Kaposi’s Sarcoma

Cutaneous B-Cell Lymphoma and Lymphedema, Cutaneous T-cell lymphoma and Lymphedema, Hodgkins Lymphoma, Kidney and Renal Cancer, Cervical Cancer, Renal Cell Carcinoma, Breast Cancer, Ovarian Cancer, Testicular, arm swelling, Skin Cancer, angiosarcoma, kaposi's sarcoma, gallium scan, axillary node dissection, gynecological cancer, axillary reverse mapping, lymphatic cancers, inguinal node dissection, cancer treatment, Complete decongestive therapy for arm lymphedema, lymphedema therapy, intensive decongestive physiotherapy, breast cancer related lymphedema, upper limb lymphedema

Moderators: jenjay, Cassie, patoco, Birdwatcher, Senior Moderators

Kaposi’s Sarcoma

Postby patoco » Tue Oct 03, 2006 12:52 pm

Kaposi’s Sarcoma

Lymphedema People

http://www.lymphedemapeople.com

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Kaposi’s Sarcoma and Lymphedema

A Review of the Literature

When Kaposi’s Sarcoma burst into the news some 20 years ago, it quickly became known as a cancer associated with HIV/AIDS. Interestingly, KS has shown that in and of itself, the cancer causes lymphedema by damaging the lymphatic system.

Since that time, however, there have been two more groups of patients who have been clinically shown to be at risk.

The first groups is that of organ transplants. Indeed, a study done by the Mayo Clinic in Rochester, Minnesota demonstrated that the risk of contracting Kaposi’s Sarcoma is 500 times greater in the organ transplant population then that of the general population.

The reason for this is simple. Organ transplant patients must take immunosuppressive drugs to prevent organ rejection.

The next group that is now showing a proclivity towards Kaposi’s Sarcoma is comprised of long term lymphedema patients. This group includes both primary and secondary lymphedema. A lymphedematous limb has long been understood to become immunodeficient and there is even conjecture from early studies that indeed even those with secondary lymphedema may already have an “at risk” lymph system, thereby possibly causing a lowered immune response throughout their body.

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What is Kaposi's sarcoma?

Although Kaposi's sarcoma (KS) is a type of cancer, it differs from other types of cancer in the way it develops. Unlike most cancers, which start in one place and may then spread to other parts of the body, KS can appear in several parts of the body at the same time. The most common site for KS is on the skin but it may also affect internal organs, particularly the lymph nodes (part of your immune system), the lungs and parts of the digestive system (the gut).

Causes of Kaposi's sarcoma

Most KS is now believed to be caused by a virus called Human Herpes Virus 8 (HHV8), which is also known as Kaposi’s Sarcoma-associated Herpes Virus (KSHV). It can affect people with a weakened immune system, including people with HIV (Human Immunodeficiency Virus) and Aids.

HHV8 is mainly spread through saliva, but can also be spread in blood and semen, or from a mother to her unborn child. The virus can be passed on through sexual contact, kissing, blood transfusions and organ
transplantation.

Types of Kaposi’s Sarcoma

There are four main types of KS They are all more common in men than women.

I. Classic Kaposi’s Sarcoma

The first, called classic KS, develops without any weakened immunity, like many other types of cancer. It is very uncommon and is usually only found in older men of Mediterranean, Middle Eastern, or Jewish descent.

This type of KS is usually only found in the skin, particularly on the lower legs and feet.

As it is a slow-growing cancer, people with early stage classic KS may not need any treatment.

II. Endemic or African Kaposi’s Sarcoma

The second type of KS, endemic or African KS, is found in parts of sub-Saharan Africa. It develops more quickly than classic KS and can affect men, women and children of all ages, although it is more common in men.
III. Aids-related Kaposi’s Sarcoma

The third type of KS, Aids-related KS, is the commonest of the four types, although it has become less common as the treatment of HIV and Aids has improved. As HIV infection develops, the immune system becomes weaker and the risk of developing KS increases.

IV. Transplant-related Kaposi’s Sarcoma

The fourth type of KS usually occurs in people who have a weakened or damaged immune system. People who have had organ transplants, such as a kidney transplant or a bone marrow transplant from a donor, take medicines which suppress their immune system. This is to reduce the risk of their body rejecting the donated organ. Although rare, KS can occur in transplant patients who are taking these immunosuppressant drugs. This type of KS may improve if the immunosuppressant drugs are reduced or stopped.

Signs and Symptoms of Kaposi’s Sarcoma

Kaposi's sarcoma on the skin appears as a small, painless, flat area (lesion) or lump, ranging in colour from brown or brown-red to reddish purple. The lesions or lumps can develop quickly. Although there may be a single area at first, it is not uncommon for more than one to appear.

Any part of the skin, including the inside of the mouth, can be affected. Often the lumps merge to form a larger tumour.

KS can also affect other parts of the body, most commonly the lymph nodes, the lungs and the organs of the digestive system. The signs and symptoms of internal KS depend on the area of the body that is affected. If the lymph nodes are affected, which is common in Aids-related KS, there may be swelling in the limbs. This is known as lymphoedema and is caused by the KS cells blocking the lymph nodes and disrupting the normal circulation of lymph fluid around the body. Lymphoedema can be a distressing and uncomfortable symptom, and while there is no actual 'cure' there are ways to relieve it.

Our section on lymphoedema gives useful advice about reducing lymphoedema through methods such as exercise and massage.
KS in the lungs commonly causes breathlessness, while a tumour in the digestive system (gut) may cause nausea, vomiting, and bleeding.

How Kaposi’s Sarcoma is diagnosed

You may begin by seeing your GP, who will examine you and check your general health. Your GP will arrange for you to have some tests. You may be referred to a hospital for specialist advice and treatment.

If you already know you have HIV or Aids, you will probably begin by seeing your HIV specialist.

At the hospital you will need to have blood tests and a full examination. Your whole body will be checked, as the lesions can be found on any areas of the skin, including the inside of the mouth, the palms of the hands, the scalp, and the soles of the feet. Although your doctor may suspect that you have KS by simply looking at the lesions, a biopsy is usually done to confirm the diagnosis.

Biopsy

This is generally a quick and simple procedure, which can often be done in an outpatient department. Using a local anaesthetic to numb the area, the doctor removes a small piece of the lesion or lump for examination under a microscope. The area may be sore for a few days afterwards.
Further Tests

If a diagnosis of KS is confirmed, further tests are usually done to see if there are any signs of KS cells elsewhere in your body. These may include any of the following:

Chest x-ray

This may be done to check for signs of KS in your lungs and airways (bronchial passages). As lung infections are common in people with Aids, it may be difficult in this situation to tell whether changes on the x-ray are actually caused by KS. A CT scan may be done to confirm the diagnosis.

CT (computerised tomography) Scan

A CT scan takes a series of x-rays which builds up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10–30 minutes. It can help to show whether there are any signs of KS in other parts of the body. It is particularly useful for diagnosing KS in the lymph nodes.

CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye which allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.

You will probably be able to go home as soon as the scan is over.

Endoscopy

This procedure enables the doctor to look inside the body, through a thin flexible tube called an endoscope that is passed down your throat. The endoscope has a tiny camera and a light on the end. If necessary, the doctor can take a small sample of the cells (a biopsy) to be examined under a microscope.

A mild sedative helps you to relax during the test and a local anaesthetic will be sprayed onto your throat to prevent any discomfort as the tube is passed down. The doctor or nurse endoscopist can examine your windpipe, lungs (bronchoscopy), oesophagus and stomach (gastroscopy) in this way, and check for any signs of KS.

Colonscopy

Another type of endoscopy is used to examine your large bowel (colon). This test is called a colonoscopy. The bowel must be empty for this test so a careful diet must be followed for a few days beforehand and you may be given laxatives to take. A bowel wash-out is usually done just before the test. This involves a nurse gently passing a tube into your back passage while you are lying on your left side. Water is then passed through the tube. You will be asked to hold the liquid in your bowel for a few minutes before you go to the toilet.

Just before the colonoscopy you may be given a mild sedative to help you to relax. Once you are lying comfortably on your side the doctor or specialist nurse will gently pass a flexible tube (called a colonoscope) into your back passage. The tube can easily pass around the curves of the bowel, and the lining of most of the bowel can be examined. A light and camera on the inside of the tube helps the doctor or nurse to see any abnormal areas or swelling.

Most people are ready to go home a couple of hours after their test. It is a good idea to arrange for someone to collect you from the hospital, as it is best not to drive for several hours after a sedative.

Lung Function test

If tests show that your lungs have been affected you may have lung function tests to check how well your lungs are working. You will be asked to blow into a machine so that a series of measurements can be taken to show how well your lungs are working.

Treatment for Kaposi’s Sarcoma

Types of Treatment

Mild cases of Kaposi's sarcoma may not need to be treated. It may be possible to use skin-camouflage to cover any skin lesions. However, if the lesions or lumps are causing embarrassment and distress, treatment may be recommended.

Your doctor is more likely to suggest that you have treatment if your KS is affecting internal organs, or if there are many skin lesions. If you have HIV that is not very well controlled, your specialist may also recommend that you start anti-HIV treatment.

The type of treatment used will depend on a number of different factors, including the size and position of the tumours and your general health.

· Classic KS does not usually require any treatment, although radiotherapy is sometimes used for larger or easily visible lesions.
· Endemic or African KS is often treated with chemotherapy.
· Treatment of Aids-related KS is often affected by the person's general health. As the immune system has already been weakened by the illness, extra care has to be taken to ensure that any side effects of treatment are not going to make your health become worse. For most people with Aids-related KS the treatment will include highly active antiretroviral therapy (HAART) which reduces the level of the HIV virus in the body and improves immunity.
· Transplant-related KS, caused by immunosuppressant drugs, can sometimes be controlled by stopping or reducing these drugs.

If you have any questions about your treatment, don't be afraid to ask your doctor or the nurse looking after you. It often helps to make a list of questions for your doctor and to take a close friend or relative with you to your appointment.

How treatment is planned

In most hospitals a team of specialists will decide the treatment that is best for you. This multidisciplinary team (MDT) will often include:

· virologist – a doctor that specialises in treating people with viruses
· oncologists – doctors who have experience treating KS using chemotherapy and radiotherapy
· specialist nurses who give information and support
· radiologists who help to analyse x-rays
· an HIV specialist.

The MDT may also include a number of other healthcare professionals, such as a:

· dietitian
· physiotherapist
· occupational therapist
· psychologist or counsellor.

Together they will be able to advise you on the best course of action and plan your treatment taking into account a number of factors. These include your age, general health, and the size and position of the tumours.
Remember to ask questions about any aspects that you do not understand or feel worried about. You may find it helpful to discuss the benefits and disadvantages of each option with your doctor, specialist nurse, or with the nurses on our cancer information and support service.

Giving your consent

Before you have any treatment, your doctor will explain the aims of the treatment to you. They will usually ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent, and before you are asked to sign the form you should have been given full information about:

· the type and extent of the treatment you are advised to have
· the advantages and disadvantages of the treatment
· any possible other treatments that may be available
· any significant risks or side effects of the treatment.

If you do not understand what you have been told, let the staff know straight away so that they can explain again. Some cancer treatments are complex, so it is not unusual for people to need repeated explanations.
It is often a good idea to have a friend or relative with you when the treatment is explained, to help you remember the discussion more fully. You may also find it useful to write down a list of questions before you go to your appointment.

People often feel that the hospital staff are too busy to answer their questions, but it is important for you to be aware of how the treatment is likely to affect you. The staff should be willing to make time for you to ask questions.

You can always ask for more time to decide about the treatment if you feel that you can’t make a decision when it is first explained to you.

You are also free to choose not to have the treatment. The staff can explain what may happen if you do not have it. It is important to tell a doctor, or the nurse in charge, so that they can record your decision in your medical notes. You do not have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.

Second opinion

Usually a number of cancer specialists work together as a team and they use national treatment guidelines to decide on the most suitable treatment for a patient. Even so, you may want to have another medical opinion. Either your specialist, or your GP, will be willing to refer you to another specialist for a second opinion, if you feel it will be helpful. The second opinion may cause a delay in the start of your treatment, so you and your doctor need to be confident that it will give you useful information.

If you decide to have a second opinion, it may be a good idea to take a friend or relative with you, and have a list of questions ready, so that you can make sure your concerns are covered during the discussion.

Anti-HIV Drugs

Most people with Aids-related Kaposi's sarcoma will be offered treatment with anti-HIV drugs (antiretroviral therapy). A combination of some of the antiretroviral drugs (usually three or more) will usually be used. To be effective, antiretroviral drugs need to be taken every day, often for the rest of your life. Your doctor will discuss the benefits and possible side effects with you if they are appropriate in your situation.

These drugs can stop the HIV virus from multiplying inside the cells that it has affected, and can stop the virus from infecting other cells. This reduces the amount of HIV in the body and limits the damage that the virus can do to the immune system. In many cases, antiretroviral therapy alone can control KS, although this may take many months.

There are different types of anti-HIV drugs. Commonly used types are

· Nucleoside reverse transcriptase inhibitors (NRTIs) such as abacavir (ABC), didanosine (ddI), emtricitabine lamiduvine (3TC), stavudine (d4T), and zidovuvine (AZT)
· Nucleotide reverse transcriptase inhibitors (NtRTIs) such as tenofovir (TFV)
· Protease inhibitors (PIs) such as amprenavir, atazanavir, indinavir, lopinavir, nelfinavir, ritonavir, and saquinavir
· Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as efavirenz and nevirapine
· Other antiretrovirals such as enfuvirtide.

You can get more information about anti-HIV treatment from some of the specialist HIV and Aids organisations.

Treating Kaposi’s Sarcoma with surgery

Surgery may be used to remove Kaposi's sarcoma from the skin, particularly when the lesions are small. This is a simple procedure and may be done in the outpatient clinic or day ward. The doctor injects local anaesthetic into the skin around the lesions to numb the area. The lesions are removed and the wound stitched. This will leave a small scar which gradually fades.

Some KS lesions can be removed using cryotherapy, which freezes the area to destroy the cancer cells. Sometimes, a laser may be used to burn away the lesion. Your doctor or specialist nurse can give you more information

Treating Kaposi Sarcoma with Chemo therapy

This is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. Commonly used chemotherapy drugs to treat Kaposi's sarcoma are doxorubicin, vincristine (Oncovin®), bleomycin, etoposide (Etopophos®, Vepesid®) and paclitaxel (Taxol).

Chemotherapy for internal KS

The chemotherapy drugs are usually given by drip (infusion) into a vein in your arm (intravenously), but some chemotherapy drugs can be taken as tablets (orally). They are then carried around the body by the bloodstream. Chemotherapy for KS is usually given every three weeks but may be given more frequently, depending on the drugs used. Treatment is often given as an outpatient.

Chemotherapy for Skin KS

If the KS is only affecting the skin, it may be possible to use chemotherapy injected directly into the skin lesion. This is known as intralesional chemotherapy and tends to be used for smaller lesions (less than 0.5cm (¼ inch) wide). It can be a useful alternative to radiotherapy for areas or skin types where radiotherapy might cause some darkening of the skin, particularly on the face. Intralesional chemotherapy can also be used for tumours inside the mouth.

For more extensive skin KS, chemotherapy is usually given as a drip into a vein.

Chemotherapy treatment can shrink the areas of Kaposi's sarcoma in the skin and make them lighter in colour. In some people the lesions may almost disappear completely.

Liposomal Chemotherapy

A different form of chemotherapy, called liposomal chemotherapy, is now often used to treat KS. The molecules of the chemotherapy drugs are enclosed (encapsulated) in a fat-based coating known as a liposome. Liposomes are able to travel to the tumour site, where they release the drug. The advantage of this type of chemotherapy is that there are fewer side effects, which means that treatment can be given over a longer period.

The liposomal chemotherapy drugs that are commonly used to treat KS are liposomal daunoroubicin (Daunoxome®) and liposomal doxorubicin (Caelyx®, Myocet®). These drugs are usually given as drips (infusions) every 2–3 weeks.

Our section on chemotherapy discusses the treatment and its side effects in more detail. Information about individual drugs and their particular side effects are also available.

Side Effects

Chemotherapy can cause unpleasant side effects. However, many people have few side effects, and those that occur can often be well controlled with medicine. The main side effects are described here, along with some of the ways they can be reduced.

Lowered resistance to infection The chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This is a common side effect of chemotherapy and usually begins seven days after treatment has been given. The number of white blood cells in your blood usually reaches its lowest point at 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal before your next course of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

· Your temperature goes above 38ºC (100.5ºF)
· You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.

Anaemia (low number of red blood cells) While having chemotherapy you may become anaemic. This may make you feel tired and breathless.

Bruising or bleeding The chemotherapy can also reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding.

Nausea and vomiting Some of the drugs used to treat KS may cause nausea (feeling sick) and vomiting. There are now very effective anti-sickness drugs (anti-emetics) to prevent or reduce nausea and vomiting. Your doctor will prescribe these for you.

Hair loss Unfortunately, some chemotherapy drugs can make your hair fall out. You can ask your doctor if the drugs you are taking are likely to cause hair loss or other specific side effects.

People who lose their hair often wear wigs, hats or bandannas. Some people are entitled to a free wig from the NHS and your doctor or nurse will be able to give you more details. If your hair falls out, it will grow back within 3–6 months, once your treatment is over.

Sore mouth Some chemotherapy drugs can make your mouth sore and cause mouth ulcers. Regular mouthwashes can help to keep your mouth clean and relieve any soreness. Your nurse will show you how to use these properly. If you don’t feel like eating during treatment, you could try a diet of soft food or replacing some meals with nutritious drinks.

Skin reaction Intralessional chemotherapy may cause temporary inflammation of the skin.

Tiredness You may feel tired and have a general feeling of weakness. It is important to allow yourself plenty of time to rest.

Although they may be hard to bear at the time, these side effects will gradually disappear once your treatment is over.

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many find they become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Treating Kaposi’s Sarcoma with Radiotherapy

Radiotherapy is a treatment which uses high-energy rays to destroy the Kaposi's sarcoma cells while doing as little harm as possible to normal cells. The radiotherapy is aimed at the skin lesions or internal tumours and is painless. Usually between one and five doses are given. After radiotherapy to the skin, small lesions may fade completely but larger and deeper lumps may become smaller and flatter, similar to a mole. Radiotherapy can be very effective in reducing symptoms of internal KS, particularly swelling, pain and bleeding.

Side Effects

Skin care Side effects of radiotherapy depend on the area of the body which is being treated. Radiotherapy to the skin alone usually causes few side effects. Pale skin around the treated area may become red, sore and itchy. People with darker skins may develop a blue or black tinge in the treated area. Advice about skin care varies from one hospital to another. Some will advise you not to wash the skin at all while you are having radiotherapy. Others will advise you to use only tepid water on the area and to pat it dry with a soft towel. Perfumed creams and lotions should be avoided and you should check with the radiotherapy staff before applying anything to your skin.

If necessary, your doctor will prescribe a special cream to soothe the sore area. Avoid exposing the treated area to the sun or extremes of hot or cold.

Hair loss Radiotherapy may make your hair fall out in the treated area. Hair in other areas of the body is not affected. Your hair may grow back once your treatment is over, but in some cases the hair loss may be permanent.

Feeling sick Radiotherapy to tumours in or near the digestive system can lead to nausea and vomiting. Anti-sickness (anti-emetic) drugs can often help to overcome this problem. It can also help if you avoid large meals and eat small amounts more often, or supplement your diet with nutritious drinks, which you can buy at most chemists.

Hoarse voice Radiotherapy near the voice box (larynx) may cause hoarseness of the voice. This is usually temporary and should begin to reduce once the treatment has finished.

Tiredness You may feel very tired. It is important to get as much rest as possible, especially if you are travelling a long way for treatment every day.

Most side effects of radiotherapy disappear gradually once your course of treatment is over, although some may continue for several months afterwards. If you have any problems during your treatment, talk to the radiotherapy staff at the hospital, as they have experience of looking after other people in the same situation as yourself.

Radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, throughout your treatment.

Treating Kaposi's sarcoma with immunotherapy
This type of treatment is occasionally used to treat Kaposi's sarcoma. It is often used alongside other treatments such as anti-HIV therapies. Immunotherapy involves the use of proteins normally produced by the body during viral infections such as flu. These anti-viral proteins can also be produced in a laboratory.

Interferon

Interferon is the most common type of immunotherapy used to treat KS and is usually given three times a week by injection under the skin. Alternatively, it may be injected into the lesion. The needle is very small and fine so the injections are only slightly uncomfortable. You will be taught how to give yourself these injections so you can do them at home.
In the first week or two of treatment, interferon can cause side effects similar to those of flu: especially chills, fever, headaches, tiredness and aching in the back, joints and muscles. However, these soon disappear. Your doctor may recommend that you take paracetamol about half an hour before your injection to prevent these side effects.

Living with Kaposi's sarcoma

Many people with slow-growing or early KS often find that physically they feel quite well, but emotionally may find it difficult to cope. For some people the appearance of KS is the first sign that they have Aids. In this situation, coming to terms with the diagnosis, whether they knew about it beforehand or not, together with the constant physical reminder of their illness, can be devastating.

It often helps to talk to someone who understands the special needs and problems of people with Aids, their partners and families. A large number of organisations offer help and support to people with Aids. Some of the main Aids organisations in the UK are listed in this section (see organisations). Local support groups can also provide support and you can get details of these from The Terrence Higgins Trust.

People affected by Kaposi's sarcoma in the skin may find this distressing. However, there is a way to reduce the differences in skin colour and make the areas of KS less noticeable. Camouflage make-up consists of specially designed creams, and the ranges available are suitable for all skin types and colours, in both men and women. Some clinical nurse specialists, the British Association of Skin Camouflage and the British Red Cross offer a camouflage make-up service with individual teaching sessions on how to apply it for the best effect.

If KS has caused swelling of the limbs and lymph nodes (lymphoedema), you may have hot, overstretched and painful skin in those areas. We have a section on lymphoedema, and our cancer information and support service can give you details of your nearest lymphoedema clinics.
If you are finding it difficult to eat and are losing weight, it may be advisable to take small, frequent, high-calorie, high-protein drinks which are available from chemists and hospital dietitians. If cleaning your teeth is painful because of mouth lesions, try using a soft toothbrush or foam stick.

http://www.cancerbackup.org.uk/Cancerty ... sissarcoma

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Lymphedema Caused by Kaposi’s Sarcoma

Acquired immune deficiency syndrome-related hyperkeratotic Kaposi's sarcoma with severe lymphoedema: report of five cases.

British Journal Dermatology (2000)

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Lymphedematous HIV-associated Kaposi's sarcoma.

July 2006 – J Cutaneous Pathology

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Lower extremity lymphedema caused by acquired immune deficiency syndrome-related Kaposi's sarcoma: case report and review of the literature.

1995 J Vasc Surg.

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Treatment of classic Kaposi's sarcoma-associated lymphedema with elastic stockings.

J Dermatol. 2006 Jul

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

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Kapposi’s Sarcoma and Pre-existing lymphedema

Lymphedema: an immunologically vulnerable site for development of neoplasms.

J Am Acad Dermatol. 2002 Jul;

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=12077591

Kaposi's sarcoma on a lymphedematous immunocompromised limb.

Int J Dermatol. 1984 Jan-Feb;23

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Disseminated Kaposi's sarcoma not associated with HIV infection in a bisexual man.

J Am Acad Dermatol. 1990

http://www.ncbi.nlm.nih.gov/entrez/quer ... ds=2229537

Kaposi's sarcoma on a lymphedematous arm after mastectomy.

Am J Clin Oncol. 1996 Feb

http://www.ncbi.nlm.nih.gov/entrez/quer ... ds=8554044

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Organ Transplant Related Kaposi’s Sarcoma

Kaposi's sarcoma risk among transplant recipients in the United States (1993-2003).

Int J Cancer. 2006 Aug 23;

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Skin tumors in organ-transplant recipients

Hautarzt. 2006 Jun 7;

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Post transplant Kaposi's sarcoma among Nigerians: a report of two cases.

Afr J Med Med Sci. 2005 Dec

http://www.ncbi.nlm.nih.gov/entrez/quer ... med_docsum

Successful treatment of post-transplant Kaposi's sarcoma by reduction of immunosuppression

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=11981080

Kaposi's sarcoma in kidney transplant recipients: a 23-year experience.

QJM. 2005 Mar

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15728402

Kaposi's sarcoma in renal transplant patients: predisposing factors and prognosis.

Transplant Proc. 2005 Mar

http://www.ncbi.nlm.nih.gov/entrez/quer ... s=15848593
patoco
Site Admin
 
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Facial Lymphedema in HIV-Kaposi Sarcoma

Postby patoco » Thu Jan 31, 2008 4:32 am

The prognostic significance of facial lymphoedema in HIV-seropositive subjects with Kaposi sarcoma.

AIDS Res Ther. 2008 Jan 29

Feller L, Masipa JN, Wood NH, Raubenheimer EJ, Lemmer J.

ABSTRACT: BACKGROUND: Kaposi Sarcoma (KS) is a multifocal angioproliferative neoplasm characterized by inflammation, oedema, neoangiogenesis and spindle cell proliferation. The pathogenesis of human immunodeficiency virus (HIV)-associated KS (HIV-KS) is multifactorial and is influenced by HIV, by human herpesvirus-8 (HHV-8), and by increased production of cytokines and growth factors. Whether HIV-KS is a true malignancy or a reactive hyperplastic inflammatory condition is debatable.

RESULTS AND CONCLUSIONS: Oedema of the face, legs and hands is a prominent feature of HIV-KS and is probably caused by lymphoedema related to the HIV-KS lesions. The cases of two HIV-seropositive subjects with KS-associated facial lymphoedema are reported. Extensive oral HIV-KS in association with facial oedema in the absence of anti-retroviral treatment appears to be an indication of a poor prognosis.

Full Text Article

http://www.aidsrestherapy.com/content/5/1/2
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Additional Information

Postby patoco » Thu Jan 31, 2008 12:07 pm

See also:

ARM OR LEG SWELLING AFTER CANCER

http://www.lymphedemapeople.com/wiki/do ... ter_cancer

Cancer Associated with Lymphedema

http://www.lymphedemapeople.com/wiki/do ... lymphedema

Secondary Lymphedema in the Cancer Patient

http://www.lymphedemapeople.com/wiki/do ... er_patient
patoco
Site Admin
 
Posts: 2175
Joined: Thu Jun 08, 2006 9:07 pm

Postby patoco » Mon Mar 24, 2008 11:47 am

Radiotherapy of classic and human immunodeficiency virus-related Kaposi's sarcoma: results in 1482 lesions.

J Eur Acad Dermatol Venereol. 2008 Mar

Caccialanza M, Marca S, Piccinno R, Eulisse G.
Department of Photoradiotherapy, Institute of Dermatological Sciences of the University, Milan, Italy. fotoradio@policlinico.mi.it

BACKGROUND: The lesions of the various forms of Kaposi's sarcoma (KS), which are relatively radiosensitive, have been treated with different modalities of radiotherapy, with heterogeneous aims and results.

OBJECTIVE: To verify the effectiveness and safety of radiotherapy on a large number of lesions endowed (classic KS) with a prolonged follow-up.

METHODS: A retrospective study was done on 711 lesions of classic KS and 771 lesions of human immunodeficiency virus (HIV)-related KS, treated with traditional X-ray therapy.

RESULTS: In classic KS, a cure rate of 98.7% resulted after 13.5 years from the end of radiotherapy. In three lesions (0.42%) in the same patient, an acute radiodermatitis occurred after traumatic action. In HIV-related KS, a complete remission was obtained in 91.43% of the lesions, partial remission in 6.74% and non-response in 0.51% at 1 to 46 months from the end of radiotherapy.

CONCLUSION: Radiotherapy showed to be a safe and effective method, with relevant importance in the therapeutic strategy of KS.

http://www.blackwell-synergy.com/doi/ab ... 07.02405.x

Thalidomide in the treatment of Kaposi's sarcoma.

Dermatology. 2007

Rubegni P, Sbano P, De Aloe G, Flori ML, Fimiani M.
Department of Clinical Medicine and Immunological Sciences, Section of Dermatology, University of Siena, Siena, Italy. rubegni@unisi.it

BACKGROUND: Kaposi's sarcoma (KS) is a lymphangioproliferative tumour. Therapy of KS depends on the characteristics of the disease, especially area and growth rate of lesions, and patient condition.

Currently symptomatic resectable lesions are excised, whereas more advanced disease and unresectable lesions are treated with radiotherapy. If a large area or internal organs are affected or other treatments fail, chemotherapy is used. Recently some authors have reported their encouraging experience in the use of thalidomide in patients with AIDS-related KS.

OBJECTIVE: To evaluate the efficacy of thalidomide in 3 patients with non-AIDS-related KS.

METHODS: Two patients with classic widespread cutaneous and 1 with iatrogenic cutaneous and visceral KS were treated with thalidomide (100 mg/day) for 12 months.

RESULTS: In all 3 patients partial remission was evident after 4 months of thalidomide therapy; in 2 out of 3 complete remission was achieved after 12 months of treatment.

CONCLUSIONS: Our results seem to confirm the utility of thalidomide in the treatment of non-AIDS-related KS. Copyright 2007 S. Karger AG, Basel.

http://content.karger.com/produktedb/pr ... =000106583

Cutaneous and lymphadenopathic Kaposi's sarcoma: a case report and review of literature

J Cutan Pathol. 2008 Feb

Hussein MR.
Department of Pathology, Faculty of Medicine, Assuit University Hospitals, Assuit University, Egypt.

Kaposi's sarcoma (KS) of childhood is an extremely rare and unexplained disease. It is usually associated with immunosuppression and human herpes virus 8 HHV-8 infection. It can involve skin, mucous membranes, lymph nodes and viscera. This investigation describes a case of a 3-year-old boy with cutaneous and lymphangiopathic KS. Initially, the patient presented with cutaneous lesions of KS behind the right ear. Two months later, the disease disseminated not only cutaneously but also to the cervical, axillary and inguinal lymph nodes. Immunological evaluation showed severe lymphocytopenia but without evidence of human immunodeficiency virus infection. The vascular nature of the lesion was supported by positive staining for CD31 and CD34. This study examines the clinicopathologic features of KS in children and summarizes the relevant literature.

http://www.blackwell-synergy.com/doi/ab ... 07.00844.x

Human immunodeficiency virus-associated Kaposi sarcoma as an immune reconstitution inflammatory syndrome: a literature review and case report.

J Periodontol. 2008 Feb

Feller L, Anagnostopoulos C, Wood NH, Bouckaert M, Raubenheimer EJ, Lemmer J.
Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, Medunsa, South Africa. lfeller@medunsa.ac.za

BACKGROUND: Kaposi sarcoma (KS) is the most common human immunodeficiency virus (HIV)-associated neoplasm (HIV-KS). Highly active antiretroviral therapy (HAART) results in a decrease in the incidence and prevalence of HIV-KS as well as in clinical improvement.

However, in a subset of subjects who are HIV seropositive, KS may recrudesce early following the introduction of HAART as an immune reconstitution inflammatory syndrome (IRIS).

METHODS: The management of a patient who is HIV seropositive with rapid clinical worsening of oral KS lesions shortly after the initiation of HAART was documented. Repeated serologic testing for CD4(+) T-cell count and microscopic examination of two biopsy specimens of the oral lesion, one taken before and the other taken after cytotoxic chemotherapy, followed by surgical excision was the treatment modality used.

RESULTS: Microscopic examination of the incisional biopsy specimen taken from the oral lesion at the time of the initial consultation confirmed the clinical diagnosis of KS. The sequential serological tests showed a progressive increase in CD4(+) T-cell counts that paralleled the rapid clinical worsening of the KS disease. This was consistent with the diagnosis of IRIS-associated HIV-KS. Subsequent cytotoxic chemotherapy brought about resolution of the IRIS and regression of the HIV-KS lesions. Microscopic examination of a biopsy specimen obtained after cytotoxic chemotherapy did not show any of the original KS. The residual palatal exophytic mass was excised.

CONCLUSIONS: IRIS-associated HIV-KS is not a disease, but rather a temporary paradoxical immunoinflammatory reaction brought about by improvement in immune status following HAART. IRIS-associated HIV-KS can be controlled effectively by limited systemic cytotoxic chemotherapy in the setting of HAART.

http://www.ncbi.nlm.nih.gov/pubmed/1825 ... d_RVDocSum

HIV-Associated Kaposi's Sarcoma

Infection. 2008 Feb

Seybold U, Mayr D, Degenhart C, Bogner JR.
Division of Infectious Diseases, Medizinische Poliklinik, Ludwig-Maximilians-Universität (LMU) Munich, Pettenkoferstr. 8a, 80336, Munich, Germany, Ulrich.Seybold@med.uni-muenchen.de.

A 25-year-old man was diagnosed with HIV infection and a CD4 count of 21/mul. He presented with chills, fever up to 39.5 degrees C and dry cough since 1 week. Antibiotic treatment for suspected pneumonia resulted in some clinical improvement. He had a blackish spot on his right forearm, which slowly evolved into a firm nodule (panel A), and a small purple spot on the hard palate. Both were interpreted as Kaposi's sarcoma (KS). Endoscopy revealed no gastrointestinal or pulmonary lesions. Human herpes virus 8 (HHV8) IgG EIA was negative both initially and after starting highly active antiretroviral therapy (HAART). Despite an increase of CD4 to 207/mul, the oral nodule evolved into a prominent tumor of 2.5x2.5 cm (panel B). Biopsy confirmed KS, showing irregular vascular spaces, prominent endothelium, extravasated erythrocytes, and atypical spindle cells positive for CD31, CD34 and HHV8 (panel C). Several weeks later, the patient developed increasing dyspnea; a CT scan revealed perihilar, radially configured pulmonary infiltrates predominantly of the left lower lobe (panel D), consistent with pulmonary KS.HIV-associated KS affects the skin and/or mucous membranes and is strictly associated with HHV8 coinfection. However, HHV8 serology may be unreliable especially in the setting of severe immunodeficiency. Usually, immune reconstitution with HAART leads to resolution of KS, but in some cases chemotherapy may be necessary.Treatment with liposomal doxorubicin led to rapid improvement of his dyspnea, weight gain of 3 kg within 6 weeks, and complete flattening of the lesion on the palate within 9 weeks.

http://www.springerlink.com/content/u746p65l27734455/
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Re: Kaposi’s Sarcoma

Postby patoco » Fri Apr 20, 2012 6:48 am

Variable clinical presentations of Classic Kaposi Sarcoma in Turkish patients.
Nar 2012

Altunay I, Kucukunal A, Demirci GT, Ates B.

Source

Department of Dermatology, Sisli Etfal Training And Research Hospital, Istanbul, Turkey.

Abstract

BACKGROUND:
Kaposi sarcoma (KS) is a vascular neoplasm with multicentric cutanenous and extracutaneous involvements, which was first described by Moriz Kaposi in 1872. Since then, different epidemiological clinical and histopathological variants of this neoplasm have been identified. Classic Kaposi sarcoma (CKS) is one of four main clinico-epidemiologiologic variants. characteristics of the disease.

MATERIALS AND METHODS:
Four Turkish inpatients with CKS were evaluated in the study. All medical history and clinical data were noted. A screening immunodeficiency workup were performed for all patients. HHV-8 immunofluorescence testing on the specimens and ELISA test for human immunodeficiency virus (HIV 1 and 2) were performed. Pulmonary X ray graphies and computurized tomography (CT) scan were applied. Stage of the tumor was determined, in each case, according to the classification system proposed by Brambilla et al in 2003.

RESULTS:
All patients are positive for HHV-8. They were all immunocompetent and negative for HIV1 and HIV2. The first patient was unusual for morphological presentation of several verrucoid lesions that was evaluated as verrucoid KS. He was considered stage IB CKS. The patient 2 was a young man and the course of KS seemed unexpectedly aggressive for CKS. His clinical appearence seemed us to be a patient with AIDSassociated KS. The patient was evaluated as stage IVB CKS. Our third patient had also prominent lymphedema associated with bluish discoloration on the toes and fingers, suggesting a diagnosis of peripheral vascular disorder. He was diagnosed as stage IIIB CKS. The fourth case was interesting for very extensive lesions involving big sized plaques and also the existence of mucosal lesion. The patient was diagnosed as stage IVB CKS.

CONCLUSIONS:
It seems that the reports of exceptional cases of KS are accumulating. Data from various cases should be collected and perhaps, novel clinical classifications should be considered.

http://www.ncbi.nlm.nih.gov/pubmed/22514583

Classic Kaposi's sarcoma in Morocco: clinico-epidemiological study at the National Institute of Oncology.

Nov 2011

Errihani H, Berrada N, Raissouni S, Rais F, Mrabti H, Rais G.

Source

Medical oncology department, National Institute of Oncology, Rabat, Morocco.

Abstract

Keywords: CKS, Morocco, clinical features, HHV-8

BACKGROUND:
Classic Kaposi's sarcoma (CKS) is a rare disease likely associated with human herpes virus 8 (HHV-8) infection, and occurs predominantly in Jewish, Mediterranean and middle eastern men. There is a dearth of data in Moroccan patients with CKS regarding epidemiology, clinical characteristics and outcomes. This report examines a cohort of patients with CKS evaluated at the national institute of oncology over 11-year period.

METHODS:
A retrospective analysis of patients referred to the national institute of oncology with classical Kaposi sarcoma, between January 1998 and February 2008, was performed. Reviewed information included demographics, clinical and pathological staging, death or last follow-up.

RESULTS:
During the study period, 56 patients with a diagnosis of CKS have been referred to our hospital. There were 11 (19.7%) females and 45 (80.3%) males (male-to-female ratio: 4:1). Mean age at diagnosis was 61.7 ± 15 (range: 15-86 years). Nodules and/or plaques were the most frequent type of lesion. The most common location was the lower limbs, particularly the distal lower extremity (90%). In addition to skin involvement, visceral spread was evident in 9 cases. The most common visceral involvement sites were lymph nodes (44%), lung (22%), and gastrointestinal tract (22%). Associated lymphoedema was seen in 24 (42%) of the patients. There were 18 stage I patients (32.14%), 8: stage II (14.28%), 21 stage III (37.5%) and 9 stage IV (16.07%). A second primary malignancy was diagnosed in 6 cases (10.7%), none of the reticuloendothelial system. With a median follow-up of 45 months, 38 (67.8) patients are alive, of whom 25 (65.78%) patients with stable disease, five with progressive disease currently under systemic chemotherapy and 8 (21.05%) are alive and free of disease, over a mean interval of 5 years.

CONCLUSION:
This is the largest reported series in our context. In Morocco, CKS exhibits some special characteristics including a disseminated skin disease at diagnosis especially in men, a more common visceral or lymph node involvement and a less frequent association with second malignancies.

http://www.ncbi.nlm.nih.gov/pmc/article ... ool=pubmed
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