Gastrointestinal Kaposi's sarcoma: Case report and review of the literature

Abstract

Kaposi's sarcoma (KS) of the gastrointestinal tract is not an uncommon disease among individuals with acquired immunodeficiency syndrome (AIDS). The majority is asymptomatic, and for this reason, gastrointestinal KS (GI-KS) remains undiagnosed. With continued tumor growth, considerable variation in clinical presentation occurs including abdominal pain, nausea, vomiting, iron deficiency anemia (either chronic or frank gastrointestinal bleeding), and rarely mechanical obstruction alone or combined with bowel perforation. Endoscopy with biopsy allows for histological and immunohistochemical testing to confirm the diagnosis of GI-KS among those with clinical symptoms. In previous studies, dual treatment with highly active antiretroviral therapy and systemic chemotherapy have been associated with improved morbidity and mortality in individuals with visceral KS. Therefore, investigators have suggested performing screening endoscopies in select patients for early detection and treatment to improve outcome. In this review, we describe a 44 years old man with AIDS and cutaneous KS who presented for evaluation of postprandial abdominal pain, vomiting, and weight loss. On upper endoscopy, an extensive, infiltrative, circumferential, reddish mass involving the entire body and antrum of the stomach was seen. Histologic examination later revealed spindle cell proliferation, and confirmatory immunohistochemical testing revealed human herpes virus 8 latent nuclear antigen expression consistent with a diagnosis of gastric KS. Following this, we present a comprehensive review of literature on KS with emphasis on gastrointestinal tract involvement and management.

Keywords: Acquired immunodeficiency syndrome; Epidemiology; Gastrointestinal endoscopy; Gastrointestinal tumor symptoms; Kaposi sarcoma.

Figure 1

Endoscopic image of the gastric cardia demonstrating Kaposi’s sarcoma lesion extension from the gastric body.

Figure 2

Endoscopic image of the gastric body showing an extensive, infiltrative, and circumferential Kaposi’s sarcoma mass involving the entire body.

Figure 3

Endoscopic image of the gastric antrum with Kaposi’s sarcoma lesion infiltration from the body.

Figure 4

Hematoxylin and eosin stain of slit-like spaces with spindle cell proliferation and associated red blood cell extravasation seen in the lamina propria.

Figure 5

Immunohistochemical stain for human herpes virus 8 showing a strongly positive latent nuclear antigen staining of the spindle cells along the slit-like spaces.