Kaposi's sarcoma in lymph nodes concurrent with Hodgkin's disease

The coexistence of Kaposi's sarcoma (KS) and Hodgkin's disease (HD) in the same lymph node is illustrated. The case concerns an 82-year-old Italian woman with a classic cutaneous KS who developed multiple lymphadenopathies. Involvement of a single node by KS and HD in the manner of a collision tumor was found unexpectedly. This very unusual finding might be regarded as more than coincidental because of the relatively frequent concurrence of diseases.     

KSHV/HHV-8 associated Kaposi's sarcoma in lymph nodes concurrent with Epstein-Barr virus associated Hodgkin lymphoma

BACKGROUND: The unusual occurrence of a metastatic Kaposi's sarcoma (KS) in a lymph node affected by Hodgkin lymphoma (HL) was originally reported when knowledge of the specific virological features of these tumours was lacking. AIM: To re-evaluate this case by assessing whether the simultaneous presence of the two tumours was linked with common aetiopathogenetic factors. METHODS: The presence of EBV was investigated by in situ hybridisation, whereas KS associated herpesvirus (KSHV)/human herpesvirus 8 (HHV-8) was detected by immunohistochemistry. Both viruses were analysed in the case reported, in 30 lymph nodes from patients with classic HL, and in 22 skin biopsies from patients with KS. RESULTS: Consistent with the findings in the HL and KS cases analysed, in the case showing features of both HL and KS in the same lymph node, EBV was detectable only in Reed-Sternberg (RS) cells, but not in KS spindle cells, whereas KSHV/HHV-8 was detectable only in KS spindle cells, and not in RS cells. CONCLUSION: It is probable that the development of KS and HL was related to two independent aetiological cofactors-KSHV/HHV-8 and EBV, respectively-and that the occurrence of the two malignancies in the same patient was merely fortuitous.     

Primary Kaposi's sarcoma in lymph nodes concurrent with chronic lymphatic leukemia.

Both Kaposi's sarcoma and chronic lymphatic leukemia affect the lymph nodes, and not infrequently, the same patient. The authors describe the occurrence of both diseases in the same lymph node. The rarity of this finding suggests different histopathogenic origins of the two diseases.     

Multicentric Castleman's disease,non-Hodgkin's lymphoma,and Kaposi's sarcoma: a rare simultaneous occurrence

A rare simultaneous occurrence of multicentric Castleman's disease, non-Hodgkin's lymphoma, and Kaposi's sarcoma was diagnosed in a 70-year-old man who presented with fever, polyarthralgia, weight loss, vascular purpura, anemia, generalized lymphadenopathy, and hepatosplenomegaly. He had no risk of HIV infection and serological tests for HIV were negative twice, but a low number of T-cells and a reversed CD4/CD8 ratio were observed. During hospitalization, he developed Kaposi's sarcoma at the right sole. Lymph node biopsies revealed multicentric Castleman's disease together with a large B-cell lymphoma, which showed monotypic IgM-lambda lymphocytes. To our knowledge, this is the first report in which systemic manifestations of all three diseases occurred simultaneously prior to any specific treatment. The altered immune status and human herpesvirus-8 infection might have played a role in the pathogenesis of this occurrence.     

The coexistence of cancer cells of different origin within the same lymph nodes

Summary The coexistence of two differently originating cancer cells within the same lymph node is reported. An 83-year-old male patient died from severe carcinomatous lymphangitis of the lungs five months after gastrectomy for gastric cancer. At autopsy, prostatic cancer metastasis to lymph node was found. Histologically, the prostatic carcinoma cells had a cribriform pattern and the gastric cells showed papillary and tubular features. Immunohistochemically, the former was immunoreactive to prostate specific antigen (PSA) and the latter was stained positively for carcinoembryonic antigen (CEA). Fifty-one of the retroperitoneal and intrapelvic lymph nodes were histologically examined; the coexistence of both types of cancer cells was found in two lymph nodes. Both types were adjoined at the hilum, as was also confirmed by an immunohistochemical double staining technique. These two lymph nodes were located in the pre-aortic and left lateral aortic areas, and they belonged to the terminal lymph node group of both the intra-pelvic and intra-abdominal intestinal organs.

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Coexistence dans les mêmes noeuds lymphatiques de cellules provenant de deux cancers différents

Résumé Les auteurs décrivent la coexistence dans un même noeud lymphatique de cellules tumorales provenant de deux cancers différents. L'observation est celle d'un sujet masculin de 83 ans décédé d'une lymphangite carcinomateuse pulmonaire cinq mois après gastrectomie pour cancer. L'autopsie montra l'existence de métastases lymphonodales d'un cancer prostatique. Histologiquement, les métastases du cancer prostatique présentaient un aspect cribriforme tandis que les cellules d'origine gastrique dessinaient des formations papillaires et tubulaires. En immunohistochimie les premières se révélaient positives à l'antigène prostatique spécifique (PSA), et les autres à l'antigène carcino-embryonnaire (ACE). Cinquante et un noeuds rétropéritonéaux et pelviens furent examinés : la coexistence des deux types de cellules métastatiques fut observée dans deux noeuds. Les deux types se retrouvaient associés au niveau du hile, fait confirmé par les réactions immunohistochimiques. Les deux noeuds intéressés étaient situés dans la région préaortique et latéro-aortiques gauche et appartenaient au groupe des noeuds proximaux qui collectent à la fois la lymphe des organes pelviens et celle des organes digestifs intra-abdominaux.

     

Simultaneous medullary carcinoma of the thyroid gland and Hodgkin's lymphoma in bilateral lymph nodes of the neck: a potential pitfall in fine-needle aspiration cytology

The clinicopathological features and the cytological findings of Hodgkin's lymphoma (HL) and medullary carcinoma (MC) of the thyroid gland are described appearing simultaneously in different organs of the cervical region of the same patient. Although the cytological features of both entities are well known, the rare clinical presentation and the epithelium-like Hodgkin and Reed-Sternberg (HRS) cells of the syncytial variant of HL led to an erroneous cytological diagnosis of metastatic carcinoma of the upper aerodigestive tract.     

Kaposi's sarcoma and malignant lymphoma in AIDS

Summary A 48-year-old homosexual with contacts in different countries, including Haiti, presented with multiple pigmented or bluish nodules on both lower legs and upper arms. He had a history of secondary syphilis, hepatitis B and herpes zoster ophthalmicus. Biopsies of the skin tumors revealed a typical Kaposi's sarcoma of low grade malignancy. The endothelial origin of the tumor was indicated by the presence of specific endothelial organelles (Weibel-Palade bodies) in the cytoplasma of the tumor cells. Erythrocytophagocytosis was found in tumor cells within and without the vascular channels. Laboratory tests were compatible with the clinical diagnosis of an acquired immune deficiency syndrome (AIDS) with a helper: suppressor T-lymphocyte ratio of 0.28 and a cutaneous anergy. In the course of the illness tumors of the stomach and duodenum were detected. Histology showed a malignant non-Hodgkin lymphoma of high grade malignancy. Within weeks the patient died in a cachectic state. Autopsy revealed a Kaposi's sarcoma of the skin with metastases in the stomach and a wide-spread malignant lymphoma in the gastrointestinal tract, in several visceral organs and in many lymph nodes.     

HHV-6 and EBV DNA quantitation in lymph nodes of 86 patients with Hodgkin's lymphoma

Human herpesvirus (HHV-6) and Epstein-Barr virus (EBV), are two ubiquitous human herpesviruses which share many common features although they belong to different sub-families. In particular, both viruses are found in lymph nodes of patients suffering from Hodgkin's lymphoma. The aim of this study was to detect and to quantify independently HHV-6 and EBV by a real-time PCR in lymph nodes from 86 patients with Hodgkin's lymphoma. EBV quantitative method was compared with LMP-1 protein detection among the same samples. EBV genome was detected for 61.6% of the patients (53/86) and the highest prevalence of this virus was observed in Hodgkin's lymphoma with mixed-cellularity histopathological type (80%). In contrast to that, HHV-6 genome was detected for 79.1% of the patients (68/86) and was most observed in the nodular-sclerosis group (83.6%). Among the 68 HHV-6 positive samples, 63 belonged to the B subtype. A large number of biopsies (47.7%) were positive for both viruses whereas a little number (7%) was negative for both. EBV quantitation and LMP-1 immunohistochemistry were correlated statistically but this latter technique was less sensitive. Among the nodular-sclerosis patients, HHV-6-/EBV+ patients were significatively older than HHV-6+/EBV- patients. Patients infected dually had higher values of quantitation for each virus than those positive for one virus. Data of the clinical follow-up obtained by diagnosis and during the treatment of 83 patients, were correlated with the virological findings.     

On the angiostrneture of lymph nodes in Hodgkin's disease

Summary Using an extended indirect immunoperoxidase method and the lectin I of Ulex europaeus (UEA-I), whose binding sites in lymph nodes are restricted to endothelial cells and erythrocytes, the angioarchitecture of 31 lymph nodes affected by Hodgkin's disease (HD) was demonstrated and analyzed. Compared with the normal state, the lymphocytic predominance type has a low relative vascular density, and venular endothelium is epithelioid throughout. Mixed cellularity types, especially those rich in epithelioid cells, have the lowest relative vascular density; the venular endothelium is often flat. In the sclerosing areas of the nodular sclerosis type structurel differences between capillaries, arterioles and venules vanish. Due to parenchymal atrophy and cellular depletion, relative vascular density is markedly increased in such areas, as is the case in lymphocytic depletion types. Despite all the histomorphological changes occurring in HD, the vascular system of the lymph node, surprisingly, does not undergo profound alteration. There is a positive correlation between the degree of epithelioid transformation of venular endothelium and trans-venular lymphocytic traffic. The conditions are described under which the otherwise non-reactive sinus endothelium expresses the UEA-I receptor.     

Kaposi's sarcoma in the bone marrow of a patient with AIDS

The authors report a case of Kaposi's sarcoma (KS) involving the bone marrow of a patient with acquired immune deficiency syndrome (AIDS). The morphologic features, differential diagnosis, immunostaining pattern, and unusually low frequency of marrow involvement by AIDS-related KS are discussed.     

Secondary involvement of lymph nodes in Kaposi sarcoma

Kaposi sarcoma is a low-grade neoplasm first described by Moricz Kaposi in 1872. Although many attempts have been made to explain its pathogenesis, its etiology still remains obscure. In this regard, many aspects of the disease's genetic, epidemiological and histopathological backgrounds are even today unclear. We present the case of a 57-year-old male patient, constant HIV negative, with a history of plaque-like lesions on his right foot approximately two years ago. Following surgical removal, a diagnosis of Kaposi sarcoma, plaque stage was settled. One year after, the patient was admitted to the hospital for pain in the right ankle and foot, associated to paresthesis and trophic lesions at this level. Similar lesions developed in the popliteal fossa. Biopsy and subsequent histological and immunohistochemical examination revealed a KS at that level. The most recent hospital admission revealed the appearance of an indolent lymphadenopathy in the groin. Our case represents a rare occurrence of Kaposi sarcoma at a HIV-negative patient, which, after several local recurrences and progressive behavior, produced a lymph node involvement at the groin level. The immunohistochemical assessments have confirmed the diagnosis.