Oral Kaposi's sarcoma: a review and update

Abstract

Kaposi's sarcoma (KS) is an important mucocutaneous neoplasm with four well-known clinicopathologic types. Involvement of the oral cavity may be seen in all variants but is most common with AIDS-KS. The latter may signal undiagnosed HIV infection. Its common association with disseminated disease has potentially important diagnostic and therapeutic implications. Oral KS (OKS) most often affects the hard and soft palate, gingiva, and dorsal tongue with plaques or tumors of coloration ranging from non-pigmented to brownish-red or violaceous. Its involvement ranges from an incidental finding to proliferative tumor formation that interferes with mastication. OKS needs to be distinguished clinically from other entities, including pyogenic granuloma, hemangioma, bacillary angiomatosis, and gingival enlargement caused by cyclosporine, a drug frequently used in recipients of organ transplantation. KS may flare as part of the immune reconstitution inflammatory syndrome in HIV patients or develop in the context of iatrogenic immunosuppression. Management, which may depend upon a variety of factors including the clinicopathologic type of KS and results of staging, ranges from no treatment to local measures such as intralesional vinblastine or systemic administration of cytotoxic chemotherapy for disseminated disease. Modification of immunosuppressive regimens often helps control post-transplant OKS but enhances the risk of graft rejection. Screening donors and recipients of organ transplants for HHV-8, with prophylactic treatment if infected as well as institution of sirolimus early after transplantation, are proposed strategies aimed at preventing post-transplant OKS.

Angiopoietin‐2 is expressed in oral Kaposi's sarcoma

“…Kaposi sarcoma (KS) is a mucocutaneous neoplasm of endothelial cell origin caused by the Kaposi sarcoma‐associated herpesvirus (KSHV or HHV8), which presents with four well‐known clinicopathologic subtypes. Involvement of the oral cavity may be seen in all subtypes, but most commonly in patients with the acquired immunodeficiency syndrome (AIDS)‐related form . Clinically, KS is characterized by brownish‐red to bluish purple lesions.…”

“…Clinically, KS is characterized by brownish‐red to bluish purple lesions. This appearance is due to red blood cell extravasation and local deposition of hemosiderin within the tumor . Indeed, KS is a highly angiogenic neoplasm with dense and irregularly shaped, leaky blood vessels.…”

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“…In a recent review, Fatahzadeh and associates reported that dose reduction and modification of immunosuppression protocols after Kaposi sarcoma facilitated acute allograft rejection. 8 In a different study, excessive reduction or withdrawal of immunosuppression after the development of Kaposi sarcoma yielded to a statistically significantly increased risk of graft loss. 9 Similarly, in an observational study, 2 of 11 patients with nonmetastatic cancer lost their grafts due to chronic rejection after conversion to sirolimus.…”

Unusual case of HIV with Kaposi sarcoma and neuroendocrine tumour

“…Oral KS can involve the palate, tongue, gingiva, uvula and oropharynx as purple macules, patches, plaques, nodules or exophytic masses 2. Cutaneous KS can present as purplish, reddish, brown or black macules, plaques or nodules.…”