CLINICAL PRESENTATION AND NATURAL HISTORY OF AIDS-RELATED KAPOSI'S SARCOMA

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Kaposi's sarcoma (KS) is the most common tumor arising in persons infected with HIV, and among all HIV risk groups it is most common in homosexual or bisexual men. During the past decade KS has shifted more and more from being an index diagnosis for AIDS to an opportunistic neoplasm occurring later in the course of AIDS and leading to increasing morbidity and mortality. This article focuses on the clinical presentation and natural history of KS; other articles deal with the epidemiology, pathogenesis, and treatment of this disease.

Section snippets

CLINICAL FEATURES

AIDS-related KS has a very variable clinical course, ranging from minimal disease, presenting as an incidental finding, to explosive growth resulting in significant morbidity and mortality. The skin lesions can appear anywhere but in some patients are concentrated on the lower extremities, face, and genitalia. The lesions are often elliptic and may be arranged in a linear fashion along skin tension lines; they may also be symmetrically distributed. Early lesions may be difficult to recognize

STAGING AND PROGNOSIS

The initial evaluation of a patient with KS includes a thorough physical examination with special attention to those areas frequently affected by the disease, such as the lower extremities, face, oral mucosa, genitalia, GI tract, and lungs. As previously noted, testing the stool for occult blood is an excellent way to screen for GI lesions. Endoscopy can be reserved for those patients with occult blood or with GI symptoms. In a similar fashion, a chest roentgenogram is an excellent way to

SUMMARY

The clinical course of KS is highly variable, ranging from minimal disease to explosive growth. Extracutaneous spread is common, involving most frequently the oral cavity, GI tract, lungs, and lymph nodes. Both corticosteroid therapy and opportunistic infections are associated with the development of KS and with exacerbation of pre-existing KS in HIV-infected patients. A typical initial evaluation includes a thorough physical examination, fecal occult blood test, chest roentgenogram, and CD4+

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      The disease presents as highly vascularized proliferative lesions, typically on the skin, often with accompanying inflammatory changes (Ganem, 2010). KS is an indolent condition in immunocompetent hosts (Brooks, 1986) but is more widespread and aggressive in states of immune deficiency including organ transplantation and AIDS (Dezube, 1996). The principal targets of KSHV infection in KS lesions are elongated spindle cells thought to be of endothelial origin because they express multiple endothelial markers (e.g., CD31, CD34, CD36) (Boshoff et al., 1995; Ensoli et al., 2001).

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    Address reprint requests to Bruce J. Dezube, MD, Division of Hematology/Oncology, Beth Israel Hospital, CC 915, 330 Brookline Avenue, Boston, MA 02215

    This work was supported by a Career Development Award from the American Cancer Society

    *

    From the Division of Hematology/Oncology, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts

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