Neoplasia

Kaposi's sarcoma (KS) is commonly seen in the gastrointestinal tract and occurs in homosexual men more frequently than in patients from other risk groups. A new human herpes virus (HHV8) or Kaposi's sarcoma-associated herpes virus (KSHV) has been recently identified as a likely aetiological agent. KS lesions in the gut have the range seen in the skin, from small telangiectatic lesions, not well shown on contrast studies and only seen at endoscopy, to larger nodular or polypoid lesions. Complications from gastrointestinal disease are unusual, but include ulceration, obstruction, haemorrhage, and diarrhoea.

Lymphoma is much less common than KS however, although the incidence of KS has decreased along with the incidence of life-threatening opportunistic infections in association with the introduction of highly active antiretroviral therapy. The incidence of lymphoma has not been affected. HIV-associated lymphomas are usually high grade non-Hodgkin's type, of B-cell origin. Extranodal involvement is typical and the gut is one of the commonest sites involved.

We thank Dr Wilfred Weinstein, UCLA Medical School, Los Angeles for providing the photograph of oesophageal candidiasis and Dr David Casemore, PHLS Glan Clwyd, North Wales for the electronmicrograph of cryptosporidium.

Figure 7.7 Discrete lesion of Kaposi's sarcoma in the rectum

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