Kaposi’s Sarcoma Restricted to an Immunocompromised District

Ruocco, Vincenzo; Brasiello, Marcella; Szolnoky, Győző; Brunetti, Giampiero; Ruocco, Eleonora

doi:10.1159/000330322

Cited by 5 publications

(3 citation statements)

References 12 publications

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“…Though Koebner phenomenon is most commonly associated with psoriasis, it is accepted that KS can occasionally exhibit the response [30]. Even without immunodeficiency, several conditions, including infections, tumors and immune reactions, can locally appear on areas of the body that have been immunologically undermined by trauma [31].…”

Section: Discussionmentioning

confidence: 99%

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient

Torrence

Wrobel

2019

Clin Diabetes Endocrinol

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Background The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed. Case presentation The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A shave biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma. Conclusions The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.

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Section: Discussionmentioning

confidence: 99%

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient

Torrence

Wrobel

2019

Clin Diabetes Endocrinol

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“…Since 2009, an increasing number of reports have appeared in literature on the ICD, and what was a “novel” pathogenic concept five years ago has been extended to a growing spectrum of variegated clinical conditions.…”

Section: The Novel Pathogenic Concept Of Immunocompromised Cutaneous mentioning

confidence: 99%

Ruocco's immunocompromised cutaneous district

et al. 2015

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The concept of 'locus minoris resistentiae' (lmr) is an old but still effective way of thinking in Medicine. In Dermatology, there are many reports of privileged localization of cutaneous diseases on injured skin, which therefore represents a typical condition of lmr. Lately the innovative concept of immunocompromised cutaneous district (ICD) has been introduced to explain why a previously injured cutaneous site may become in time a privileged location for the outbreak of opportunistic infections, tumors, and immune reactions. An ample documentation of multifarious disorders (infectious, neoplastic, immune) appearing in ICDs was delineated by Ruocco et al. in 2009. These cases were grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns, and traumas. In the following five years, what was a "novel" pathogenic concept has been extended to an enlarging variety of clinical conditions. This paper focuses on ICD and the expanding spectrum of this now established pathogenic concept.

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“…64,65 Also a localized trauma may be responsible for facilitating the onset of KS lesions selectively on the traumatized area. 66,67 Environmental cofactors and risk for KS In cancer pathogenesis, the possibility exists that following an initial stable, genetic damage (initiation event), a transient post-initiation insult (promotion event), nonsufficient by itself to induce a cancer, could contribute to increase cancer incidence. 68 Viruses, like chemicals, can act both as initiators as well as promoters, depending on their prevalent effects either mutagenic (eg, herpesviruses) or epigenetic (eg, papillomaviruses).…”

Section: Gene Polymorphisms and Risk For Ksmentioning

confidence: 99%

Kaposi’s sarcoma: Etiology and pathogenesis, inducing factors, causal associations, and treatments: Facts and controversies

Ruocco

Tornesello

et al. 2013

Clinics in Dermatology

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100

117

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Kaposi's sarcoma (KS), an angioproliferative disorder, has a viral etiology and a multifactorial pathogenesis hinged on an immune dysfunction. The disease is multifocal, with a course ranging from indolent, with only skin manifestations to fulminant, with extensive visceral involvement. In the current view, all forms of KS have a common etiology in human herpesvirus (HHV)-8 infection, and the differences among them are due to the involvement of various cofactors. In fact, HHV-8 infection can be considered a necessary but not sufficient condition for the development of KS, because further factors (genetic, immunologic, and environmental) are required. The role of cofactors can be attributed to their ability to interact with HHV-8, to affect the immune system, or to act as vasoactive agents. In this contribution, a survey of the current state of knowledge on many and various factors involved in KS pathogenesis is carried out, in particular by highlighting the facts and controversies about the role of some drugs (quinine analogues and angiotensin-converting enzyme inhibitors) in the onset of the disease. Based on these assessments, it is possible to hypothesize that the role of cofactors in KS pathogenesis can move toward an effect either favoring or inhibiting the onset of the disease, depending on the presence of other agents modulating the pathogenesis itself, such as genetic predisposition, environmental factors, drug intake, or lymph flow disorders. It is possible that the same agents may act as either stimulating or inhibiting cofactors according to the patient's genetic background and variable interactions. Treatment guidelines for each form of KS are outlined, because a unique standard therapy for all of them cannot be considered due to KS heterogeneity. In most cases, therapeutic options, both local and systemic, should be tailored to the patient's peculiar clinical conditions.

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Kaposi’s Sarcoma Restricted to an Immunocompromised District

Cited by 5 publications

References 12 publications

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient

Ruocco's immunocompromised cutaneous district

Kaposi’s sarcoma: Etiology and pathogenesis, inducing factors, causal associations, and treatments: Facts and controversies

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