Figure - available from: Case Reports in Oncological Medicine
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The cut surface of liver shows a well-demarcated perivascular infiltration marked by reddish-brown tumorous tissue (arrows) (a). The head of the pancreas shows a reddish-brown infiltrating lesion (arrows) (d). Representative microscopic sections show spindle cells proliferation involving hepatic lobules ((b) H&E, ×20) and pancreatic acini ((e) H&E, ×10) with positive staining for HHV-8 antibody consistent with Kaposi’s sarcoma ((c), (f)).
Source publication
We report a case of AIDS-related Kaposi's sarcoma (KS) with Primary Effusion Lymphoma (PEL) in a 28-year-old, African American male. Kaposi's sarcoma is an AIDS defining disease and typically will disseminate early in the course of the disease affecting the skin, mucous membranes, gastrointestinal tract, lymph nodes, and lungs. This case reports an...
Citations
... It was first described in 1872 by Moritz Kaposi, a Hungarian dermatologist, initially affecting mostly Mediterranean or Jewish older men. But it was not until 1981 when a demographic change was discovered by Alvin Friedman Kein proving its association with HIV infection [3][4][5]. There are four variants of its presentation: classic, endemic, posttransplant, and, lastly, the acquired immunodeficiency syndrome (AIDS) associated or epidemic [1,3,5]. ...
... But it was not until 1981 when a demographic change was discovered by Alvin Friedman Kein proving its association with HIV infection [3][4][5]. There are four variants of its presentation: classic, endemic, posttransplant, and, lastly, the acquired immunodeficiency syndrome (AIDS) associated or epidemic [1,3,5]. The AIDS-associated presentation was for many years the most common AIDS-associated tumor in the United States [6]. ...
Kaposi sarcoma is one of the acquired immunodeficiency syndrome (AIDS) defining diseases. AIDS-associated Kaposi sarcoma affects primarily the skin and the lungs. Although gastrointestinal involvement is relatively common, biliary tract involvement has rarely been reported. It has been associated mostly with extension from liver disease. We describe an uncommon presentation of disseminated Kaposi sarcoma causing extrahepatic cholestasis due to extrahepatic biliary tract involvement that resolved after sphincterotomy with biliary stenting.
We present a case of a 35-year-old African American male diagnosed with human immunodeficiency virus (HIV) infection in 2005. He presented with AIDS after discontinuation of antiretroviral therapy for one year, subsequently being diagnosed with systemic Kaposi sarcoma. He presented with signs and symptoms of obstructive biliary disease, including jaundice, abdominal pain, fatigue, and fever. We encountered a rare presentation of malignant single extrahepatic biliary stenosis secondary to biliary Kaposi sarcoma. The biochemical pattern markedly improved after endoscopic retrograde cholangiopancreatography with sphincterotomy and stenting. However, and despite the resumption of combined antiretroviral therapy, deep immunosuppression caused worsening clinical condition and death five months after initial presentation.
Certainly, among the multiple etiologies of biliary obstruction in AIDS, Kaposi sarcoma is one to consider.
... The development of NHL in a patient infected with HIV was declared an acquired immunodeficiency syndrome (AIDS)-defining illness in 1985 and since then, it has been approximated that between 5 and 20% of all HIV-positive patients will develop NHL at some point during their lifetime [1]. The mechanism of the proliferation of the disease with HHV-8 remains uncertain [3]. Since the introduction of highly active antiretroviral therapy (HAART) in the 1990's, the incidence of AIDS-related NHL has decreased. ...
Primary effusion lymphoma (PEL) is a rare condition, which accounts for approximately 4% of all human immunodeficiency virus (HIV)-associated non-Hodgkin lymphomas. PEL has a predilection for body cavities and occurs in the pleural space, pericardium, and peritoneum. Without treatment, the median survival is approximately 2-3 months, and with chemotherapy, the median survival is approximately 6 months. We describe the case of a 47-year-old male with HIV and Kaposi's sarcoma who presented with complaints of abdominal pain and distension and was subsequently diagnosed with PEL. Despite limited clinical data being available, chemotherapy with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH) has proven to increase survival rates in patients with this condition.
Background:
The presence of a lymphoma associated with a solid synchronous neoplasm or collision neoplasm has been rarely in the literature, and a detailed characterization of these cases is lacking to date.
Objective:
To describe the main clinicopathological features of synchronous/collision tumors.
Methods:
A systematic search in PubMed, Scielo, and Virtual Health Library literature databases for cases or case series of synchronous or collision lymphoma and other solid neoplasms reported up to March 2021 was performed. Three reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The systematic review was performed following the Preferred Reporting Items for Systematic Meta-Analyses guidelines.
Results:
Mean age of patients was 62.9 years (52.9% men). A total of 308 cases were included (62% synchronous and 38% collision). The most frequent location of both synchronous and collision tumors was the gastrointestinal tract with the most common solid neoplasm being adenocarcinoma, and the most frequent lymphoma diffuse large B-cell lymphoma (21.7%) and mucosa-associated lymphoid tissue lymphoma (20.4%). Of the total number of mucosa-associated lymphoid tissue lymphomas and gastric adenocarcinomas, the presence of Helicobacter pylori infection was documented in 47.3% of them. Only 2% of all cases had a previous history of lymphoma. Thus, in most cases (98%), lymphoma was discovery incidentally. In addition, nodal lymphoma was associated with metastasis in 29 (9.4%) cases as collision tumor, most commonly (90%) in locoregional lymph nodes of the solid neoplasm.
Conclusions:
The frequent association of some type of B-cell lymphoma and adenocarcinoma in synchronous/collision tumors of the gastrointestinal tract points to common pathogenic mechanisms in both neoplasia, particularly related to chronic inflammation in this location. In most cases, lymphoma identified in locoregional lymph nodes or distant of a carcinoma seems to represent an incidental finding during the carcinoma diagnostic/therapeutic approach. A synergy between carcinoma and lymphoma (involving inflammation and immunosuppression mechanisms) may favor tumor progression and dissemination. A better understating of the interactions lymphoma/carcinoma in the setting of synchronous/collision tumors may help to improve patient management and prognosis.
While infection should always lead the differential when a patient with AIDS presents with fever, inflammatory and malignant aetiologies should also be considered. With profound immunocompromise, malignancies can develop as sequelae of viral oncogene expression. Human herpesvirus 8 (HHV-8) infection drives several AIDS-related cancers including Kaposi sarcoma (KS), multicentric Castleman disease and primary effusion lymphoma (PEL), which can present simultaneously with variable clinical features. Herein, we describe a case of synchronous visceral KS and extracavitary PEL in a patient with AIDS. The patient was treated with systemic chemotherapy and remains in remission after four cycles. We review other cases of copresenting HHV-8-related malignancies, explore the salient pathomechanisms and clinical features of these cancers and discuss treatment strategies.
Although the human immunodeficiency virus (HIV) has not been isolated in pancreatic tissue (Bennett et al. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Elsevier/Saunders, Philadelphia, 2015), infections and inflammatory conditions of the pancreas are common during the course of acquired immunodeficiency syndrome (AIDS) and contribute significantly to its associated morbidity and mortality. HIV infection itself has been associated with an increased risk of clinical pancreatitis, but specific etiologies are broad. These include antiretroviral medications, chemoprophylaxis drugs for opportunistic infections, malignancy, and the virus itself. Similarly, bacterial, viral, fungal, and mycobacterial pathogens can contribute to the acute pancreatic inflammatory conditions. The pancreas can serve as the primary nidus of infection or ultimately be involved after dissemination of opportunistic infections. In addition, one must consider etiologies that are seen in the general population such as gallstones and complications of alcohol and intravenous drug abuse.
