Association of Kaposi's sarcoma with second primary malignancies possible etiopathogenic implications

Abstract

The association of Kaposi's sarcoma (KS) with second primary cancers, especially of the lymphoreticular system, has been frequently noted. To confirm these reports in a systematic way, data on a series of 92 patients with KS treated at Memorial Sloan-Kettering Cancer Center (MSKCC) 2949-1975 were subjected to extensive statistical analysis. Use was made also 4517 double primaries including all sites, diagnosed at MSKCC 1949-1974, and 1959 simultaneous double primaries from the Third National Cancer Survey. Some key results: (1) of KS patients had toher primary malignancies; (2) there was a 20-fold increase in the incidence of lymphoreticular malignancies after diagnosis of KS; (3) in the MSKCC series double primaries, lymphoreticular malignancies were involved in 8% of cases; for KS alone the corresponding figure was 58%. Our findings provide evidence in support of possible etiopathogenic mechanisms that may be involved in the natural course of KS.

Classic Kaposi Sarcoma in the United States over the last two decades: A clinicopathologic and molecular study of 438 non-HIV-related Kaposi Sarcoma patients with comparison to HIV-related Kaposi Sarcoma

“…4 While a controversial increased incidence of multiple myeloma and other hematopoietic neoplasms in Classic Kaposi Sarcoma has been extensively reported in the literature, 14,16,18,[21][22][23][24][25][26][27][28][29] the suggested link between HHV-8 and multiple myeloma 30 supports an increase, such as noted in our study, in multiple myeloma in Kaposi Sarcoma patients. An increased incidence of other hematopoietic neoplasms was also observed in our cohort.…”

“…This correlates well with hypothesis that HHV-8 has a role in the etiology of Classic Kaposi Sarcoma as well as in the development of second malignancies. 9,21 Likewise, the Classic Kaposi Sarcoma may be a sign of underlying malignancy.…”

“…31 HHV-8 is tightly connected as the etiologic agent in Kaposi Sarcoma with roles for the viral lytic gene and the lack of specific HHV-8 T-cell immune response in patients with Kaposi Sarcoma being recently documented. 21,[31][32][33][34][35][36][37] This virus induces cytokines, which are known to play a role in the development of Classic Kaposi Sarcoma. 10,38 It is hypothesized that lymphoproliferative disorders or other malignancies might pass HHV-8 to its lytic phase, in sites of latency, 39 and 40 Although the majority of our subgroup of Classic Kaposi Sarcoma patients, representing a cross-section oflesional stage and patient gender, were positive by PCR analysis for HHV-8, one case with ample material was negative.…”

Gastrointestinal tract spindle cell lesions—just like real estate, it's all about location

“…8 Patients typically survive an average of 10-15 years following their initial diagnosis and commonly die of an unrelated cause. Secondary malignancies have been reported in 435% of the patients, 12 with approximately half of these tumors being of hematopoietic/lymphoreticular derivation (ie, leukemia, lymphoma, multiple myeloma). Cutaneous lesions are usually first noted in the distal portion of the lower extremities and evolve in stages, consisting initially of purple patches, followed by plaques and nodules.…”

Recent insights into the pathogenesis of Kaposi's sarcoma

“…Herpes saimiri is the closest relative of KSHV on the basis of the identified DNA fragments. It is non-pathogenic in its natural host, the squirrel monkey, but causes polyclonal T-cell lymphomas and acute leukaemia in other primates and can transform human and simian T lymphocytes in vitro (Albrecht et al, 1992 (Safai et al, 1980). In addition, 9/17 Sicilian patients were reported to have had malaria before developing KS (Geddes et al, 1994).…”