PICTURES IN DIGESTIVE PATHOLOGY

 

Coexistence of Kaposi sarcoma and gastric diffuse large B-cell lymphoma in a HIV-infected patient

 

 

João Santos-Antunes^1,2, Susana Lopes¹, Elsa Fonseca³, Fátima Carneiro³ and Guilherme Macedo¹

¹Department of Gastroenterology. Faculty of Medicine. Centro Hospitalar S. João. Porto, Portugal.
Departments of ²Biochemistry (U38-FCT) and ³Pathology. Faculty of Medicine. University of Porto. Portugal

 

 

A 24 years-old man without medical history was admitted due to weight loss, asthenia, anorexia, fever, and the appearance of multiple brownish nodules in the scalp, upper and lower limps and trunk, associated with axillary and inguinal adenopathies. Blood stests revealed anemia (hemoglobin 8.9 g/dL), leukopenia (3,000x10⁹ leukocytes/L) and thrombocytopenia (28,000x10⁹ platelets/L) and elevated inflammatory markers (C-reactive protein, 34.3 mg/L). Abdominal ultrasound was normal. Antibodies anti-HIV were requested, and they were positive for HIV-1. The cutaneous lesions were compatible with Kaposi Sarcoma.

To evaluate the extension of Kaposi sarcoma, an upper endoscopy was performed. A large area of pigmented mucosa was seen in the palate (Fig. 1). Also, a well-demarcated non-elevated brownish lesion was seen in the esophagus (Fig. 2). In the stomach, multiple reddish lesions were seen diffusely in the antrum, body, and fundus, all consistent with Kaposi lesions (Fig. 3). In the posterior wall of the body one of these lesion was in an elevated area (Fig. 4), and biopsies were performed in this site. Pathological analysis showed diffuse large B-cell lymphoma (Figs. 5 and 6).

 

 

Currently, patient status is poor. He has severe pancytopenia, disseminated Kaposi sarcoma (with cutaneous, esophageal, gastric and bronchial disease) and also pneumocistosis. He has been under highly active antiretroviral therapy and doxorrubicin for Kaposi sarcoma, not having at the moment clinical conditions for aggressive therapy against lymphoma.

Kaposi sarcoma is the most common malignancy in this setting, and frequently involve the gastrointestinal tract (1,2). HIV-infected patients have a well-established increased risk of Kaposi sarcoma and lymphoma. However, the coexistence of gastric Kaposi sarcoma and gastric diffuse large B-cell lymphoma (and, in our case, in the same lesion) was not previously reported.

 

References

1. Danzig JB, Brandt LJ, Reinus JF, et al. Gastrointestinal malignancy in patients with AIDS. Am J Gastroenterol 1991;86:715-8.         [ Links ]

2. Friedman SL, Wright TL, Altman DF. Gastrointestinal Kaposi sarcoma in patients with acquired immunodeficiency syndrome: endoscopy and autopsy findings. Gastroenterology 1985;89:102-8.         [ Links ]