Indian Journal of Pathology and Microbiology
Home About us Instructions Submission Subscribe Advertise Contact e-Alerts Ahead Of Print Login 
Users Online: 991
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size


 
CASE REPORT Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 535-536
Kaposi's sarcoma: HIV-negative man with isolated penile localization


1 Department of Urology, 30000, Hassan II University Hospital, Fes, Morocco
2 National Oncology Institute, Ibn Sina University Hospital, Rabat, Morocco
3 Department of Radiotherapy, National Oncology Institute, Ibn Sina University Hospital, Rabat, Morocco
4 Department of Pathological Anatomy, 30000, Hassan II University Hospital, Fes, Morocco

Click here for correspondence address and email

Date of Web Publication22-Oct-2010
 

   Abstract 

Kaposi's sarcoma is the malignant proliferation of the endothelial cell vessels. Its genesis is still unclear; however, it seems to be related to the herpes virus infection (HHV-8). This neoplasia usually affects the lower limbs and the affected persons are mostly from the Mediterranean region. The exclusive penile localization of the Kaposi's sarcoma in a patient with a negative HIV serologia is exceptional. Our case is of a 73-year old patient with a negative HIV serology presenting an exclusive penile localization of the Kaposi's sarcoma treated by radiotherapy.

Keywords: HIV, Kaposi′s sarcoma, penis

How to cite this article:
Soufiane M, Fadl TM, Nawfel M, Ouafae M, Kawtar Z, Afaf L, Jamal EM, Hassan FM. Kaposi's sarcoma: HIV-negative man with isolated penile localization. Indian J Pathol Microbiol 2010;53:535-6

How to cite this URL:
Soufiane M, Fadl TM, Nawfel M, Ouafae M, Kawtar Z, Afaf L, Jamal EM, Hassan FM. Kaposi's sarcoma: HIV-negative man with isolated penile localization. Indian J Pathol Microbiol [serial online] 2010 [cited 2017 Oct 17];53:535-6. Available from: http://www.ijpmonline.org/text.asp?2010/53/3/535/68294



   Introduction Top


Kaposi's sarcoma is a rare tumor arising from the endothelial cells. It appears like a purplish macular lesion which progresses to become a papule, patch, nodule and rarely tumor. The exact origin of this pathology is still unknown but the current thinking is the narrow link between the appearance of the Kaposi's sarcoma and the infection by the herpes virus (HHV-8). [1],[2] This proliferation classically develops over the extremities. Exclusive penile localization in a patient with negative HIV serology is very rare.


   Case Report Top


A 73-year-old male presented with a tumor over the glans penis which appeared nine months ago. According to the patient it was like a macule, which evolved to a papule and finally evolved to a tumor. The physical examination found an exophytic tumor over the glans with ulceration and was surrounded by small purplish macules. The systemic examination did not reveal any other dermatological lesion and no inguinal adenopathy was seen [Figure 1].
Figure 1: Exophyti c tumor over the glans

Click here to view


Complete blood count, blood ionogram and hepatic assessment did not feature any anomaly. The HIV serology was negative. A tumorectomy and electro coagulation of the small macule was performed. The histological study of the tumor revealed a classical Kaposi's sarcoma [Figure 2]. There were spindle cells with nuclear atypia, occasional mitoses and blood-filled vascular slits. Human herpes virus-8 DNA was detected in the tumor tissue. Abdominal and thoracic scanning was normal. The patient received radiotherapy of 8 Gray for the lesion and a two-year follow-up did not reveal any anomaly [Figure 3].
Figure 2: Moderately atypical spindle cells with rare mitoses delineating blood-fi lled vascular slits (hematoxylin and eosin, ×400)

Click here to view
Figure 3 : Result aft er surgery and radiotherapy

Click here to view



   Discussion Top


Kaposi's sarcoma is a rare affection reported for the first time by Moritz Kaposi in 1872. It frequently affects aging persons from the Mediterranean Sea surroundings. Nevertheless, with the appearance of the syndrome of acquired immunodeficiency (AIDS), the incidence of this sarcoma has multiplied. The first references in the literature concerning the penile localization of the Kaposi sarcoma is by Linker et al.[3] who present four cases of penile localization (glans) and 13 cases with a secondary development on the external genitals.

The AIDS epidemic caused the rise of the incidence of genital localizations especially in the African countries. [4] Katongole-Mpidde et al. [4] reported 29 cases of genital localization of the Kaposi's sarcoma, 25 of these cases were diagnosed between 1986 and 1989 and 70.4 % were positive HIV. Indeed, more than 3% of HIV positive patients developing a Kaposi's sarcoma have it on the external genitals and 20% of these patients simultaneously develop with systemic lesions.

On the other hand, exclusive localization on the external genitals among seronegative patients is an extremely rare clinical form. Micalli et al.[5] report that exclusive penile localization affects old HIV negative patients. Morelli et al.[6] noted the Herpes Virus infection and Kaposi's sarcoma association in an HIV negative patient so that the link between these two pathologies is established.

Genital Kaposi's sarcoma is usually located over the glans, prepuce and balano-prepucial location or the meatus and seldom over the scrotum. [7] The clinical features are variable, and there is no optimal treatment yet. Indeed, the surgical excision is recommended for the small solitary lesions and the radiotherapy is recommended by several authors for large lesions after biopsy and histological confirmation. The other therapeutic options are local chemotherapy by intra-tumoral injection, the topic treatment by alitretinoοne gel application, the physical destruction by the laser, the cryosurgery or electrocoagulation. [4],[5]

Systemic chemotherapy is used for the severe forms with high success rate. [ 3],[5] Our patient was managed with tumorectomy, electro-coagulation and radiotherapy. After a follow-up period of two years no evidence of recurrence was observed.

 
   References Top

1.Perez A, Sanchez JL, Almodovar PI. Kaposi's sarcoma is not a neoplasm let alone a sarcoma. Int J Dermatol 2003;42:844-5.  Back to cited text no. 1      
2.Antman K, Chang Y. Kaposi's sarcoma. N Engl J Med 2000;342:1027-38.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Linker D, Lieberman P, Grabstald H. Kaposi's sarcoma of genitourinary tract. Urology 1975;5:684-7.  Back to cited text no. 3  [PUBMED]    
4.Katongole-Mbidde E, Banura C, Nakakeeto M. Diagnostic implications of genital Kaposi's sarcoma. East Afr Med J 1989;66:499-502.  Back to cited text no. 4  [PUBMED]    
5.Micali G, Nasca MR, De Pasquale R, Innocenzi D. Primary classic Kaposi's sarcoma of the penis: report of a case and review. J Eur Acad Derm Venereol 2003;17:320-3.  Back to cited text no. 5      
6.Morelli L, Pusiol T, Piscioli F, Hofler H, Weirich G, Werner M, et al. Herpes virus 8-associated penile Kaposi's sarcoma in an HIV-negative patient: First report of a solitary lesion. Am J Dermatopathol 2003;25:28-31.  Back to cited text no. 6      
7.Vitale F, Viviano E, Perna AM, Bonura F, Mazzola G, Ajello F, et al. Serological and virological evidence of nonsexual transmission of human herpesvirus type 8 (HHV8). Epidemiol Infect 2000;125:671-5.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Mellas Soufiane
B.P. 7206, Fès Zouhour, 30014, Fès
Morocco
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68294

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 Isolated Kaposi Sarcoma in two HIV negative patients
Seleit, I., Attia, A., Maraee, A., Samaka, R., Bakry, O., Eid, E.
Journal of Dermatological Case Reports. 2011; 5(2): 24-26
[Pubmed]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed11642    
    Printed94    
    Emailed1    
    PDF Downloaded48    
    Comments [Add]    
    Cited by others 1    

Recommend this journal