Case of classic Kaposi sarcoma of the penis successfully treated with radiotherapy

Abstract

Case of classic Kaposi sarcoma of the penis successfully treated with radiotherapyDear Editor, Kaposi sarcoma (KS), first described in 1872 by Moritz Kaposi, is a multicentric angioproliferative disorder of endothelial origin. 1 The pathogenesis of KS is still uncertain, but recent data showed a strong correlation between all forms of KS and human herpesvirus (HHV)-8 infection. 2 Although the initial presentation on the penis is often observed in AIDS patients, penile KS in HIV-negative patients has rarely been reported in the published work. 3 A 65-year-old Japanese man with no history of homosexual or bisexual activity presented with asymptomatic reddish nodules on the glans penis ( Fig. 1a,b). The lesion had enlarged gradually for 4 years. There were no other skin lesions as well as urethral discharge or enlarged inguinal lymph nodes. Past medical history included only hypertension and diabetes mellitus, but no immunosuppressive drug intake or organ transplantation. He had lived in Brazil for 46 years since the age of 2. Routine laboratory investigations showed no abnormal finding and HIV-1 and -2 antibodies were negative. A histopathological examination of the nodule showed slit-like spaces filled with red blood cells and extensive proliferation of spindle-shaped cells (Fig. 1c). Immunohistochemical staining revealed positivity of the spindleshaped cells for CD31, CD34 (Fig. 1d), D2-40 ( Fig. 1e) and HHV-8 latency-associated nuclear antigen 1 (LANA-1) ( Fig. 1f). Investigations for HHV-8 by real-time polymerase chain reaction using RNA extracted from the lesion revealed positive results (data not shown). Further analysis of the VR1 region of the K1 gene confirmed subtype C7 of HHV-8 (data not shown). Treatment with 4-MV X-ray radiotherapy, a total of 60 Gy, resulted in good response, leaving only hyperpigmentation ( Fig. 1g,h). There has been no change for 6 months. No biopsy was performed to confirm residual and recurrent lesions. Figure 1. (a) Reddish nodules on the ventral glans penis. (b) Reddish nodules on the right lateral glans penis. (c) Slit-like spaces filled with red blood cells and extensive proliferation of spindle-shaped cells (hematoxylin-eosin, original manifestation 9200). (d) The neoplastic cells are positive for the vascular marker CD34 (9200). (e) The neoplastic cells are positive for the lymphatic marker D2-40 (9200). (f) The neoplastic cells are positive in nuclear for the human herpesvirus type 8 latency-associated nuclear antigen 1 (9200). (g) Hyperpigmentation on the ventral glans penis after radiotherapy. (h) Hyperpigmentation on the right lateral glans penis after radiotherapy.It has been reported that only 2.6% of classic KS develop on the penis. 2 The differential clinical diagnosis for penis lesion include pyogenic granuloma, condyloma acuminata, glomus tumor and angiosarcoma. It can be easily distinguished by histopathological examination and immunohistochemical staining for CD34 and LANA-1. Because the patient had lived in Brazil for 46 years, we aimed to clarify the route of i...

Primary penile Kaposi’s sarcoma in HIV-seronegative patient: a case report and literature review

“…As showed by epidemiological evidences that highlight the strong link between the disease pathogenesis and HHV-8 infection, most of the patients with penile KS resulted positive for serology HHV-8 research. Equally, the histopathological examination found typical features However, according to our case, only few patients referred to have risk sexual intercourse(21)(22)(23). As concerned to the im-…”

“…In our case, we managed it with complete surgical excision of the lesion, as described by other authors (24, 26, 28, 30, 31, 35, 36, 38-40, 43, 44, 47, 49), with a disease recurrence in five cases (24,30,31,36,39) from a period of about 1-2 years. Other approaches described in literature could include radiotherapy (25,29,37,42), subtotal circumcision associated with biopsy (45), cryotherapy associated with 5% Imiquimod cream (21), excisional biopsy associated with IFNα (32), biopsy with chemotherapy (39), CO2 (48), biopsy with radiotherapy (46). Furthermore, in five cases no therapy was performed (22,23,33,34), two of them for the spontaneous regression of the disease (33,34).…”

Imaging of Kaposi sarcoma

“…On contrast CT scans, KS lesions along the GU tract tend to enhance [50]. Differential diagnosis of classic KS on the penis includes pyogenic granuloma, condyloma acuminata, glomus tumor, and angiosarcomas [51]. In addition to antiretroviral therapy in the setting of HIV, radiotherapy, chemotherapy, laser therapy, and surgery represent treatment options [51].…”

The Role of Carbon Dioxide Laser Therapy in Penile Kaposi’s Sarcoma: A Case Series of Three HIV-Negative HHV-8-Positive Patients

“…Cryotherapy is mostly effective for small lesions, with 85% of clinical response. On the other hand, radiotherapy may be useful in large scrotal and penile lesions, but it is a time-consuming process [9]. A 50% decrease or greater was achieved in 62% of lesions for intralesional vincristine [10], 50 to 90% for intralesional interferon alpha-2 [11], 56% for imiquimod [12].…”