Slide on kaposi sarcoma presented by Muluti at the CDH zambia

1. KAPOSI SARCOMA
Presenter: Muluse Chipo Muluti
Moderator: Dr Ngoma

2. Introduction
• Kaposi sarcoma (KS) is an
angioproliferative malignancy caused by
HHV-8, commonly seen in
immunocompromised individuals,
especially those with HIV/AIDS.
• It is a systemic tumor of endothelial cell
origin.
• It has Four clinical variants
• Responds to radiation and chemotherapy,

3. Clinical variants of KS
• classic KS
• endemic African KS
• immunosuppressive therapy–related KS
• HIV/AIDS-related KS

4. Classic KS
• Occurs in elderly males of eastern
European heritage.
• Predominantly arises on the legs but also
occurs in lymph nodes and abdominal
viscera.
• slow progression and has good prognosis

5. Classic KS

7. African-Endemic KS
• It occurs in people living in Equatorial Africa.
• HHV-8 infection is much more common in
Africa than in other parts of the world,
increasing the chance of KS developing.
• Males > females
• Has poor prognosis (young adults 5–8
years; young children 2–3 years)
• Four clinical patterns

8. African KS

9. African-Endemic KS patterns
a) Nodular type: benign course and resembles classic KS.
b) Florid or vegetating type: more aggressive. Nodular
extend deeply into the subcutaneous fat, muscle, and bone.
c) Infiltrative type: more aggressive has mucocutaneous and
visceral .
d) Lymphadenopathic type: children and young adults.
confined to lymph nodes and viscera, also involves the skin
and mucous membrane.

10. Iatrogenic Immunosuppression-
Associated KS
• It is rare.
• Most commonly in solid-organ transplant
recipients
• chronic use of immunosuppressive drugs
• Resolves on cessation of immunosuppression.

11. HIV/AIDS-Associated KS
• AIDS increases risk of KS ( 20,000 times that those
not infected with HIV)
• This occurs more often in men than in women
• Common in homosexual men
• Rapid progression, extensive systemic involvement
• HIV-1 associated Kaposi sarcoma has high
occurrence in homosexual men.
• Most cultures of these tumors yield cells with
properties of hyperplastic endothelial cells
• KS of the bowel and/or lungs is responsible for
numerous deaths

12. Route of Infection
• KSHV appears to be shed in saliva independent of
subjects immune status
• Viral DNA is detected in breast milk samples in African
patients.
• HHV 8 infects dividing B cells CD45+phase
• Sexually transmitted among men who have sex with
men. Who have higher prevalence ( 30- 60%)
• Infections are common in Africa (>50%) with infections
acquired early in life by nonsexual routes, through
contact with oral secretion

13. Pathogenesis
• HHV-8 causes KS by infecting endothelial
and immune cells, evading immune
detection, and promoting angiogenesis via
VEGF. It suppresses apoptosis through
LANA-1 and cytokines, leading to
uncontrolled cell growth. Immune
suppression (e.g., HIV, transplant drugs)
creates a favorable environment for KS
development.

14. Clinical manifestation
• Mucocutaneous lesions are usually
asymptomatic
• lower extremities - edema and moderate
to severe pain
• Urethral or anal canal lesions- obstruction
• Pulmonary KS - bronchospasm, intractable
coughing, shortness of breath, progressive
respiratory failure.

15. Skin Lesions (Most Common Presentation)
• Color: Pink, red, purple, or brown macules,
plaques, or nodules.
• Distribution: Common on lower limbs, face (nose,
ears), and genitalia.
• Progression: Begins as flat macules, later forming
raised plaques and nodular tumors.
• Usually painless and non-pruritic, but may
ulcerate in advanced cases.

16. Mucosal Involvement
• Oral KS: Common in AIDS-associated KS,
affecting the hard palate, gingiva, and tongue.
• Symptoms include bleeding, pain, and
difficulty eating.

17. Oral kaposi sacroma

18. Lymphatic System Involvement
• Causes lymphedema, especially in the lower
limbs and genitalia.
• Can occur even without visible skin lesions
due to lymphatic obstruction.

19. Visceral Involvement (Advanced KS)
Gastrointestinal KS
• Symptoms include bleeding, weight loss, abdominal
pain, and diarrhea.
• Endoscopy may reveal red/violaceous lesions in the GI
tract.
Pulmonary KS
• Symptoms include cough, hemoptysis, dyspnea, and
pleural effusion.
• Can be life-threatening if extensive.

20. Investigations
• Skin biopsy- Vascular channels lined by
atypical endothelial cells.
- extravasated erythrocytes
with hemosiderin deposition
Imaging – abdominal ultrasound, cxr

21. Differential diagnosis
• Dermatofibroma
• melanocytic nevus
• ecchymosis
• granuloma annulare
• insect bite reactions

22. Management
Localized Treatment
• Cryotherapy – Effective for superficial
lesions.
• Intralesional chemotherapy (e.g.,
vinblastine) – Used for small symptomatic
lesions.
• Radiotherapy – Preferred for a few
localized lesions, especially in classic KS.

23. Systemic Treatment
• HAART (Highly Active Antiretroviral Therapy)
The backbone of KS treatment in HIV-positive patients,
often leading to lesion regression.
Chemotherapy
• Liposomal anthracyclines (e.g., doxorubicin,
daunorubicin) – First-line therapy.
• Paclitaxel – Used for refractory or advanced cases.
• Other agents (e.g., vincristine, vinblastine, bleomycin) –
Used in some combination therapies.

24. THE END