The spectrum of underlying causes of iatrogenic Kaposi's sarcoma in a large series: A retrospective study

Abstract

Background:The frequency of clinicoepidemiological variants of Kaposi's sarcoma (KS) differs markedly throughout the world. The iatrogenic variant is mainly associated with the use of immunosuppressive therapy.Aims:We aimed to investigate the distribution of KS variants in our practice and elucidate the underlying causes of iatrogenic KS.Methods:Consecutive KS patients seen in a single tertiary center were grouped according to the tumor variants and iatrogenic KS patients were evaluated about associated conditions.Results:Among 137 patients, classic variant was the most frequent presentation (n = 88), followed by iatrogenic (n = 37) variant. Among the iatrogenic group, ten were transplant recipients. In 16 iatrogenic KS patients, systemic corticosteroid was used, in four for myasthenia gravis (MG) and in three for rheumatoid arthritis. In three patients, KS developed under topical corticosteroid (TC) treatment. Among iatrogenic KS patients, ten of them had a second primary neoplasm and one had congenital immunodeficiency syndrome.Conclusions:Our study revealed one of the highest rates for iatrogenic KS (27%) reported in the literature. Besides well-known causes, relatively frequent association with MG was remarkable. Usage of different forms of TCs was the cause of KS in a few cases.

Recurrent Kaposi sarcoma of the ear in an HIV‐negative patient: A case report with review of the literature. Is ear a predilection site for Kaposi sarcoma in HIV‐negatives?

“…In this article, we presented a case of recurrent KS on the ear with a literature review on ear KS cases (Table 1). 5,6,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The literature review disclosed 24 cases since the year 1941 until 2020, highlighting the rarity of this presentation. Sixteen males and seven females aged 3-85 years (median, 62 years; mean, 57.4 years) were retrieved.…”

“…Among these, four cases had visceral involvement including lymph node, bone, urethra, stomach, colon, liver, and spleen, and the rest were limited to the skin including just limited to the auricle ( n = 11), ear and mucosal sites ( n = 4), ear and extremities ( n = 9), and ear and other sites in the head and neck region (chin and eyelid) ( n = 3). Among the 13 HIV‐negatives, five cases had some degrees of immunosuppression (one case kidney transplantation, 25 one case congenital immunodeficiency, 25 one case receiving systemic corticosteroid, 23 one case non‐Hodgkin lymphoma, 21 and the last a case of severe lymphocytopenia 17 ). While excision was the most common treatment option, other modalities were antiretroviral medications for HIV‐positives, radiotherapy and chemotherapy with liposomal doxorubicin, bleomycin, vincristine, and IFN‐alpha for more widespread disease.…”

“…Sixteen males and seven females aged 3-85 years (median, 62 years; mean, 57.4 years) were retrieved. Of these 24 cases of ear skin KS, two cases were HIV-positive, 24,27 13 cases were HIV-negative, 6,[16][17][18][19][20][21][22][23]25,26 and others were unknown. Among these, four cases had visceral involvement including lymph node, bone, urethra, stomach, colon, liver, and spleen, and the rest were limited to the skin including just limited to the auricle (n = 11), ear and mucosal sites (n = 4), ear and extremities (n = 9), and ear and other sites in the head and neck region (chin and eyelid) (n = 3).…”

Iatrogenic Kaposi Sarcoma Precipitated by Anti-Tumor Necrosis Factor-Alpha (Anti-TNF-α) Therapy

“…Four sub-types of KS are described: classic (Mediterranean), epidemic (AIDS-associated), endemic (sub-Saharan Africa), and iatrogenic [ 1 - 2 ]. The iatrogenic variant of KS is classically reported in organ transplant patients undergoing immunosuppressive therapy or those receiving long-term steroids [ 3 ]. However, over the past few decades, the use of biologic agents such as tumor necrosis factor-alpha (TNF-α) inhibitors has led to an increase in cases of KS.…”

Outcome markers of ART-treated HIV+ patients with early stage Kaposi’s sarcoma

“…It is clear from the epidemiological association of KS with HIV-induced immunosuppression, immunosuppressive therapy, and aging [6][7][8] that immune dysregulation plays a key role in the pathogenesis of KS. However, the fundamental mechanisms underlying KS development are largely unknown.…”