Photogallery. HIV infection and neoplastic skin diseases

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Malignant neoplasms constitute a group of the most important secondary diseases that develop in people infected with the human immunodeficiency virus (HIV). The first neoplastic disease described in HIV-infected patients is Kaposi's sarcoma. In contrast to other types of Kaposi's sarcoma, its epidemic (AIDS-associated) type is more common in young and middle-aged HIV-positive individuals, especially among men who have same-sex sex. Epidemic Kaposi's sarcoma does not have a favourite localisation. However, there is a tendency to lesions of the scalp (face, ear flaps), upper extremities, anogenital area, oral mucosa. On the trunk, the pathological process spreads along the Langer lines. Skin rashes are represented by spotty, papular, nodular elements of red-brown or purple colour. The aggressive course is characteristic: rapid dissemination and generalisation of rashes.

Plasmoblastic lymphoma is associated with immunodeficiency states and is rare. The tumour lesion is usually located in the oral cavity. Few cases of plasmoblastic lymphoma with skin and soft tissue involvement have been described in the literature.

Squamous cell skin cancer in the context of HIV infection is a dangerous disease. In people living with HIV, it manifests at a significantly earlier age and is associated with a high risk of local recurrence. The extent of invasion and the likelihood of metastasis are influenced by HIV-associated immunodeficiency.

In the vast majority of cases, risk factors and clinical manifestations of basal cell skin cancer do not differ from those in immunocompetent individuals. Basal cell carcinomas rarely metastasise. Nevertheless, metastatic forms lead to unfavourable outcome.

Here is a photo gallery of cases of neoplastic skin lesions developed in HIV-positive patients.

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Sergey Prozherin

Sverdlovsk Regional Center for Prevention and Control of AIDS

编辑信件的主要联系方式.
Email: rjdv@eco-vector.com
ORCID iD: 0000-0001-9956-4700
SPIN 代码: 5354-4893
Scopus 作者 ID: 57221442199
俄罗斯联邦, Ekaterinburg

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2. Fig. 1. Patient V., 23 years old. Epidemic Kaposi’s sarcoma. On the face and neck, numerous puple-blue blotchy and papular elements. Manifestation of the disease and its progression are favoured by immunodeficiency and/or low number of CD4⁺ T-lymphocytes. In this case, their number was 24 cells/μL. In this type of Kaposi’s sarcoma there is often rapid dissemination of rashes. A large number of lesions in a rather limited area of the skin in this case indicates an aggressive course of the disease.

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3. Fig. 2. Patient A., 69 years old. Epidemic Kaposi’s sarcoma. Spotty and papular rashes on the face, on the eyelids of the right eye ― tumour-like foci red-violet. Localisation of lesions on the skin of the nose, eyelids, and ear flaps is characteristic of this type of Kaposi’s sarcoma.

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4. Fig. 3. Patient N., 55 years old. Epidemic Kaposi’s sarcoma. There are oval and irregularly shaped red-violet coloured spots and papules on the trunk. There is yellow-green staining around some foci, indicating active tumour growth.

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5. Fig. 4. Patient K., 37 years old. Epidemic Kaposi’s sarcoma. On the torso there are rounded, purple-coloured patchy and papular efflorescences. The distribution of rashes on the trunk along the lines of least skin tension is characteristic of AIDS-associated Kaposi’s sarcoma.

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6. Fig. 5. Patient P., 36 years old. Plasmoblastic lymphoma with skin and subcutaneous tissue lesions of the right buttock region (with decay). Immunohistochemical study revealed that tumour cells in the biomaterial from the neoplasm express MUM-1, irregularly ― CD45, EMA (epithelial membrane antigen), focally ― CD79a; no significant expression of CD3, CD20, CD30, CD56, PAX-5, bcl-6 was found. Ki-67 marker of proliferative activity was 90%. Associated diagnosis: “Herpes zoster”.

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7. Fig. 6. Patient N., 37 years old. Epidemic Kaposi’s sarcoma. On the extensor surface of the left elbow joint a violet-coloured nodule measuring 4.5×3 cm.

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8. Fig. 7. Patient O., 46 years old. Squamous cell carcinoma of the lower lip: exophytic mass with ulceration and crusted areas. On histological examination, the level of invasion of keratinizing squamous cell carcinoma was 3 mm.

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9. Fig. 8. Patient L., 39 years old. Squamous cell (non-keratinizing by biopsy) skin cancer of the pubic area.

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10. Fig. 9. Patient T., 46 years old. Squamous cell carcinoma of the skin and soft tissues of the left inguinal region. Histological examination of the biopsy specimen revealed tumour cells of squamous epithelium without signs of keratinisation (non-keratinising form of carcinoma). This form is characterised by a rapid course, rapid invasion into deep-lying tissues and frequent metastasis.

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11. Fig. 10. Patient A., 48 years old. Squamous cell cancer of the penis. Exophytic tumor on the inner layer of the foreskin with a diameter of about 2 cm and ulcerated surface. Tumor within subepithelial connective tissue, no signs lymphovascular invasion were detected.

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12. Fig. 11. Patient M., 35 years old. Basal cell carcinoma of the skin of the nose. Nodular-ulcerated form. A round-shaped lesion with a funnel-shaped ulcer in the central part.

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13. Fig. 12. Patient R., 33 years old. Squamous cell carcinoma of the head of the penis. Carcinoma developed against a background of long-standing anogenital warts. Venereal warts in HIV-positive persons are more often co-infected with different types of human papillomavirus of high oncogenic risk compared to people without HIV; therefore the likelihood of neoplastic foci developing in them is increased. Concomitant diagnosis: “Molluscum contagiosum of the skin of the pubic area”.

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14. Fig. 13. Patient V., 56 years old. A superficial form of basal cell skin cancer of the back developed at the site of a postoperative scar.

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15. Fig. 14. Patient E., 38 years old. Bulging dermatofibrosarcoma with ulceration. Solitary nidus on the outer surface of the ankle joint.

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