Kaposi sarcoma is a tumour caused by human herpes virus 8, also known as Kaposi sarcoma-associated herpes virus. It usually affects the skin and oral mucosa; however, it can also sometimes affect the lungs, the liver, the stomach, the bowel, and lymph nodes. Several body sites may be affected simultaneously. The involvement of the tonsils is rare. We described an isolated localization of Kaposi’s sarcoma of the right tonsil in a HIV-positive patient.
HIV/AIDS represents an important clinical and public health issue worldwide. The estimated HIV/AIDS prevalence in 2012 was 35,300,000 worldwide in 2012 (WHO. Global report: UNAIDS report on the global AIDS epidemic 2013, UNAIDS/JC2502/1/E.). In case of severe immunodeficiency, the probability of occurrence of several opportunistic disorders (e.g., infections and tumours) can increase. Kaposi’s sarcoma (KS) is a frequently reported neoplasia in HIV-positives; it is caused by human herpes virus 8 (HHV-8), also known as KS-associated herpes virus (KSHV) [
Here, we present a case of KS of the right tonsil in a HIV-positive patient, surgically treated and exposed to antiretroviral drugs.
A 42-year-old man was admitted to the Emergency Department of the S.Francesco Hospital, Nuoro, Italy, because of a painless swelling, moderate bleeding, located in his right tonsil. He referred to its occurrence without any other relevant symptoms 1 month ahead.
Oral examination shows a purple swelling (Figure
Intraoperative photo: KS involved right tonsil.
The histopathological analysis identified a KS (Figures
(E.E 100x). Picture that shows a nodular lesion between vascular area in the chorion under the epithelium.
(H E 200x). KS of the tonsil demonstrates irregularly shaped vascular channels, interlacing bundles of spindle-shaped cells.
(I.I 200x). CD34 immunoreactivity is seen in the neoplastic spindle cells.
(400x). Picture that shows the nuclear human herpes 8 immunopositivity.
His past medical history includes a borderline hypertension treated with a diet approach.
After surgical treatment his CD4 lymphocyte count and HIV viral load were 207 cells/
TIS classification [
TIS classification | Clinical categories | |
---|---|---|
Good category | Poor category | |
T | Skin, lymphonode, mucosa of the mouth | Oedema and ulceration, KS of the mouth, KS of the gastrointestinal tract, KS of the viscera |
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I | CD4 cells count |
CD4 cells count 200 cells/ |
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S | No history of opportunistic disease; no fever, loss of weight, persistent diarrhea | Disease as lymphoma, neurological disease, fever, and so forth |
After 15 months since KS diagnosis the patient is alive and KS-free with a CD4 cell count of 342 cells/
KS is an important opportunistic disease, which frequently occurs in HIV-positive patients characterized by a severe immunodeficiency. The KS incidence in the general population is 1 case per 100,000 inhabitants [
The AIDS-related KS lesions, affecting the skin of the upper trunk and face [
The therapeutic choice and the following prognosis are extremely variable, depending on the stage and the KS type.
The AIDS Clinical Trials Group Oncology Committee published criteria for the evaluation of the epidemic KS [
This classification includes two group of patients: “Good risk category (T0I0S0)” and “Poor risk category (T1I1S1).” The patient that we described was classified as T0I0S0.
KS can be treated with radiotherapy, chemotherapy, biologic agent as interferon alfa, and surgery: in HIV-positive patients it can be managed with HAART or with a combination of this therapeutic approach.
HAART seems to be indispensable in the treatment of the AIDS-related KS, alone or in combination with systemic or/and local therapy [
Radiotherapy is an effective palliative treatment reducing pain, bleeding, and oedema. Cutaneous KS is highly radiosensitive as described by Donato et al. in a group of 38 AIDS-associated KS lesions [
Chemotherapy (CHT) can be local (intralesional injection) or systemic (intravenous). Local CHT, based on bleomycin, cisplatin, and vinblastine, can represent an alternative therapy for limited cutaneous KS with complete or partial response rates (range: 60–92%) [
Interferon alfa, showing immunomodulatory, antiviral, and antiangiogenetic actions, can be used alone or in combination with HAART. It can favour a remission of the KS lesions in 20 to 60% of the exposed cases [
Patients with clinical progression despite CHT and/or HAART can be currently approached with the so-called “Target Therapy” (i.e., antiangiogenetic agents such as inhibitor of vascular endothelial growth factor (VEGF) and thalidomide, metalloproteinases (MMPs), and cytokine signalling pathway inhibitors) [
Biopsy of the lesion is deemed mandatory for the histological diagnosis, but in cases of isolated cutaneous and visceral KS surgical excision is recommended in association with HAART, as showed in our review [
The patient we managed underwent tonsillectomy and HAART with complete eradication of the tumours.
Isolated KS of the tonsil is very rare and can simulate benign or malignant lesions, such as pyogenic granuloma, carcinomas, and sarcomas. Histological diagnosis, HIV testing and CT scans of the chest and abdomen, and an endoscopy of the upper gastrointestinal tract can be helpful for an appropriate stage of the tumours and, consecutively, to plan a better therapeutic approach.
Patient gave informed consent.
The authors state they have no conflict of interests.