AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?

Abstract

BackgroundKaposi Sarcoma (KS) is a malignancy of endothelial skin cells with multifocal localization on the skin, lymph nodes and visceral organs. Although all clinical variants are associated with HHV-8 infection, specific differences in the clinical onset and in the natural history of AIDS-KS and Classic-KS have been described. The present randomised prospective-observational study aimed to investigate whether the ultrasound pattern and color Doppler flow imaging of vascularisation of skin lesions of patients with Classic KS (CKS) or AIDS-KS could provide useful information to the evaluation of clinical activity of the disease.MethodsCutaneous lesions of 24 patients with histologically confirmed KS were investigated using very high frequency ultrasound probes; 16 patients had CKS and 8 had AIDS-KS. HHV-8 infection was confirmed in all patients by investigating the specific humoral response to viral antigens. Immunological and virological parameters were also assessed to monitor HIV or HHV-8 viral infection. For each patient, a target skin lesion was selected on the basis of size (diameter from 0.4 to 2 cm). Each lesion was analyzed in terms of size, depth and color Doppler pattern.ResultsThe B-mode ultrasound patterns of skin lesions did not differ when comparing CKS patients to AIDS-KS patients, whereas the color Doppler signal, which is associated with vascular activity, was detected in the KS lesions of 6/8 AIDS-KS patients (75.0%) and in 2/16 CKS (16,7%); the latter two patients showed a clinically progressive and extensive disease stage (IV B).ConclusionsOur preliminary results suggest that small cutaneous KS lesions - in both CKS and AIDS-KS patients- display similar B-mode ultrasound patterns ( hypoechoic, well defined, superficial lesions). However, the color Doppler signal, which is associated with endothelial activity and angiogenesis, which play a substantial role in KS progression, could constitute a useful tool for evaluating disease activity.

Uncommon Diagnosis of Oral Kaposi's Sarcoma in an Elderly Human Immunodeficiency Virus–Seronegative Adult

“…KS lesions may begin asymptomatically and may even become nodular, being perceived only at an advanced stage. In this report they, were polypoid and erythematous lesions without any symptoms of pain, accompanied by red maculae on the hard palate and without lesions on other parts of the body …”

“…KS in individuals without HIV is rare, and this case is closer to the classic KS, which has a higher incidence in individuals from the European Mediterranean and is found in men aged 60 and older. The individual in this study was from Portugal, with a familial European Mediterranean background, and was aged 83 at the time of diagnosis …”

Ultrasonographic intraoperative monitoring and follow‐up of Kaposi's sarcoma nodules under treatment with intralesional vincristine

“…Although skin ultrasonography (US) has been recently used as diagnostic tool in a variety of dermatologic diseases, including inflammatory dermatosis, benign and malignant neoplasms, as well as in cosmetic dermatology, to date limited literature exists on the use of US in mucocutaneous KS. Moreover, contradictory ultrasonographic aspects of the morphological structure of KS lesions are described in the literature …”

Classic Kaposi’s sarcoma: a rare case with unusual presentation

“…It is more common in male than female having ratio of 15:1 with predilection for elderly males. Four variants are known that is classical (sporadic), endemic (African), iatrogenic (immunosuppressive drugs associated) and AIDS-associated [2,3]. The histopathology depends upon the stage of KS as it progresses from the patch to plaque to nodular stage.…”