Kaposi’s Sarcoma Involving the Gastrointestinal Tract
Article Outline
A 32-year-old man with human immunodeficiency virus (HIV) infection noncompliant with his antiretroviral medications presented with a 2-week history of progressively worsening odynophagia, dysphagia, and 1 episode of hematemesis. On exam he was cachexic, and had well-demarcated purplish papules on his back, trunk, and extremities. Laboratory studies revealed an absolute CD4 count of 1, HIV viral load of 11,469 copies/mL, and a hemoglobin level of 11.0 g/dL. Upper endoscopy revealed hemorrhagic, raised, plaque-like lesions in the oropharynx and middle and upper thirds of the esophagus, as well as patchy raised erythematous lesions in the gastric body and antrum (Figure A). Biopsy specimens were obtained from the gastric and esophageal lesions (Figure B, H&E low-power magnification, 10×; Figure C, magnification, 20×). The patient was started on a multi-drug, antiretroviral regimen.
Discussion
Biopsy specimens revealed whorls of spindle-shaped cells and neovascularization with small-vessel proliferation suggestive of Kaposi’s sarcoma (KS). Treatment was initiated with liposomal doxorubicin. Our patient clinically improved, and had complete resolution of odynophagia and dysphagia. He was subsequently lost to follow-up evaluation.
KS is the most common gastrointestinal malignancy in acquired immune deficiency syndrome.1 Gastrointestinal disease occurs in about 40% and often is asymptomatic. Patients with KS can present with abdominal pain, weight loss, nausea, vomiting, gastrointestinal bleeding, intestinal obstruction, malabsorption, or diarrhea.2
Treatment usually is palliative and is aimed primarily at improving symptoms and preventing progression. Treatments may include antiretroviral medications, radiation therapy, chemotherapy, or combination.3 Depending on the severity of HIV and disease burden of KS, highly-active antiretroviral therapy could be first-line therapy. Antiretrovirals may help decrease the proportion of new lesions, promote regression of existing lesions, and improve survival with or without chemotherapy.3 Systemic chemotherapy is usually reserved for cases with widespread disease. Due to favorable response rates and toxicity profiles, liposomal anthracyclines (eg, doxorubicin) have become first-line systemic agents for treatment of disseminated KS.
References
- Gastrointestinal malignancy in patients with AIDS. Am J Gastroenterol. 1991;86:715–718
- . Gastrointestinal KS in patients with the acquired immune deficiency syndrome: endoscopic and autopsy findings. Gastroenterology. 1985;89:102–108
- . Management of AIDS-related Kaposi sarcoma: advances in target discovery and treatment. AIDS Read. 2004;14:236–238
PII: S1542-3565(07)01109-3
doi:10.1016/j.cgh.2007.11.013
© 2008 AGA Institute. Published by Elsevier Inc. All rights reserved.
