Disseminated Kaposi sarcoma with osseous metastases in patients with HIV infection. Case report

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Abstract

Background. Kaposi sarcoma is a low-grade vascular tumor affecting blood and lymphatic vessels associated with the human herpes virus type 8 (HHV-8). As a rule, the skin of the lower extremities is involved in the process first of all, and then other organs and lymph nodes are involved. There are 4 various types of the disease with different clinical picture: the classic, the endemic, the epidemic and immunosuppression subtype. The epidemic subtype is the most common and has the most aggressive course, with specific lesions of a multiple kind, including the skin, mucous membrane layers, the lymph nodes, the gastrointestinal tract, the lungs and the spleen. Osseous metastases are extremely rare.

Aim. Show the case of Kaposi sarcoma with osseous metastases in patient with the human immunodeficiency virus (HIV) infection.

Results. We observed a 43-year-old patient with HIV infection and stage 4b Kaposi sarcoma against the background of the irregular antiretroviral therapy in the progression stages. The duration of the anamnesis was 32 months. The clinical debut of the cancer process was noted with skin lesions on the shoulder. Histological and immunohistochemical analysis of skin biopsies showed the morphological picture of Kaposi sarcoma. HHV-8 was expressed in tumor cells. During the endoscopic examination the lesions of oral mucosa, stomach and proximal colon were confirmed morphologically, and spiral computed tomography of the chest revealed the lesions in the lungs. On this point, the patients received oxaliplatin-based chemotherapy and aetoposidum for 6 months and against the background of this treatment we observed the disease progression associated with the involvement of the retroperitoneal lymph nodes, the left adrenal gland and the penis. Circumcision was performed in the case associated with the involvement of the penis. The treatment was continued. The lytic left iliac bone lesion, the retroperitoneal lymph nodes, the iliac lymph node groups, as well as the left inguinal lymph nodes, the left adrenal gland and the lungs were characterized by a high F-18 FDG uptake after 3 months of the treatment, according to the results of Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT).

Conclusion. Kaposi sarcoma in patients with HIV infection had an aggressively course with disseminated skin lesions and internal organ involvement, including bones as showed in this clinical case. In this case, the axial skeleton was more commonly involved. PET/CT is a diagnostic imaging method in the differential diagnosis and determination of the prevalence of the cancer process.

About the authors

Nikolai A. Ognerubov

Derzhavin Tambov State University; Tambov Regional Oncological Clinical Dispensary

Author for correspondence.
Email: ognerubov_n.a@mail.ru
ORCID iD: 0000-0003-4045-1247
SPIN-code: 3576-3592

D. Sci. (Med.), Cand. Sci. (Law), Prof.

Russian Federation, Tambov

Tatyana S. Antipova

"PET-Technoligy" Ltd

Email: antipovats@gmail.com
ORCID iD: 0000-0003-4165-8397

doctor

Russian Federation, Tambov

References

  1. Yergiyev O, Mohanty A, Curran-Melendez S, et al. Fine-needle aspiration cytology of disseminated Kaposi sarcoma of the bone in an AIDS patient. Acta Cytol. 2015;59(1):113-7. doi: 10.1159/000369855
  2. Клинические рекомендации «Саркома Капоши». M.: Общероссийская общественная организация «Российское общество дерматовенерологов и косметологов», 2016 [Klinicheskie rekomendatsii "Sarkoma Kaposhi". Moscow: Obshcherossiiskaya obshchestvennaya organizatsiya "Rossiiskoe obshchestvo dermatovenerologov i kosmetologov", 2016 (in Russian)].
  3. Global Cancer Observatory, 2020. Available at: https://gco.iarc.fr/today/data/factsheets/cancers/19-Kaposi-sarcoma-fact-sheet.pdf. Accessed: 22.11.2021.
  4. Global Cancer Observatory, Russian Federation, 2020. Available at: https://gco.iarc.fr/today/data/factsheets/populations/643-russian-federation-fact-sheets.pdf. Accessed: 22.11.2021.
  5. Niedt GW, Schinella RA. Acquired immunodeficiency syndrome: clinicopathologic study of 56 autopsies. Arch Pathol Lab Med. 1985;109(8):727-34.
  6. Lemlich G, Schwam L, Lebwohl M. Kaposi’s sarcoma and acquired immunodeficiency syndrome: postmortem findings in twenty-four cases. J Am Acad Dermatol. 1987;16:319-25.
  7. Restrepo CS, Martínez S, Lemos JA, et al. Imaging Manifestations of Kaposi Sarcoma. Radiographics. 2006;26(4):1169-85. doi: 10.1148/rg.264055129
  8. Herts BR, Megibow AJ, Birnbaum BA, et al. High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT. Radiology. 1992;185:777-81.
  9. Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer. 2008;8(1). doi: 10.1186/1471-2407-8-190
  10. Meyer-Rochow GY, Lee KM, Smeeton IW, Shaw JH: Primary Kaposi sarcoma of the appendix: a rare cause of appendicitis. ANZ J Surg. 2007;77:402-3. doi: 10.1111/j.1445-2197.2007.04078.x
  11. Elizalde JI, Escorsell A, García-Pugés A, et al. Isolated rectal Kaposi sarcoma (article in Spanish). Rev Esp Enferm Dig. 1993;84:399-401.
  12. Bell BM, Syed A, Carmack SW, et al. Disseminated Kaposi Sarcoma with Osseous Metastases in an Hiv-Positive Patient. Baylor Univ Med Cent Proc. 2016;29(1):52-4. doi: 10.1080/08998280.2016.11929358
  13. Sharma S, Kurra C, Hyska-Campbell M, et al. Kaposi Sarcoma mimicking pedal osteomyelitis in a patient with HIV. Radiol Case Reports. 2019;14(12):1495-99. doi: 10.1016/j.radcr.2019.09.025
  14. Tourlaki A, Germiniasi F, Mancuso R, et al. Bone involvement in classic Kaposi’s sarcoma. Eur J Dermatol. 2020;30(2):148-50. doi: 10.1684/ejd.2020.3754
  15. Celik ZE, Celik M, Sen E, et al. Incidentally Detected Kaposi Sarcoma of Adrenal Gland with Anaplastic Features in an HIV Negative Patient. Case Rep Pathol. 2016;2016(11):1-5. doi: 10.1155/2016/1280201
  16. Ben Tekaya A, Tekaya R, Mahmoud I, et al. Kaposi sarcoma in an HIV-negative Tunisian patient: A rare cause of metatarsalgia. Egypt Rheumatol. 2017;39(1):53-6. doi: 10.1016/j.ejr.2016.05.004
  17. Ritz-Quillac L, Machet L, Machet MC, et al. Bone Involvement in a Case of Kaposi Sarcoma. Dermatology. 1999;198(1):73-4. doi: 10.1159/000018069
  18. Огнерубов Н.А., Блохин А.В., Гумарева Г.Е. Саркома Капоши полового члена у ВИЧ-отрицательных пациентов: клинические случаи. Онкоурология. 2021;17(1):120-5. [Ognerubov NA, Blokhin AV, Gumareva GE. Kaposi’s sarcoma of the penis in HIV-negative patients: case series. Onkourologiya = Cancer Urology. 2021;17(1):120-5 (in Russian)]. doi: 10.17650/1726-9776-2021-17-1-120-125
  19. Katz MH, Hessol NA, Buchbinder SP, et al. Temporal trends of opportunistic infections and malignancies in homosexual men with AIDS. J Infect Dis. 1994;170(1):198-202.
  20. Caponetti G, Dezube BJ, Restrepo CS, Pantanowitz L. Kaposi sarcoma of the musculoskeletal system: A review of 66 patients. Cancer. 2007;109(6):1040-52. doi: 10.1002/cncr.22500
  21. Thanos L, Mylona S, Kalioras V, et al. Osseous Kaposi sarcoma in an HIV-positive patient. Skeletal Radiol. 2004;33:241-3. doi: 10.1007/s00256-003-0732-z
  22. Abid H, Shimi M, El Ibrahimi A, et al. Classic Kaposi sarcoma with massive bone destruction: rare form (a case report). Sch J Med Case Rep. 2015;3:540-2.
  23. Aprosio N, Batzenschlager A, Hamid M, et al. Kaposi disease with mesenteric localization (article in French). Presse Med. 1984;13:504.
  24. Pantanowitz L, Dezube BJ. Bone lesions in Kaposi sarcoma. AIDS Read. 2007;17:204.
  25. Restrepo CS, Martínez S, Lemos JA, et al. Imaging manifestations of Kaposi sarcoma. Radiographics. 2006;26:1169-85.
  26. Krishna G. Osseous Kaposi Sarcoma. JAMA J Am Med Assoc. 2003;289(9):1106-06. doi: 10.1001/jama.289.9.1106

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2. Fig. 1. A 43-year-old patient. The lytic osseous destruction in the left iliac wing, measuring 12×8 mm, with diffuse RFP uptake is detected on axial CT and combined PET/CT images, SUVmax 2.00 (arrow).

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3. Fig. 2. A 43-year-old patient. Enlarged common, external and internal iliac, left inguinal lymph nodes, measuring about 12 mm with focal radiopharmaceutical uptake are detected on axial CT and combined PET/CT images, SUVmax 3.91.

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4. Fig. 3. A 43-year-old patient. The formation measuring 25×35 mm with focal RFP uptake in the left adrenal gland is detected on axial CT and combined PET/CT images, SUVmax 3.44.

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5. Fig. 4. A 43-year-old patient. The polypoid formation on the right arytenoepiglottic fold measuring 11×14 mm is detected on axial CT and combined PET/CT images, SUVmax 11.15.

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6. Fig. 5. A 43-year-old patient. Axial CT and combined PET/CT scans showing multiple focal formations and areas of reduced pneumatization by the type of frosted-glass in both lungs with metabolic activity by the uptake of 18F-FDG, SUVmax 2.73.

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