Sarcoma De Kaposi

Solivetti et al. Journal of Experimental & Clinical Cancer Research 2011, 30:40 http://www.jeccr.com/content/30/1/40

RESEARCH

Open Access

AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?
Francesco M Solivetti1*, Fulvia Elia1, Alessandra Latini2, Carlo Cota3, Paola Cordiali-Fei4 and Aldo Di Carlo5
Abstract
Background:Kaposi Sarcoma (KS) is a malignancy of endothelial skin cells with multifocal localization on the skin, lymph nodes and visceral organs. Although all clinical variants are associated with HHV-8 infection, specific differences in the clinical onset and in the natural history of AIDS-KS and Classic-KS have been described. The present randomised prospective-observational study aimed to investigatewhether the ultrasound pattern and color Doppler flow imaging of vascularisation of skin lesions of patients with Classic KS (CKS) or AIDS-KS could provide useful information to the evaluation of clinical activity of the disease. Methods: Cutaneous lesions of 24 patients with histologically confirmed KS were investigated using very high frequency ultrasound probes; 16 patients had CKS and 8 had AIDS-KS.HHV-8 infection was confirmed in all patients by investigating the specific humoral response to viral antigens. Immunological and virological parameters were also assessed to monitor HIV or HHV-8 viral infection. For each patient, a target skin lesion was selected on the basis of size (diameter from 0.4 to 2 cm). Each lesion was analyzed in terms of size, depth and color Doppler pattern. Results:The B-mode ultrasound patterns of skin lesions did not differ when comparing CKS patients to AIDS-KS patients, whereas the color Doppler signal, which is associated with vascular activity, was detected in the KS lesions of 6/8 AIDS-KS patients (75.0%) and in 2/16 CKS (16,7%); the latter two patients showed a clinically progressive and extensive disease stage (IV B). Conclusions: Our preliminaryresults suggest that small cutaneous KS lesions - in both CKS and AIDS-KS patientsdisplay similar B-mode ultrasound patterns ( hypoechoic, well defined, superficial lesions). However, the color Doppler signal, which is associated with endothelial activity and angiogenesis, which play a substantial role in KS progression, could constitute a useful tool for evaluating disease activity.

BackgroundKaposi’s Sarcoma (KS) is a tumour affecting mainly the skin, with multifocal expression and possible lymph nodal and visceral involvement [1]. Classically, it consists of four clinical variants: Classic KS (CKS) - or Mediterranean KS-, iatrogenic KS, African KS, and AIDS-KS. All four variants are associated with Human Herpesvirus-8 (HHV-8), and they show a similar histological pattern. HHV-8infection of endothelial cells or circulating endothelial and/or haematopoietic
* Correspondence: solivetti@ifo.it 1 Radiology Department, San Gallicano Dermatology Institute - Rome - Italy Full list of author information is available at the end of the article

progenitors leads to changes in their morphology, glucose metabolism, growth rate, lifespan and gene expression, resulting in theprecipitation of KS [2]. In Italy, the most commonly observed clinical variants are CKS, typically found in persons over 60 years of age, and the epidemic form, AIDS-KS, which affects younger persons with HIV infection. In HIV-positive persons, KS constitutes an AIDS-defining condition [3]. Another subvariant of KS (termed “gay Kaposi”) has also been described in HIV-negative homosexuals [4] and is possiblyrelated to the sexual transmission of HHV-8 infection [5]. The clinical onset of KS is characterised by violaceous macules and papules, which over the course of months or

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