No abstract

Kapoi sarcoma is a neoplasm of multifocal origin that may involve skin as well as the viscera. It can involve skin of any part of the body, but exclusive involvement of genitalia alone is uncommon. It can occur as a sporadic, endemic or in association with HIV and non-HIV induced immunosuppression. A case of Kaposi sarcoma localized to genitalia is presented herein. To the best of our knowledge, it appears to be the first case reported from Saudi Arabia. Case ReportA 75-year-old male with diabetes mellitus (Type II NIDDM) on diet control was hospitalized for the complaints of loss of appetite and generalized weakness with a 12 week history of reddish nodules over the genitalia. There was no history of abdominal pain, loose motions, hematemesis or melena. He denied any risk factors for HIV infection or use of immunosuppressive drugs. Physical examination revealed pallor and dependent edema of both lower legs. There was no lymphadenopathy or organomegaly. Cardiovascular, respiratory and central nervous system examination revealed no abnormalities. Local examination of genitalia showed 12 reddish brown nodules and plaques involving the scrotum and shaft of the penis (Figure 1). A clinical suspicion of Kaposi sarcoma was confirmed by the histopathological study (Figure 2) of one of the nodules over the scrotum. It showed aggregated spindle-shaped cells and vascular spaces in the entire dermis. Vascular spaces were lined by plump endothelial cells and did not contain RBCs. The spindle cells were arranged in bundles. In between the spindle cells, extravasated RBCs and brownish granular hemosiderin pigment were seen. The epidermis did not show any remarkable changes. Laboratory data were as follows: microcytic hypochromic anemia (Hb levels varying between 7 to 9 g/dL), hematocrit values 28% to 35%, WBC count varying between 12,500/mm3 to 18,600 mm3, lymphocytes 5% to 15% and ESR 138 mm/hr (Westergren method). Coombs' test was negative. Routine urinalysis showed many pus cells and RBCs. Urine culture isolated different organisms on various occasions (E. coli, Klebsiella pneumoniae, Proteus mirabilis and Citrobacter diversus). Stool analysis showed no parasite or occult blood. Serological tests for HIV infection, HBsAg and syphilis were negative. Blood sugars, liver function test and serum electrolytes were within normal limits. Other biochemical indices were as follows: BUN 70 mg/dL, serum creatinine 2.5 mg/dL, total serum proteins 4.6 g/dL and 24-hour urinary proteins 0.06 g/day. Chest x-ray and skeletal survey were within normal limits. Upper GI tract endoscopy and barium studies could not be performed because of poor general condition of the patient. Ultrasound of the abdomen revealed free fluid in the abdomen. Diagnostic tapping of the abdomen revealed turbid yellowish fluid. Cytochemical analysis showed mesoepithelial cells, 0 to 4 pus cells/hpf, absence of bacteria and malignant cells and protein levels of 0.497 g/dL. CT scan of the chest and abdomen showed no significant findings except free fluid in the abdomen....