential dissemination and warrants investigation for secondary malignancies.
Area of Science:
- Oncology
- Dermatology
- Virology
Background:
- Kaposi's sarcoma (KS) is an opportunistic infection, typically associated with Human Immunodeficiency Virus (HIV).
- Classical KS, while generally indolent, can exhibit aggressive behavior.
- Human Herpes Virus type 8 (HHV-8) is associated with KS development.
Observation:
- An 82-year-old man with no HIV presented with rapidly progressing, livid red plantar plaques evolving into invasive nodules with edema.
- Skin lesions became vegetative, necrotic, and spread to hands and eyelids within 6 months.
- The patient developed gastrointestinal hemorrhage and oral lesions consistent with a distinct angiosarcoma.
Findings:
- Histology confirmed classical Kaposi's sarcoma, with HHV-8 detected in skin samples.
- Despite chemotherapy, the disease progressed, leading to fatal gastrointestinal bleeding and oral obstruction.
- A secondary, low-grade angiosarcoma developed, distinct from the initial KS.
Implications:
- The extent and speed of initial skin lesion spread are critical indicators of aggressive KS dissemination.
- Endoscopic evaluation is recommended due to the high incidence of gastrointestinal involvement in KS.
- Aggressive classical KS necessitates investigation for a potential second primary malignancy, particularly vascular tumors.