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: Kaposi sarcoma, Acquired immunodeficiency syndrome, Gastrointestinal endoscopy, Epidemiology, Gastrointestinal tumor symptoms

Core tip: Gastrointestinal Kaposi’s sarcoma (GI-KS) is more common than originally thought and the majority of patients are asymptomatic and remain undiagnosed. Therefore, clinicians should maintain a high suspicion, especially among acquired immunodeficiency syndrome patients. Screening endoscopies are frequently performed and a recent retrospective study suggested using certain clinical factors (low CD4 cell count of < 100 cell/μL, men who have sex with men, and presence of cutaneous Kaposi’s) which may predict occurrence of GI-KS endoscopically. Endoscopy to detect GI-KS prior to clinical symptom development is desired as initiation of combined highly active antiretroviral therapy and liposomal doxorubicin therapy has shown to improve outcome.