|
Pulmonary Kaposi sarcoma in the era of highly active
antiretroviral therapy.
HIV Med. 2006 Jul;7(5):291-3.
OBJECTIVE:
Since the introduction of highly active antiretroviral therapy (HAART)
there has been a dramatic reduction in the incidence of Kaposi
sarcoma (KS) and an improvement in survival. We wished to examine
whether the outcome in pulmonary KS (pKS) has also altered. METHODS:
In a single-institution cohort of 1140 HIV-positive patients with
KS, 305 patients were diagnosed in the HAART era (1996-2004). We
examined the clinicopathological features and outcomes of these
patients, of whom 25 had pKS and 280 did not. RESULTS: Patients with
pKS had lower CD4 cell counts at the time of KS diagnosis
(Mann-Whitney U-test P=0.005). The incidence of pKS was higher in
African patients than in non-African patients in this sample
(Fisher's test, P=0.001). There were no significant differences in
age, gender, plasma HIV-1 viral load or prior HAART treatment at the
time of KS diagnosis. Five-year overall survival in the pKS group
was 49% [95% confidence interval (CI) 26-73%] as compared with 82%
(95% CI 76-87%) for the non-pKS group (log rank, P<0.0001).
CONCLUSION: PKS remains an ominous diagnosis in the era of HAART,
with a median survival of just 1.6 years.
Pulmonary
Kaposi's sarcoma in pregnancy.Am
J Perinatol. 2004 Aug; 21(6):355-63.
Kaposi's
sarcoma in human immunodeficiency virus (HIV) -infected women, often
misdiagnosed, has an aggressive clinical course, with high rates of
visceral involvement and decreased survival. We describe the first
case of isolated pulmonary Kaposi's sarcoma in pregnancy. A
nulliparous woman was diagnosed with AIDS after presenting at 25
weeks gestation with a cough and multiple pulmonary nodules.
Extensive pulmonary evaluation was nondiagnostic until thorascopic
lung biopsy revealed Kaposi's sarcoma. Despite combination
antiretroviral therapy, her malignancy progressed. Labor was induced
at 33.5 weeks gestation for nonreassuring fetal testing. She
received chemotherapy postpartum and remains in remission. Pulmonary
Kaposi's sarcoma should be considered in the differential diagnosis
of HIV-infected obstetric patients with respiratory compromise.
Definitive diagnosis is necessary given the aggressive clinical
course that is potentially responsive to therapy.
Pulmonary Kaposi's sarcoma
revealed by a solitary nodule in a patient with acquired
immunodeficiency syndrome.
Am J Respir Crit Care Med. 1994 Apr;149(4 Pt 1):1041-3
Kaposi's sarcoma
is very common in patients with AIDS. Usually, skin lesions are
associated with various visceral involvements. A homosexual patient
with AIDS presented with cough and dyspnea, which were followed months
later by hemoptysis. He had no skin lesions or endobronchial Kaposi's
sarcoma at any time. His chest radiograph showed only an irregular
solitary nodule. It exhibited very slow development over time. Surgery
was performed, and this solitary nodule proved to be pulmonary
Kaposi's sarcoma. Pulmonary Kaposi was the sole manifestation of this
associated AIDS sarcoma. This very unusual case report of pulmonary
Kaposi sarcoma indicates that this diagnosis should be considered in
patients with AIDS presenting with a solitary pulmonary nodule.
Bronchopulmonary Kaposi's sarcoma in patients with AIDS.Thorax.
1992 Sep;47(9):721-5
BACKGROUND:
Kaposi's sarcoma in HIV antibody positive patients may affect the
lungs. This study describes the presentation, chest radiographic
appearances, and pulmonary function test abnormalities in patients
with AIDS who had tracheobronchial Kaposi's sarcoma. METHODS AND
RESULTS: Twenty nine (8%) of 361 consecutive HIV antibody positive
patients undergoing bronchoscopy for respiratory symptoms had
tracheobronchial Kaposi's sarcoma. Eight patients had intercurrent
infections and one had previously received chemotherapy for cutaneous
Kaposi's sarcoma; these patients were excluded. Seven of the remaining
20 patients had localised Kaposi's sarcoma (lesions confined to the
trachea or the subsegments of one lobe) and 13 had widespread Kaposi's
sarcoma (affecting the trachea and one lobe or the subsegments of more
than one lobe); 19 patients also had cutaneous and palatal Kaposi's
sarcoma. Seven patients, four with widespread disease, had a normal
radiograph. All patients had reduced transfer factor (TLCO) and
transfer coefficient (KCO) but only those with widespread disease had
reductions in forced expiratory volume in one second (FEV1), forced
vital capacity (FVC), and peak expiratory flow (PEF). Follow up
pulmonary function testing in seven patients (median three months
later) showed further reductions in TLCO. All four patients who
received no treatment had progressive radiographic abnormalities;
bronchoscopy in two patients showed progressive tracheobronchial
disease, and two patients had further reductions in FEV1 and FVC. In
three patients treated with chemotherapy palliation of symptoms was
achieved but two had further reductions in FEV1 and FVC and the
radiograph deteriorated. Bronchoscopy showed regression of disease in
only one patient. CONCLUSION: Pulmonary Kaposi's sarcoma produces
abnormalities of TLCO even in patients with localised disease; airflow
obstruction may occur in patients with widespread disease.
Bronchoscopic reassessment of the extent of disease may not accurately
reflect response to chemotherapy.
Pulmonary Kaposi's
sarcoma. Premortem histologic diagnosis. Am
J Surg Pathol. 1986 May;10(5):301-11
Nine open lung
biopsies and nine transbronchial biopsies from 10 patients with
pulmonary Kaposi's sarcoma were reviewed to define the pattern of
involvement in the lung by Kaposi's sarcoma and to determine the
usefulness of transbronchial biopsy in making the diagnosis. There
were nine patients with acquired immune deficiency syndrome (AIDS) and
one patient with sporadic pulmonary Kaposi's sarcoma. A lymphatic
distribution was seen in all cases. A spectrum ranging from
distinctive polymorphous cellular infiltrates ultimately interpreted
as Kaposi's sarcoma to "classic" Kaposi's sarcoma was found.
Recognition of the former enabled retrospective recognition of
Kaposi's sarcoma in four of eight transbronchial bronchial biopsies.
The diagnosis of pulmonary Kaposi's sarcoma in one other patient was
made solely on the basis of transbronchial biopsy. Eight patients died
from pulmonary Kaposi's sarcoma; two patients are alive with extensive
pulmonary Kaposi's at last follow-up. We believe that transbronchial
biopsy may be useful in establishing a diagnosis of pulmonary Kaposi's
sarcoma in many more patients than is generally appreciated.
Pulmonary Kaposi's
sarcoma in the acquired immune deficiency syndrome. Clinical,
radiographic, and pathologic manifestations.
Am J Med. 1986 Jul;81(1):11-8
Pulmonary
Kaposi's sarcoma related to the acquired immune deficiency syndrome
(AIDS) has not been well characterized. To define the clinical,
radiographic, and pathologic features of this entity, 11
autopsy-proved cases of pulmonary Kaposi's sarcoma were reviewed. The
most common clinical symptoms were dyspnea and cough, but hemoptysis
and stridor were also found. Nodular infiltrates and pleural effusions
were the most commonly found radiographic abnormalities. Pulmonary
function tests were sensitive in detecting the pulmonary abnormalities
due to Kaposi's sarcoma. A low diffusion capacity, lack of arterial
desaturation with exercise, and obstruction to airflow were suggestive
of pulmonary involvement with this malignancy. Although endobronchial
Kaposi's sarcoma was visualized at bronchoscopy as cherry-red,
slightly raised lesions, bronchial biopsy specimens always showed no
abnormalities. Transbronchial brushings and biopsy specimens and
analysis of pleural fluid were also not helpful in establishing a
diagnosis. In the seven subjects with extensive parenchymal Kaposi's
sarcoma at autopsy, the pleura was always involved. Eight subjects had
involvement of the tracheobronchial tree. In all of the subjects,
pulmonary Kaposi's sarcoma was a significant cause of morbidity, and
in three of 11 subjects (27 percent) it was the direct cause of death.
|
