Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2015; 6(3): 89-95
Published online Aug 6, 2015. doi: 10.4292/wjgpt.v6.i3.89
Gastrointestinal Kaposi’s sarcoma: Case report and review of the literature
Ann Joo Lee, Lacie Brenner, Bashar Mourad, Carmela Monteiro, Kenneth J Vega, Juan Carlos Munoz
Ann Joo Lee, Lacie Brenner, Juan Carlos Munoz, Division of Gastroenterology, Department of Medicine, University of Florida College of Medicine Jacksonville, Jacksonville, FL 32209, United States
Bashar Mourad, Department of Medicine, University of Florida College of Medicine Jacksonville, Jacksonville, FL 32209, United States
Carmela Monteiro, Department of Pathology, University of Florida College of Medicine Jacksonville, Jacksonville, FL 32209, United States
Kenneth J Vega, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Author contributions: Lee AJ and Mourad B collected the patient’s clinical data; Lee AJ, Brenner L and Munoz JC performed the endoscopy and obtained biopsies for diagnosis; Monteiro C analyzed the histopathology; Lee AJ, Munoz JC and Vega KJ performed the literature review and wrote the paper.
Supported by University of Florida College of Medicine Jacksonville.
Institutional review board statement: This research did not require approval by the University of Florida College of Medicine/Jacksonville institutional review board.
Informed consent statement: This research did not require an informed consent.
Conflict-of-interest statement: No conflict of interest exists for all authors in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenneth J Vega, MD, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard WP 1345, Oklahoma City, OK 73104, United States. kenneth-vega@ouhsc.edu
Telephone: +1-405-2715428 Fax: +1-405-2715803
Received: April 21, 2015
Peer-review started: April 24, 2015
First decision: June 3, 2015
Revised: June 21, 2015
Accepted: July 11, 2015
Article in press: July 14, 2015
Published online: August 6, 2015
Processing time: 109 Days and 9.6 Hours
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.