Kaposis Sarcoma

FIGURE 10-63 (see Color Plate)

Kaposi's sarcoma of the lower leg in a male transplant recipient. Kaposi's sarcoma is a tumor, perhaps of lymphatic endothelial origin, that presents as purple papules or plaques that advance to nodules of the extremities, oral mucosa, or viscera. In transplant recipients it presents on average by 21 months post-transplant, with the largest number (46%) within the first post-transplant year. It is seen most often in men (3:1) and in those of Arabic, black, Italian, Jewish, and Greek ancestry. It accounts for 5.7% of the malignancies reported to the Cincinnati Transplant Tumor Registry (nonmelanoma skin cancers and in situ carcinomas of the uterine cervix excluded). Transplant programs in Italy and Saudi Arabia have reported higher rates of post-transplant Kaposi's sarcoma. Visceral involvement is less common in the transplant recipient than in the AIDS patient, but it must be remembered that it may be seen in the liver, lungs, gastrointestinal tract, and nodes. Mortality is increased with visceral involvement (57% versus 23%). HHV-8 has been proposed as the causal agent of this tumor; however, not all investigators feel the evidence is conclusive. Of note, the occurrence in AIDS patients is decreased in those who receive foscarnet, cidofovir, and ganciclovir, but not acyclovir. Treatment includes decreasing immunosuppression, local radiation, excision, interferon, or chemotherapy.

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