Clinical observations of skin Kaposi’s sarcoma

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Abstract

Kaposi's sarcoma is an angioproliferative disease of endothelial origin associated with human herpes virus-8 (HHV-8), or Kaposi's sarcoma herpesvirus. The disease was first described in 1872 by Moritz Kaposi as a pigmented cutaneous sarcoma localized on the lower extremities.

The disease is considered quite rare, but at present there is an increase in the incidence worldwide, due to which there is a growing interest in this problem. Today, it remains the leading skin pathology among HIV-positive patients, occurring in 20%. However, the assessment of the pathological process can be difficult, and the diagnosis may not be made at all, due to atypical clinical manifestations (especially in HIV-negative patients), so the problem of Kaposi's sarcoma diagnostics remains relevant for doctors of any specialty, especially dermatovenerologists and oncologists.

Kaposi's sarcoma can affect almost any organ, including the skin. The most common localization is on the skin of the extremities and face. Clinical manifestations are rashes in the form of spots, nodules, plaques, nodes. Kaposi's sarcoma is classified according to clinical and epidemiological forms: classical, endemic, epidemic and iatrogenic. Recently, a fifth form has been described, called non-epidemic Kaposi's sarcoma, which is observed in HIV-negative men who have sex with other men.

The persistence of HHV-8 alone in the human body is not sufficient for Kaposi's sarcoma to occur, as the development of the disease is dependent on immunosuppressive conditions such as HIV infection, cytostatic drugs, and chronic systemic inflammatory diseases (e.g., rheumatoid arthritis). The interaction between human immune dysfunction and the local inflammatory response to herpesvirus creates a favourable environment for the onset and progression of the disease.

These clinical cases demonstrate an atypical clinical course of Kaposi's sarcoma of the skin with the absence of HIV-1, HIV-2 and HHV-8 in the blood of the presented patients.

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About the authors

Natalia P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Olga V. Grabovskaya

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: olgadoctor2013@yandex.ru
ORCID iD: 0000-0002-5259-7481
SPIN-code: 1843-1090

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Anastasia V. Shepeleva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: dr.shepelevaavl@gmail.com
ORCID iD: 0009-0001-5251-5394
Russian Federation, Moscow

Lyailya N. Kayumova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: avestohka2005@inbox.ru
ORCID iD: 0000-0003-0301-737X
SPIN-code: 4391-9553

MD, Cand. Sci. (Medicine), Associate Professor

Russian Federation, Moscow

Sofia V. Alferova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: sofia.alferova@mail.ru
ORCID iD: 0009-0000-5000-8359
SPIN-code: 1987-3444
Russian Federation, Moscow

References

  1. Brambilla L, Maronese CA, Bortoluzzi P, et al. Mucosal Kaposi’s sarcoma in HIV-negative patients: A large case series from a single, tertiary referral center in Italy. Int J Dermatol. 2021;60(9):1120–1125. doi: 10.1111/ijd.15557
  2. Teplyuk NP, Ruvinova PM, Varshavsky VA, et al. Kaposi’s sarcoma in Russian HIV-negative patients: A single-center case series. Int J Dermatol. 2021;60(2):e37–e40. doi: 10.1111/ijd.15368
  3. Addula D, Das CJ, Kundra V. Imaging of Kaposi sarcoma. Abdom Radiol (NY). 2021;46(11):5297–5306. doi: 10.1007/s00261-021-03205-6
  4. Grabar S, Costagliola D. Epidemiology of Kaposi’s sarcoma. Cancers (Basel). 2021;13(22):5692. doi: 10.3390/cancers13225692
  5. Federal clinical guidelines. Kaposi’s sarcoma. Russian Society of Dermatovenereologists and Cosmetologists; 2020. (In Russ).
  6. Osei N, Fletcher G, Showunmi A, Ahluwalia M. A case of non-cutaneous Kaposi sarcoma. Cureus. 2022;14(12):e32394. doi: 10.7759/cureus.32394
  7. Iftode N, Rădulescu MA, Aramă ȘS, Aramă V. Update on Kaposi sarcoma-associated herpesvirus (KSHV or HHV8): Review. Rom J Intern Med. 2020;58(4):199–208. doi: 10.2478/rjim-2020-0017
  8. Openshaw MR, Gervasi E, Fulgenzi CA, et al. Taxonomic reclassification of Kaposi sarcoma identifies disease entities with distinct immunopathogenesis. J Transl Med. 2023;21(1):283. doi: 10.1186/s12967-023-04130-6
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  10. Wang J, Reid H, Klimas N, Koshelev M. An unusual series of patients with Kaposi sarcoma. JAAD Case Rep. 2019;5(8):646–649. doi: 10.1016/j.jdcr.2019.05.016
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Supplementary files

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2. Fig. 1. Patient Sh., 20 years old, Kaposi’s sarcoma of the skin: rashes in the form of nodules on the oral mucosa above the central and lateral incisors.

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3. Fig. 2. Patient Sh., 20 years old, Kaposi’s sarcoma of the skin: plaque on the skin of the lower limb, dense-elastic consistency, bluish-brownish colour, with a smooth surface.

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4. Fig. 3. Patient Sh., 20 years old, Kaposi’s sarcoma of the skin. Histological changes in the skin: tumour growth in the dermis of spindle cell structure, without pronounced polymorphism, with single mitoses and angiomatosis. Haematoxylin and eosin staining, ×200.

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5. Fig. 4. Patient Sh., 20 years old, Kaposi’s sarcoma of the skin. Immunohistochemical study: positive staining of reaction with antibodies to CD34 demonstrating angiomatosis.

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6. Fig. 5. Patient Sh., 20 years old, Kaposi’s sarcoma of the skin. Clinical improvement after a course of Prospidin in the form of a significant reduction in the intensity of staining, infiltration of rashes.

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7. Fig. 6. Patient T., 69 years old, Kaposi’s sarcoma of the skin: a node on the skin of the penis of hemispherical shape, bright pink in colour, with a smooth surface.

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8. Fig. 7. Patient T., 69 years old, Kaposi’s sarcoma of the skin. Histological changes in the skin: fibroblast proliferation, angiomatosis and full blood vessels are observed in the connective tissue. Haematoxylin and eosin staining, ×200.

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9. Fig. 8. Patient T., 69 years old, Kaposi’s sarcoma of the skin. Immunohistochemical study: tumour cells express HHV-8.

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10. Fig. 9. Patient T., 69 years old, Kaposi’s sarcoma of the skin. Immunohistochemical study: positive staining of the reaction with antibodies to CD34 demonstrating vascular proliferation.

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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