Sánchez DJ, Hernández GA, Sobrino CS, Lárraga OA, Sánchez BG, López BP, Elguero PE

Language: Spanish
References: 36
Page: 416-423
PDF size: 95.26 Kb.

ABSTRACT

Background: Kaposi sarcoma may be the initial manifestation of immunodeficiency acquired syndrome (AIDS )in 30% of patients. The digestive tract is the thirth most affected site after the skin and lymph nodes. Objective: To correlate the clinic and endoscopic manifestations of patients with AIDS. Method: 12 consecutive cases with AIDS and Kaposi sarcoma. We analyzed clinical data, positivity , immune state (leucocytes, lymphocytes, viral load, CD4 and CD8 counts, CD4/CD8 relation), opportunistic infections, tumors, endoscopic characteristics of the associated tumors, and histologic results. Results: 12 patients. 11 men and 1 woman with an average age of 37.3 years old, a Karnofsky score = 80%, weight = 55.7 kg. All of them acquired the disease by sexual contact. The symptoms were weight loss in 6 cases, anemia in 6, abdominal pain 6, fever 6, melena 4, odynophagia 3, diarrhea 4, hematemesis 2, abdominal distention 2, dysphagia 2, bright red blood per rectum 1. The distribution of Kaposi sarcoma was as follows: hard palate 7, soft palate 2, larynx 3, esophagus 2, stomach 10, duodenum 2, colon 5 and anal conduct 1. The endoscopic appearance was in the majority a purple or blue elevated plaque that had various sizes. The biopsy was positive to Kaposi sarcoma in at least one lesion of each patient. The haemoglobin was = 11.5, leukocytes = 5463, total lymphocytes = 2377 (35.7%), CD4 = 247.8 (10.8%), CD8 = 1008.7 (54.6%). CD4/CD8 relation = 0.20, T4/T8 = 0.25M, the viral load was = 140,629 copies. Conclusions: The Kaposi sarcoma appears as a multiple lesion with diverse aspect and colors that go from purple to blue or red. There is correlation between a high number of Kaposi sarcoma lesions, affected organs, immunologic status and mortality.

REFERENCES

1. Kaposi M. Idiopathic multiple pigmented sarcoma of the skin. CA Cancer J Clin 1982; 32: 342-7.

2. Kaplan NM, Palmer BF, Terada LS, et al. AIDS vasculopathy. Am J Med Sci 2000; 320(6): 379-87.

3. Bruce J. Acquired immunodeficiency syndrome-related Kaposi’s sarcoma: clinical features, staging, and treatment. Semin Oncol 2000;7(4): 424-30.

4. Safai B, et al. The natural history of Kaposi’s sarcoma in the acquired immunodeficiency syndrome. Ann of intern Med 1985;103(5): 744-50.

5. Antman K, Chang Yuan. Medical progress: Kaposi ’s sarcoma. N Engl J Med 2000; 342(14): 1027-38.

6. Barrison IG, et al. Upper gastrointestinal Kaposi’s sarcoma in patients positive for HIV antibody without cutaneous disease. Br Med J 1988; 296: 92-3.

7. Gary D, et al. Endoscopic evolution of gastric Kaposi’s sarcoma. Gastrointest Endosc 1987; 33(6): 450-3.

8. Chalasani N, et al. Etiology and outcome of lower gastrointestinal bleeding in patients UIT AIDS. Am J Gastroenterol 1998; 93(2): 175-8.

9. Calzona A, et al. Massive gastrointestinal hemorrhage in a renal transplant recipient due to visceral Kaposi’s sarcoma. Endoscopy 2002; 34: 179.

10. Bini EJ, et al. Risk factors for rebleeding and mortality from acute upper gastrointestinal hemorrhage in human immunodeficiency virus infection. Am J Gastroenterol 1999; 94(2): 358-63.

11. Biggar RJ, Rabkin CS. The epidemiology of AIDS-related neoplasms. Hematol Oncol Clin North Am 1996; 10: 997-1010.

12. Fiorelli V, Gendelman R, Sirianni MC, et al. [Gamma]-interferon produced by CD8+ T cells infiltratina Kaposi’s sarcoma induce spindle cells with angiogenic phenotypic and synergy with human immunodeficiency virus-1Tat protein: an inmune response to human herpesvirus-8 infection? Blood 1998; 91: 956-67.

13. Fiorelli VA, Gendelman R, Samaniego F, et al. Cytokines from activated T cells induce norma endothelial cells to acquire the phenotypic and functional features of AIDS-Kaposi’s sarcoma spindle cells. J Clin Invest 1995; 95: 1723-34.

14. Kennedy MM, Lucas SB, Jones RR, et al. HHV8 and Kaposi’s sarcoma: a time cohort study. Mol Pathol 1997; 50: 96-100.

15. DiGiovanna JJ, Safai B. Kaposi’s sarcoma: retrospective study of 90 cases with particular emphasis on the familial occurrences, ethnic background and prevalence of other disease. Am J Med 1981; 71: 779-83.

16. Bayley AC. Aggressive Kaposi’s sarcoma in Zambia, 1983. Lancet 1984; 1: 1318-20.

17. Montagnino G, Bencini OL, Tarantino A, et al. Clinical features and course of Kaposi’s in kidney transplant patients. Reporte of 13 cases. Am J Nephrol 1994; 14: 121-6.

18. Lesnoni La Parala I, Masini C, Nanni G, et al. Kaposi’s sarcoma in renal-transplant recipients. Experience at the Catholic University in Roma, 1988-1996. Dermatology 1997; 194: 229-33.

19. Malekzadeh MH, Church JA, Siegel SE, et al. Human immunodeficiency virus-associated Kaposi’s sarcoma in a pediatric renal transplant recipient. Nephron 1987; 47: 62-5.

20. Strauchen JA, Hauser AD, Burstein D, et al. Body cavity-based malignant lymphoma containing Kaposi sarcoma-associated herpesvirus in an HIV-negative man with previous Kaposi sarcoma. Ann Intern Med 1996; 125: 822-5.

21. Wang AY, Li PK. To KF, et al. Coexistence of Kaposi’s sarcoma and tuberculosis in a renal transplant recipient. Transplantation 1998; 66: 115-8.

22. Beral V, Peterman TA, Berkerlman RL, et al. Kaposi’s sarcoma among persons with AIDS: a sexually transmitted infection? Lancet 1990; 335: 123-8.

23. Friedman L, Wright T, Altman F. Gastrointestinal Kaposi’s in patients with acquired immunodeficiency syndrome. Gastroenterology 1985; 89: 102-8.

24. Nesbitt S, Mark PF, Zimmerman HM. Disseminated visceral idiopathic hemorrhagic sarcoma (Kaposi’s disease): report of a case with necropsy finding. Ann Intern Med 1945; 22: 601-605.

25. Cox FH, Helwing EG, Kaposi’s sarcoma. Cancer 1959; 12: 289-98.

26. While JAM, King MH. Kaposi’s sarcoma presenting with abdominal symptoms. Radiology 1964; 46: 197-201.

27. Mitchell N, Feder I. Kaposi’s sarcoma with secondary involvement of the jejunum, perforation and peritonitis. Ann Intern Med 1949; 31: 324-9.

28. Sherwin B, Gordimer H, Kaposi’s sarcoma. Case report with unique visceral manifestations. Ann Surg 1952; 135: 118-23.

29. Adlersberg R. Kaposi’s sarcoma complicating ulcerative colitis. Am J Clin Pathol 1970; 54: 143-6.

30. Sunter JP. Visceral Kaposi’s sarcoma. Occurrence in a patient suffering from celiac disease. Arch Pathol Lab Med 1978; 102: 543-5.

31. Peerone V, Pergola M, Abate G, et al. Protein-losing enteropathy in a patient with generalized Kaposi’s sarcoma. Cancer 1981; 47: 588-91.

32. Novis BH, King H, Bank S. Kaposi’s sarcoma presenting with diarrhea and protein losing enteropathy. Gastroenterology 1974; 67: 996-1000.

33. Bry D, FarmanJ, Dallemand S, et al. Kaposi’s sarcoma of theintestinal tract: roentgen manifestations. Gastrointest Radiol 1978; 3: 425-30.

34. Rajan RK, Godman S, Floch MH. Gastroscopic finding in Kaposi’s sarcoma. Gastrointest Endosc 1968; 16: 104-106.

35. Ahmed N, Nelson RS, Goldstein HM, Sinkovics JG. Kaposi’s sarcoma of the stomach and duodenum. Endoscopic and roentgenologic correlation. Gastrointest Endosc 1975; 21: 149-152.

36. Saltz K, Kurtz C, Lightdale J. et al. Kaposi’s Sarcoma. Gastrointestinal involvement correlation with skin findings and immunologic function. Dig Dis Sci 1984; 29: 817-23.