Malignant
Kaposi’s sarcoma
This
malignant tumour of proliferating capillaries and lymphatics may be multifocal.
There are two types: the classical, and that associated with
immuno-suppression. Human herpesvirus type 8 (HHV8) has been isolated from, and
linked to, both types.
Classical Kaposi’s sarcoma is seen
most often inAfricans and in elderly Jews of European origin. The tumours are
usually on the feet and ankles but may be seen on the hands and on cold parts
of the skin (e.g. the ears and nose). Initially they are dark blue to purple
macules progressing to tumours and plaques which ulcerate and fungate. The rate
of spread is variable but often slow. Tumours may metastasize to lymph nodes
and spread to internal organs; oedema of the legs may be severe.
These
tumours are very sensitive to radiotherapy which is the treatment of choice
during the early stages; chemotherapy, with chlorambucil or vinblas-tine, helps
when there is systemic involvement. Life expectancy is 5–9 years.
Kaposi’s sarcoma and immunosuppression (seeFigs
14.32–14.34). Smaller and more subtle (e.g. bruise-like) lesions may occur in
an immunodeficient host. This tumour has recently become well known because of
its association with AIDS caused by the
human immunodeficiency virus (HIV-1). Lesions of AIDS-related Kaposi’s sarcoma
can appear anywhere but are most common on the upper trunk and head and neck.
The initial bruise-like lesions tend to fol-low tension lines; they become
raised, increasingly pigmented and evolve into nodules and plaques. Lesions
frequently arise on the oral mucous mem-branes. Interestingly, HIV-positive
intravenous drug abusers do not develop Kaposi’s sarcoma as often as do
HIV-positive homosexuals. The prognosis of AIDS patients with Kaposi’s sarcoma
is poor as most will develop opportunistic infections and the life expect-ancy
in this situation is around 1 year. Single lesions respond to radiotherapy,
cryotherapy or intralesional vinblastine; systemic treatment with α-interferon has helped some
with multiple lesions.
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