Aggressive behavior of classical Kaposi's sarcoma and coexistence with angiosarcoma
Aggressive behavior of classical Kaposi's sarcoma and coexistence with angiosarcoma
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DOI：
10.1093/gerona/60.4.520
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发表时间：
2005-04-01
影响因子：
5.1
通讯作者：
Incalzi, RA
中科院分区：
文献类型：
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作者：
Gambassi, G;Semeraro, R;Incalzi, RA
一名 82 岁的白人男性就诊，足底表面出现最初无症状的青红色斑块，后来逐渐融合并演变成侵袭性生长的结节，并伴有大面积水肿。组织学可以诊断卡波西肉瘤的经典形式。 HIV血清学检测结果呈阴性，而通过皮肤样本的聚合酶链反应检测到相关的8型人类疱疹病毒。在接下来的 6 个月内，皮肤损伤会变得营养不良并部分坏死。并延伸至手部和眼睑。长春花碱化疗似乎可以稳定皮肤病，但患者继发于胃部扩散，出现严重胃肠道出血。发病12个月后，植物性易出血病灶逐渐堵塞患者口腔：组织学特征符合低度恶性血管肉瘤，与卡波西肉瘤不同。患者无法再咀嚼和吞咽；他接受了人工营养，但不久后就去世了。这个病例说明，即使是其经典形式，卡波西肉瘤也可能是一种恶性的、快速进展的肿瘤。学习要点。 a) 即使没有与疾病进展相关的其他变量（即组织学模式、人类疱疹病毒 8 型阳性单核细胞），初始皮肤病变的扩散程度和速率也应被视为侵袭性扩散的早期迹象。 b) 鉴于胃肠道受累的发生率较高，内窥镜检查可能会有用。 c) 当经典卡波西肉瘤再次表现出攻击性行为时。应检查源自血管组织的原发性恶性肿瘤。带回家的信息。即使是其古典形式。卡波西肉瘤可能是恶性的。肿瘤进展迅速并累及内脏；此外，四名患者中近一名可能出现第二种恶性肿瘤。由于局部皮肤病变可以通过放射治疗完全消退，因此在大多数情况下观察等待可能是不合适的。
An 82-year-old Caucasian man presented with initially asymptomatic livid red plaques on the plantar surface of the feet that become confluent and evolved into invasively growing nodules accompanied by massive edema. Histology allowed a diagnosis of the classical form of Kaposi's sarcoma; the serology test result for HIV was negative, whereas the associated human herpes virus type 8 was detected by polymerase chain reaction on the skin sample. Over the subsequent 6 months, skin lesions become vegetative and partially necrotic. and extended to the hands and eyelids. Chemotherapy with vinblastine appeared to stabilize the cutaneous disease, but the patient developed a massive gastrointestinal hemorrhage secondary to dissemination to the stomach. Twelve months after the onset of the disease, vegetative and easily bleeding lesions progressively occluded the mouth of the patient: histological features were consistent with a low-grade angiosarcoma distinct from that of Kaposi's sarcoma. The patient could not chew and swallow anymore; he was put on an artificial nutrition but died shortly thereafter. This case illustrates that, even in its classical form, Kaposi's sarcoma may be a malignant, rapidly progressing tumor.Learning Points. a) The extent and rate of spread of initial skin lesions should be considered to be early signs of aggressive dissemination, even in the absence of other variables (i.e., histological pattern, human herpes virus type 8 positive mononuclear cells) associated with progression of the disease. b) An endoscopy may be useful given the high prevalence of gastrointestinal involvement. c) When classical Kaposi's sarcoma displays aggressive behavior a second. primary malignant tumor arising from the vascular tissue should be investigated.Take-Home Message. Even in its classical form. Kaposi's sarcoma may be a malignant. rapidly progressing tumor with visceral involvement; also, a second malignancy may occur in nearly one patient of four. Because localized skin lesions can regress completely with radiotherapy, watchful waiting is probably inappropriate in most cases.