Kaposi's sarcoma classification: Difference between revisions

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Kaposi's sarcoma may be classified according to the clinical setting of the [[disease]] into five subtypes include Classic Kaposi's sarcoma, African [[cutaneous]] Kaposi's sarcoma, African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma, [[Immunosuppression]]-associated Kaposi's sarcoma, and [[AIDS]]-associated Kaposi's sarcoma.
Kaposi's sarcoma may be classified according to the clinical setting of the [[disease]] into five subtypes include Classic Kaposi's sarcoma, African [[cutaneous]] Kaposi's sarcoma, African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma, [[Immunosuppression]]-associated Kaposi's sarcoma, and [[AIDS]]-associated Kaposi's sarcoma.
==Classification==
==Classification==
* According to the clinical setting of the [[disease]], clinical presentation, [[epidemiology]], and [[prognosis]] Kaposi's sarcoma may be classified into five different subtypes which include:<ref name="pmid21377267">{{cite journal |vauthors=Uldrick TS, Whitby D |title=Update on KSHV epidemiology, Kaposi Sarcoma pathogenesis, and treatment of Kaposi Sarcoma |journal=Cancer Lett. |volume=305 |issue=2 |pages=150–62 |date=June 2011 |pmid=21377267 |doi=10.1016/j.canlet.2011.02.006 |url=}}</ref><ref name="pmid6861160">{{cite journal |vauthors=Krigel RL, Laubenstein LJ, Muggia FM |title=Kaposi's sarcoma: a new staging classification |journal=Cancer Treat Rep |volume=67 |issue=6 |pages=531–4 |date=June 1983 |pmid=6861160 |doi= |url=}}</ref><ref name="pmid18655700">{{cite journal |vauthors=Grayson W, Pantanowitz L |title=Histological variants of cutaneous Kaposi sarcoma |journal=Diagn Pathol |volume=3 |issue= |pages=31 |date=July 2008 |pmid=18655700 |pmc=2526984 |doi=10.1186/1746-1596-3-31 |url=}}</ref>
*<nowiki/>According to the clinical setting of the [[disease]], clinical presentation, [[epidemiology]], and [[prognosis]] Kaposi's sarcoma may be classified into five different subtypes<ref name="pmid21377267">{{cite journal |vauthors=Uldrick TS, Whitby D |title=Update on KSHV epidemiology, Kaposi Sarcoma pathogenesis, and treatment of Kaposi Sarcoma |journal=Cancer Lett. |volume=305 |issue=2 |pages=150–62 |date=June 2011 |pmid=21377267 |doi=10.1016/j.canlet.2011.02.006 |url=}}</ref><ref name="pmid6861160">{{cite journal |vauthors=Krigel RL, Laubenstein LJ, Muggia FM |title=Kaposi's sarcoma: a new staging classification |journal=Cancer Treat Rep |volume=67 |issue=6 |pages=531–4 |date=June 1983 |pmid=6861160 |doi= |url=}}</ref><ref name="pmid18655700">{{cite journal |vauthors=Grayson W, Pantanowitz L |title=Histological variants of cutaneous Kaposi sarcoma |journal=Diagn Pathol |volume=3 |issue= |pages=31 |date=July 2008 |pmid=18655700 |pmc=2526984 |doi=10.1186/1746-1596-3-31 |url=}}</ref>
*<nowiki/>African [[cutaneous]] Kaposi's sarcoma and African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma could be classified under the term of [[endemic]] Kaposi's sarcomas.


:* Classic Kaposi's sarcoma
:* African [[cutaneous]] Kaposi's sarcoma
:* African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma
:* [[Iatrogenic]] Kaposi's sarcoma (immunosuppression-<nowiki/>associated Kaposi's sarcoma)
:* [[AIDS]]-associated Kaposi's sarcoma
* African [[cutaneous]] Kaposi's sarcoma and African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma could be classified under the term of [[endemic]] Kaposi's sarcomas.
<br />
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{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Types}}
! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Types}}
! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Characteristics}}
! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Characteristics}}
|-
|-
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |Classic Kaposi's sarcoma <ref name="pmid25889316">{{cite journal| author=Vincenzi B, D'Onofrio L, Frezza AM, Grasso RF, Fausti V, Santini D et al.| title=Classic Kaposi Sarcoma: to treat or not to treat? | journal=BMC Res Notes | year= 2015 | volume= 8 | issue=  | pages= 138 | pmid=25889316 | doi=10.1186/s13104-015-1076-1 | pmc=4395989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25889316  }}</ref><ref name="StratigosPotouridou1997">{{cite journal|last1=Stratigos|first1=John|last2=Potouridou|first2=Irene|last3=Katoulis|first3=Alexander|last4=Hatziolou|first4=Eftichia|last5=Christofidou|first5=Eleftheria|last6=Stratigos|first6=Alexander|last7=Hatzakis|first7=Angelos|last8=Stavrianeas|first8=Nicholas|title=Classic Kaposi's sarcoma in Greece: a clinico-epidemiological profile|journal=International Journal of Dermatology|volume=36|issue=10|year=1997|pages=735–740|issn=0011-9059|doi=10.1046/j.1365-4362.1997.00284.x}}</ref>
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |Classic (Mediterranean) Kaposi's sarcoma <ref name="pmid25889316">{{cite journal| author=Vincenzi B, D'Onofrio L, Frezza AM, Grasso RF, Fausti V, Santini D et al.| title=Classic Kaposi Sarcoma: to treat or not to treat? | journal=BMC Res Notes | year= 2015 | volume= 8 | issue=  | pages= 138 | pmid=25889316 | doi=10.1186/s13104-015-1076-1 | pmc=4395989 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25889316  }}</ref><ref name="StratigosPotouridou1997">{{cite journal|last1=Stratigos|first1=John|last2=Potouridou|first2=Irene|last3=Katoulis|first3=Alexander|last4=Hatziolou|first4=Eftichia|last5=Christofidou|first5=Eleftheria|last6=Stratigos|first6=Alexander|last7=Hatzakis|first7=Angelos|last8=Stavrianeas|first8=Nicholas|title=Classic Kaposi's sarcoma in Greece: a clinico-epidemiological profile|journal=International Journal of Dermatology|volume=36|issue=10|year=1997|pages=735–740|issn=0011-9059|doi=10.1046/j.1365-4362.1997.00284.x}}</ref><ref name="pmid11489800">{{cite journal| author=Landau HJ, Poiesz BJ, Dube S, Bogart JA, Weiner LB, Souid AK| title=Classic Kaposi's sarcoma associated with human herpesvirus 8 infection in a 13-year-old male: a case report. | journal=Clin Cancer Res | year= 2001 | volume= 7 | issue= 8 | pages= 2263-8 | pmid=11489800 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11489800  }}</ref><ref name="CetinAktas2018">{{cite journal|last1=Cetin|first1=Bulent|last2=Aktas|first2=Bilge|last3=Bal|first3=Oznur|last4=Algin|first4=Efnan|last5=Akman|first5=Tulay|last6=Koral|first6=Lokman|last7=Kaplan|first7=Mehmet Ali|last8=Demirci|first8=Umut|last9=Uncu|first9=Dogan|last10=Ozet|first10=Ahmet|title=Classic Kaposi's sarcoma: A review of 156 cases|journal=Dermatologica Sinica|volume=36|issue=4|year=2018|pages=185–189|issn=10278117|doi=10.1016/j.dsi.2018.06.005}}</ref>
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* Vascular sarcoma
*[[Vascular]] sarcoma
* Common in Mediterranean elderly men
* Common in Mediterranean [[elderly]] [[men]]
*Indolent clinical behavior
*Indolent [[clinical]] [[behavior]]
*Pigmented macular–papular lesions on mucocutaneous surface
*Pigmented [[macular]]–[[Papule|papular]] lesions on [[mucocutaneous]] surface
*Typically appears as dark blue or purple
*Typically appears as dark [[blue]] or purple
*Lesions may present as solitary nodules or plaques and tumors to a size of several centimeters
*[[Lesions]] may present as [[solitary]] [[nodules]] or [[plaques]] and [[tumors]] to a size of several centimeters
*Usually, present in the skin of the lower extremities and progresses very slowly
*Usually, present in the [[skin]] of the [[lower extremities]] and progresses very slowly
*Mucous membranes of the mouth and GI tract and regional lymph nodes could be affected
*[[Mucous membranes]] of the [[mouth]] and [[GI]] tract and regional [[lymph nodes]] could be affected
*Factors that affect the selection of local therapy are the extent and location of the lesions and the rapidity of clinical change
*Factors that affect the selection of local [[therapy]] are:
*Local therapy includes surgery, intra-lesional injection of vinblastine, topical retinoid, radiotherapy and cryotherapy.
**The extent and location of the [[lesions]]
*Radiotherapy is a treatment option for the multifocal but relatively localized KS. <br />
**The rapidity of [[clinical]] change
*
*Local [[therapy]] includes:
*
**[[Surgery]]
*  
**Intra-lesional injection of [[vinblastine]], [[topical]] [[retinoid]], [[radiotherapy]], and [[cryotherapy]].
 
**[[Radiotherapy]]: The treatment option for the multifocal but relatively localized [[KS]]. <br />
*  
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="6;" | Endemic African Kaposi's sarcoma <ref name="pmid213772672">{{cite journal| author=Uldrick TS, Whitby D| title=Update on KSHV epidemiology, Kaposi Sarcoma pathogenesis, and treatment of Kaposi Sarcoma. | journal=Cancer Lett | year= 2011 | volume= 305 | issue= 2 | pages= 150-62 | pmid=21377267 | doi=10.1016/j.canlet.2011.02.006 | pmc=3085592 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377267  }}</ref>
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="1;"|Common features
|-
| style="padding: 5px 5px; background: #F5F5F5;" |
* Usually seen in areas with high [[prevalence]] of [[HHV-8]] such as sub-Saharan Africa, called, Kaposi’s sarcoma-associated [[herpesvirus]] ([[KSHV]])
*Seropositivity in Sub-Saharan Africa is >50%
*If caused by an undiagnosed [[HIV]] infection, it can be treated by [[antiretroviral]] medications
*<nowiki/><nowiki/><nowiki/>If caused by [[infection]] other than [[HIV]], it can be treated by [[radiotherapy]] or [[chemotherapy]]
*The limitations of achieving an optimal and affordable [[therapeutic]] approach in sub-Saharan Africa is:
**Resource-limited settings and infrastructure issues such as lack of trained personnel to administer [[chemotherapy]] and lack of [[infusion]] centers, and the inability to monitor blood work, a high rate of co-morbid [[tuberculosis]]
*Oral agents such as [[etoposide]] may have the benefit of easing the administration
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="1;"|African [[cutaneous]]  Kaposi's sarcoma
|-
|-
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |African [[cutaneous]] Kaposi's sarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*
*[[Risk factors]] (other than [[HIV]])
** Chronic [[malaria]]
** Chronic [[parasitic infections]]
**[[Malnutrition]]
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" rowspan="1;"|African [[Lymphadenopathy|lymphadenopathic]]  Kaposi's sarcoma
|-
|-
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |African [[Lymphadenopathy|lymphadenopathic]] Kaposi's sarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*
* A very [[aggressive]] form
* Affects very young children, < 10 years of age
* Not related to [[HIV]]
*Affects the [[skin]] and [[lymph nodes]]
|-
|-
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |[[Iatrogenic]] Kaposi's sarcoma (immunosuppression-associated Kaposi's sarcoma)
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |[[Iatrogenic]] ([[transplant]]-related) Kaposi's sarcoma ([[immunosuppression]]-associated Kaposi's sarcoma)<ref name="pmid4884743">{{cite journal| author=Siegel JH, Janis R, Alper JC, Schutte H, Robbins L, Blaufox MD| title=Disseminated visceral Kaposi's sarcoma. Appearance after human renal homograft operation. | journal=JAMA | year= 1969 | volume= 207 | issue= 8 | pages= 1493-6 | pmid=4884743 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4884743  }}</ref><ref name="pmid728865">{{cite journal| author=Klepp O, Dahl O, Stenwig JT| title=Association of Kaposi's sarcoma and prior immunosuppressive therapy: a 5-year material of Kaposi's sarcoma in Norway. | journal=Cancer | year= 1978 | volume= 42 | issue= 6 | pages= 2626-30 | pmid=728865 | doi=10.1002/1097-0142(197812)42:6<2626::aid-cncr2820420618>3.0.co;2-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=728865  }}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* The association of [[KS]] with [[immunosuppression]] is noted in solid [[organ]] [[transplant]] [[patients]] and other [[patients]] on chronic [[immunosuppressive]] agents
*Reduction or removal of [[immunosuppression]] may not always lead to a resolution of [[KS]]
*[[Systemic therapy]] with  liposomal [[doxorubicin]] should be considered if [[immunosuppression]] removal didn't work or was not possible
<br />
*
*
|-
|-
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |[[AIDS]]-associated Kaposi's sarcoma
| rowspan="1;" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" |(Epidemic) [[AIDS]]-associated Kaposi's sarcoma<ref name="pmid21751599">{{cite journal| author=Thomas S, Sindhu CB, Sreekumar S, Sasidharan PK| title=AIDS associated Kaposi's sarcoma. | journal=J Assoc Physicians India | year= 2011 | volume= 59 | issue=  | pages= 387-9 | pmid=21751599 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21751599  }}</ref><ref name="Friedman-KienSaltzman1990">{{cite journal|last1=Friedman-Kien|first1=Alvin E.|last2=Saltzman|first2=Brian R.|title=Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi's sarcoma|journal=Journal of the American Academy of Dermatology|volume=22|issue=6|year=1990|pages=1237–1250|issn=01909622|doi=10.1016/0190-9622(90)70169-I}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
* The most common [[malignant]] [[neoplasm]] occurring in [[AIDS]] [[patients]]
*A highly varied [[neoplastic]] disease
*Characterized by multifocal [[mucocutaneous]] [[lesions]], often with [[lymphatic]] and [[visceral]] involvement
*The first [[epidemic]] occurred in [[homosexual]] men in 1981 in NewYork and California.
*95% of all [[AIDS]]_associated Kaposi's sarcoma ([[AIDS]]-KS) are in [[homosexual]] men
*The remaining 5% occurs in other population who are at risk of [[AIDS]]
*[[Etiology]] [[hypotheses]]:
**Endothelial-tumor [[growth factors]]
**[[Oncogenic]] [[expression]]
**[[Genetic]] predisposition
**Environmental cofactors
**Direct [[virus]]-like agent unidentified yet
*All available [[treatments]] help control the [[lesions]], none lengthens [[Survival rate|survival]]
*[[Treatments|Treatment]] includes:
**Localized [[radiation]] therapy
**[[Cryotherapy]]
**[[Electrocautery|Electrocauterization]]
**[[Surgical]] [[excision]]
**[[Systemic]] [[chemotherapeutic]] regimens
**[[Interferon]]
*
<br />
*
*



Latest revision as of 16:00, 4 November 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2] Huda A. Karman, M.D.

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Overview

Kaposi's sarcoma may be classified according to the clinical setting of the disease into five subtypes include Classic Kaposi's sarcoma, African cutaneous Kaposi's sarcoma, African lymphadenopathic Kaposi's sarcoma, Immunosuppression-associated Kaposi's sarcoma, and AIDS-associated Kaposi's sarcoma.

Classification

Types Characteristics
Classic (Mediterranean) Kaposi's sarcoma [4][5][6][7]
Endemic African Kaposi's sarcoma [8] Common features
  • Usually seen in areas with high prevalence of HHV-8 such as sub-Saharan Africa, called, Kaposi’s sarcoma-associated herpesvirus (KSHV)
  • Seropositivity in Sub-Saharan Africa is >50%
  • If caused by an undiagnosed HIV infection, it can be treated by antiretroviral medications
  • If caused by infection other than HIV, it can be treated by radiotherapy or chemotherapy
  • The limitations of achieving an optimal and affordable therapeutic approach in sub-Saharan Africa is:
    • Resource-limited settings and infrastructure issues such as lack of trained personnel to administer chemotherapy and lack of infusion centers, and the inability to monitor blood work, a high rate of co-morbid tuberculosis
  • Oral agents such as etoposide may have the benefit of easing the administration
African cutaneous Kaposi's sarcoma
African lymphadenopathic Kaposi's sarcoma
Iatrogenic (transplant-related) Kaposi's sarcoma (immunosuppression-associated Kaposi's sarcoma)[9][10]


(Epidemic) AIDS-associated Kaposi's sarcoma[11][12]


References

  1. Uldrick TS, Whitby D (June 2011). "Update on KSHV epidemiology, Kaposi Sarcoma pathogenesis, and treatment of Kaposi Sarcoma". Cancer Lett. 305 (2): 150–62. doi:10.1016/j.canlet.2011.02.006. PMID 21377267.
  2. Krigel RL, Laubenstein LJ, Muggia FM (June 1983). "Kaposi's sarcoma: a new staging classification". Cancer Treat Rep. 67 (6): 531–4. PMID 6861160.
  3. Grayson W, Pantanowitz L (July 2008). "Histological variants of cutaneous Kaposi sarcoma". Diagn Pathol. 3: 31. doi:10.1186/1746-1596-3-31. PMC 2526984. PMID 18655700.
  4. Vincenzi B, D'Onofrio L, Frezza AM, Grasso RF, Fausti V, Santini D; et al. (2015). "Classic Kaposi Sarcoma: to treat or not to treat?". BMC Res Notes. 8: 138. doi:10.1186/s13104-015-1076-1. PMC 4395989. PMID 25889316.
  5. Stratigos, John; Potouridou, Irene; Katoulis, Alexander; Hatziolou, Eftichia; Christofidou, Eleftheria; Stratigos, Alexander; Hatzakis, Angelos; Stavrianeas, Nicholas (1997). "Classic Kaposi's sarcoma in Greece: a clinico-epidemiological profile". International Journal of Dermatology. 36 (10): 735–740. doi:10.1046/j.1365-4362.1997.00284.x. ISSN 0011-9059.
  6. Landau HJ, Poiesz BJ, Dube S, Bogart JA, Weiner LB, Souid AK (2001). "Classic Kaposi's sarcoma associated with human herpesvirus 8 infection in a 13-year-old male: a case report". Clin Cancer Res. 7 (8): 2263–8. PMID 11489800.
  7. Cetin, Bulent; Aktas, Bilge; Bal, Oznur; Algin, Efnan; Akman, Tulay; Koral, Lokman; Kaplan, Mehmet Ali; Demirci, Umut; Uncu, Dogan; Ozet, Ahmet (2018). "Classic Kaposi's sarcoma: A review of 156 cases". Dermatologica Sinica. 36 (4): 185–189. doi:10.1016/j.dsi.2018.06.005. ISSN 1027-8117.
  8. Uldrick TS, Whitby D (2011). "Update on KSHV epidemiology, Kaposi Sarcoma pathogenesis, and treatment of Kaposi Sarcoma". Cancer Lett. 305 (2): 150–62. doi:10.1016/j.canlet.2011.02.006. PMC 3085592. PMID 21377267.
  9. Siegel JH, Janis R, Alper JC, Schutte H, Robbins L, Blaufox MD (1969). "Disseminated visceral Kaposi's sarcoma. Appearance after human renal homograft operation". JAMA. 207 (8): 1493–6. PMID 4884743.
  10. Klepp O, Dahl O, Stenwig JT (1978). "Association of Kaposi's sarcoma and prior immunosuppressive therapy: a 5-year material of Kaposi's sarcoma in Norway". Cancer. 42 (6): 2626–30. doi:10.1002/1097-0142(197812)42:6<2626::aid-cncr2820420618>3.0.co;2-7. PMID 728865.
  11. Thomas S, Sindhu CB, Sreekumar S, Sasidharan PK (2011). "AIDS associated Kaposi's sarcoma". J Assoc Physicians India. 59: 387–9. PMID 21751599.
  12. Friedman-Kien, Alvin E.; Saltzman, Brian R. (1990). "Clinical manifestations of classical, endemic African, and epidemic AIDS-associated Kaposi's sarcoma". Journal of the American Academy of Dermatology. 22 (6): 1237–1250. doi:10.1016/0190-9622(90)70169-I. ISSN 0190-9622.


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