acquired immunodeficiency syndrome revealed by oral kaposi’s sarcoma

8/19/2019 Acquired Immunodeficiency Syndrome Revealed by Oral Kaposi’s Sarcoma

http://slidepdf.com/reader/full/acquired-immunodeficiency-syndrome-revealed-by-oral-kaposis-sarcoma 1/2

International Journal of Oral and Craniofacial Science

Citation: Atarguine H, Benmoussa S, Abbad F, Hocar O, Ihbibane F, et al. (2016) Acquired Immunode ciency Syndrome Revealed by Oral Kaposi’sSarcoma. Int J Oral Craniofac Sci 2(1): 001-002.

001

eertechz

Abst rac t

Kaposi’s sarcoma is the malignant proliferation of the endothelial cell vessels. It is a systemic,malignant and multifactor disease. It usually presents initially as violaceous cutaneous lesions.Outside of a known context of an immune de ciency, an isolated oral lesions may not think to Kaposi’ssarcoma. Hence the interest of the histological and immunohistochemical study.

This paper reviews one such case of Kaposi’s sarcoma in a 42-year-old woman who present anisolated pigmented lesions of the tongue, related to Kaposi’s sarcoma, without cutaneous or visceralinvolvement, and which led to the discovery of acquired immunode ciency syndrome (HIV). Thestabilization was obtained with antiretroviral triple therapy.

seat o a moderate cytonuclear atypia. Te interstitial tissue is brousand seat o deposits o hemosiderin and red cell. Te spindle cellsshow a moderate cytonuclear atypia o neutrophils ( Figure 2A,2B).Immunohistochemistry showed an intense cytoplasmic expression oendothelial and spindle cells o the anti-CD34 antibody ( Figure 3),also a cytoplasmic membrane and ocal expression o spindle cells othe anti- D2-40 antibody ( Figure 4).

HIV serology (ELISA and Western Blot) was positive. CD4 cellswere 146/ mm3. Syphilitic serology ( PHA, VDRL) was positive,

and serology o hepatitis B and C were negative. Hemogram andbiochemical tests were unremarkable. Complete work-up (includingchest radiography and ultrasonography o the abdomen) disclosedno signs o visceral involvement o KS. Te patient was classied asa good risk according to the staging classication system or AIDS-related KS proposed by the AIDS Clinical rial Group [ 2]. Teoncologist suggested the antiretroviral treatment in order to allowImmune restoration, and to control the progression o KS. Tepatient was treated with antiretroviral triple therapy and 2,4 millionunits benzathine penicillin G (Once weekly or 3 weeks).

Introduction

Kaposi’s Sarcoma (KS), being rst described in 1872 [1], is anunusual vascular neoplasm that most likely arises rom endothelialcells, with some evidence o lymphatic origin. Different clinicaland epidemiological variants have been identied. Lesions o KStypically mani ests as bluish-purple macules and plaques on the

skin, particularly o the ace and lower extremities. Oral mucosa,lymph nodes and visceral organs may be affected, sometimes withoutcutaneous involvement.

Here, we report the case o a 42-year-old emale, havingpigmented macules o the tongue, without other sites, revealingKaposi’s sarcoma an acquired immunodeciency syndrome withgood response to antiretroviral triple therapy.

Case Report

A 42-year-old married woman, without specic medical history,was re erred to our service or the evaluation o a pigmented lesion othe tongue, painless, non-pruritic and without changing o the taste

that had appeared 20 days earlier. In the course o disease, she had aever, diarrhea and weight loss.

Oral examination shows a conuent brownish macules bunchedat the tongue, without other associated lesions o the oral cavity(Figure 1). No other similar lesions in any other region o the bodywere detected. Lymphadenopathy was not detected and physicalexamination showed no abnormalities.

An incisional biopsy was per ormed and the specimen wassubmitted or the histopathological examination which revealed atumor proli eration in contact with the dermal vessels. It is made o a

usi orm cell population and o small vascular structures dissecting thedermis. Vascular lights are lined by a monomorphic endothelial cells

Case Report

Acquired ImmunodefciencySyndrome Revealed by OralKaposi’s Sarcoma

Hanane Atarguine 1*, SoundousBenmoussa 2, Fayçal Abbad 3, OuafaHocar 1, Fatima Ihbibane 2, HananeRais 3, Noura Tassi 2, Nadia Akhdari 1

and Said Amal 1

1Department of Dermatology, Hospital Arrazi, CHU Mohamed VI, Marrakech, Maroco2Department of Infectious Diseases, Hospital Arrazi,CHU Mohamed VI, Marrakech, Maroco3Department of Pathological Anatomy and Cytology,CHU Mohamed VI, Marrakech, Maroco

Dates: Received: 21 January, 2016; Accept ed: 08February, 2016; Published: 10 February, 2016

*Corresponding author: Dr, Hanane Atarguine,Department of Dermatology, Hospital Arrazi, CHUMohamed VI, 40000 Marrakech, Maroco, Tel:+212672691777; E-mail:

www.peertechz.com

Keywords: Kaposi′s sarcoma; Oral; Acquiredimmunode ciency syndrome; HIV

Figure 1: Con uent brownish macules bunched at the tongue without otherassociated lesions of the oral cavity.

8/19/2019 Acquired Immunodeficiency Syndrome Revealed by Oral Kaposi’s Sarcoma

http://slidepdf.com/reader/full/acquired-immunodeficiency-syndrome-revealed-by-oral-kaposis-sarcoma 2/2

Citation: Atarguine H, Benmoussa S, Abbad F, Hocar O, Ihbibane F, et al. (2016) Acquired Immunode ciency Syndrome Revealed by Oral Kaposi’sSarcoma. Int J Oral Craniofac Sci 2(1): 001-002.

Hanane et al. (2016)

002

disease is unknown, but the condition is considered by most workersto be neoplastic in nature; while other theories have proposed KSrepresenting reticuloendothelial hyperplasia. Current evidencesuggests that KS is caused by human herpes virus 8 (HHV-8). Tecourse o the disease is strongly inuenced by the immune status othe patient. Lesions o KS typically mani ests as bluish-purple maculesand plaques on the skin, particularly o the ace and lower extremities.Any mucosal site may be involved; the hard palate, gingiva andtongue are affected most requently [5]. An Isolated Kaposi Sarcomao the onsil has been reported in the literature [ 6]. O signicanceis that, oral lesion may be the initial site o involvement or the onlysite or the rst indication o HIV in ection as evidenced by our casehow is unique as the patient had oral KS, without the evidence o anycutaneous involvement.

A biopsy is, there ore, necessary to ascertain an accuratediagnosis, and the Immunohistochemical staining may be done orCD34 antibody. It yields positive results or endothelial lining o slitlike spaces and or spindle cells [7].

Te prognosis is variable depending upon the orm o the diseaseand the patient’s immune status.

In the majority o subjects who are HIV-seropositive with KS,effective antiretroviral treatment decreases the incidence and theprevalence o KS and causes regression o established lesions [8].

Conclusion

Certain clinical situations not immediately orienting towards

the diagnosis o Kaposi’s sarcoma, such as the appearance o asimple modication o the color o a mucosa in an unknownimmunosuppression context.

References1. Kaposi M (1872) Idiopanthisches multiples Pigmentsarkom der Haut. Arch

Derm Vatol Syph 4: 265-273 .

2. Krown SE, Metroka C, Wentz JC (1989) Kaposi’s sarcoma in the acquired immune de ciency syndrome: A proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol 7: 1201-1207 .

3. Mukai MM, Chaves T, Caldas L, Neto JF, Santamarίa JR (2009) Primary Kaposi’s sarcoma of the penis. An Bras Dermatol 84: 524–526.

4. Borkovic SP, Schwartz RA (1982) Kaposi’s sarcoma. Am Fam Physician 26: 133–137 .

5. Neville BW, Damm DD, Allen CM, Bouquot JE (2002) Oral & MaxillofacialPathology. 2 nd ed. Philadelphia: Saunders.

6. Pittore B, Pelagatti CL, Deiana F, Ortu F, Maricosu E, et al. (2015) Isolated kaposi sarcoma of the tonsil: a case report and review of the scienti c literature. Case Rep Otolaryngol 2015: 874548 .

7. Lin G, Wang H, Fan X, Li H, Wang Z, et al. (2015) Disseminated Kaposi sarcoma in a HIV negative patient. Int J Clin Exp Pathol 8: 80-3378 .

8. Arul AS, Kumar AR, Verma S, Arul AS (2015) Oral Kaposi’s sarcoma: Sole presentation in HIV seropositive patient. J Nat Sci Biol Med 6: 459-461 .

Figure 2: Normal acanthotic epidermis surmounted by an orthokeratose.Dermal proliferation made of spindle cells and vascular cells (A, Hematoxylin-eosin, original magni cation x 20). Signi cant dermal proliferation made ofvascular structures of which the lights are lined by a monomorphic endothelialcells seat of a moderate cytonuclear atypia (B, Hematoxylin-eosin, originalmagni cation x 60).

Figure 3: An intense cytoplasmic expression of endothelial and spindle cells

of the anti-CD34 antibody (Immunohistochemistry).

Figure 4: Cytoplasmic and focal expression of spindle cells of the anti- D2-40

antibody (Immunohistochemistry).

Copyright: © 2016 Atarguine H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permitsunrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Te outcome was avorable with recovery o the weight, regressiono ever and diarrhea without major side effects. Tree months aferthe beginning o treatment, oral lesions are in slow regression,without the appearance o other sites.

Discussion

Kaposi’s sarcoma (KS) is a vascular neoplasm, it can be classiedinto our distinct orms: classic, endemic, iatrogenic and AIDS-associated [3,4]. Te mere presence o KS lesions in HIV-seropositivesubjects constitutes a diagnostic sign or AIDS. Te etiology o the