Classical Kaposi's sarcoma in north-east Sardinia: an overview from 1977 to 1991.

The incidence of classical Kaposi''s sarcoma in 1977-91 was studied in north-east Sardinia. In this period, 160 new cases were observed in a defined area, of which 124 were in males. This represented a standardised incidence of the disease of 1.58/100,000 inhabitants per year (2.43 for males and 0.77 for females). This is the highest incidence of classical Kaposi''s sarcoma so far recorded. The incidence increased with age, particularly after the age of 70 in males.     

Disseminated Kaposi's sarcoma in a patient with acquired ichthyosis

An elderly black male with Kaposi's sarcoma of the skin and lymph nodes is presented. The patient developed several violaceous papules involving the nose, which suggested a diagnosis of sarcoidosis clinically but proved to be Kaposi's sarcoma on biopsy. His clinical course was complicated by the development of acquired ichthyosis. The prognosis and treatment of generalized Kaposi's sarcoma is discussed.     

Incidence rates of classical Kaposi's sarcoma and multiple myeloma do not correlate.

We compared population-based incidence rates for classical Kaposi''s sarcoma and multiple myeloma. Neither for men (Spearman''s rank correlation coefficient (r) = 0.01, P = 0.97, 13 pairs) nor for women (r = 0.24, P = 0.42, 13 pairs) did the incidences of the two conditions correlate. This absence of correlation does not support the hypothesis that Kaposi''s sarcoma and multiple myeloma share a common aetiology, such as HHV-8.     

High risk of Kaposi's sarcoma and central nervous system lymphoma in the same individuals: A finding related to acquired immunodeficiency syndrome

Kaposi's sarcoma and central nervous system (CNS) lymphoma are the 2 most common malignancies related to HIV infection. To investigate the association between Kaposi's sarcoma and CNS lymphoma, a population-based retrospective cohort study was conducted. Using U.S. Surveillance, Epidemiology and End Results Program data, the gender-specific age- and calendar year-adjusted standardized incidence ratios were calculated for the pre-AIDS (1973–1980) and AIDS (1981–1990) eras, as an estimate of the relative risk (RR) of developing one condition following another. For the AIDS era in men, the RR of CNS lymphoma following Kaposi's sarcoma was 979.7 and that of Kaposi's sarcoma following CNS lymphoma was 231.1. There were no instances of the co-occurrence of these malignancies in women in either era or in men for the pre-AIDS era. The extremely high RRs for the co-occurrence of Kaposi's sarcoma and CNS lymphoma in men during the AIDS era suggests that the association of these malignancies occurs within the same HIV-infected individuals. © 1996 Wiley-Liss, Inc.     

Non-AIDS-related malignancies: expert consensus review and practical applications from the multidisciplinary CANCERVIH Working Group

Malignancies represent a major cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected patients. The introduction of combined antiretroviral therapy has modified the spectrum of malignancies in HIV infection with a decreased incidence of acquired immunodeficiency syndrome (AIDS) malignancies such as Kaposi's sarcoma and non-Hodgkin's lymphoma due to partial immune recovery and an increase in non-AIDS-defining malignancies due to prolonged survival. Management of HIV-infected patients with cancer requires a multidisciplinary approach, involving both oncologists and HIV physicians to optimally manage both diseases and drug interactions between anticancer and anti-HIV drugs. The French CANCERVIH group presents here a review and an experience of managing non-AIDS malignancies in HIV-infected individuals.     

Neopterin and alpha-interferon in patients affected by Kaposi's sarcoma from Africa

The presence of circulating alpha-interferon and neopterin was investigated in sera of 47 patients affected by African Kaposi's sarcoma, both HIV-seropositive (13 patients) and HIV-seronegative (34 patients). For comparison, analyses were also performed in 20 HIV-seropositive symptomatic African subjects as well as in 20 African and 20 Italian healthy individuals.Alpha-interferon and neopterin levels appeared significantly higher in comparison with healthy control groups (P < 0.001) but not with HIV-seropositive African individuals without Kaposi's sarcoma. Moreover, alpha-interferon and neopterin levels were significantly higher in progressive Kaposi's sarcoma (27 patients) than in regressive Kaposi's sarcoma (20 patients) (P < 0.001). A significant correlation between alpha-interferon and neopterin was observed (r = 0.57; P < 0.01). Furthermore, alpha-interferon levels of HIV-seropositive Kaposi's sarcoma patients resulted significantly higher in comparison with the seronegative ones (P < 0.05).It is concluded that alpha-interferon and neopterin may be reliable prognostic markers in Kaposi's sarcoma patients.     

Kaposi's Sarcoma following Chronic Lymphocytic Leukemia: A Rare Entity

Cutaneous manifestations can occur in the wide range of internal malignancy. They can occur by metastases or local spread, direct infiltration, or a site of primary malignancy itself. Sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes. Chronic lymphocytic leukemia (CLL) is the most common leukemia all over the world. Cutaneous lesions occur in up to 25% of patients. Most commonly seen cutaneous lesions in CLL are those of infectious or hemorrhagic origin. Skin cancer risk was also increased eightfold in CLL when compared with normal population, so cutaneous lesions in CLL can be the first manifestation of secondary skin malignancy. Herein, we report an interesting case of Kaposi''s sarcoma which was diagnosed during the course of CLL.Key Words: Kaposi''s sarcoma, Chronic lymphocytic leukemia, Secondary malignancy     

Over-expression of hepatocyte growth factor in human Kaposi's sarcoma

Kaposi's sarcoma is a highly vascularized multifocal tumor which frequently appears as a complication of HIV infection. It has been suggested that a disorder in the cytokine network may contribute to the development of the disease. We examined the expression of several cytokines in human sporadic Kaposi's sarcoma specimens, as well as in spindle cells cultured from human lesions, and consistently found high levels of expression of hepatocyte growth factor (HGF). In addition, human lesion-derived spindle cells synthesize and secrete biologically active hepatocyte growth factor and express the hepatocyte-growth-factor receptor (c-MET). Moreover, elevated levels of transforming growth factor β1 (TGFβ1) mRNA were found in lesions of human sporadic Kaposi's sarcoma and in lesion-derived spindle cells which also over-express urokinase. Since HGF, TGFβ1 and urokinase are all involved in capillary-vessel organization, dysregulation of these interacting agents may play a role in the initiation and/or progression of Kaposi's sarcoma, stimulating the growth of spindle cells and recruiting endothelial cells into the lesion. © 1996 Wiley-Liss, Inc.     

Linkage of AIDS and cancer registries in Italy

We report the first results of a comparison between the Italian Registry on AIDS (RAIDS) and 13 population-based cancer registries (about 8 million population in 1991) with respect to the notification of Kaposi's sarcoma and non-Hodgkin's lymphoma. Routine indicators of data quality and completeness have been found in both types of registry, consistent with the best international standards. A linkage process was carried out on about 339,000 cancer notifications and 3,134 AIDS notifications and was herein restricted to individuals under the age of 50. Out of 243 Kaposi's sarcomas at either type of registry, 90 (37%) were reported as such by both; 68% of individuals with Kaposi's sarcoma at cancer registries could be identified at the AIDS registry, including AIDS-defining illnesses other than Kaposi's sarcoma; 62% of individuals with Kaposi's sarcoma at RAIDS could be found at cancer registries. Of 2,104 non-Hodgkin's lymphomas at either type of registry, 55 were reported as such by both; 65% of individuals reported as having non-Hodgkin's lymphoma at the AIDS registry were found at cancer registries. Our present results indicate the scope for improving cancer assessment in individuals with HIV infection and AIDS and the potential of AIDS and cancer registries for such a purpose. Int. J. Cancer 75:831–834, 1998. © 1998 Wiley-Liss, Inc.     

Ablation of neoplasia by direct current.

The application of low-voltage direct electrical current (DEC) has been studied in animals and humans for the ablation of anal condylomata, oesophageal cancer and Kaposi''s sarcoma. Twenty milliamps of DEC passed through multiple 6 cm x 1 cm, flat-plate longitudinal electrodes into the squamous mucosa of the oesophagus of healthy dogs for periods ranging from 10 min to 2 h resulted in denudation and necrosis of the oesophageal mucosa at the site of application of the current. In humans, the application of DEC to two patients with benign anal condyloma acuminata, three patients with inoperable obstructing oesophageal cancer and one patient with disseminated Kaposi sarcoma resulted in striking necrosis of tumour tissue that was confirmed by macroscopic and microscopic studies. These initial findings imply promising therapeutic potential for the use of DEC as a simple, effective, safe, low-cost alternative for ablation of neoplasia.     

Efficacy and safety of Stealth liposomal doxorubicin in AIDS-related Kaposi's sarcoma. The International SL-DOX Study Group.

The utility of current chemotherapeutic regimens in the treatment of AIDS-related Kaposi''s sarcoma (AIDS-KS) is often compromised by both limited efficacy and substantial toxicity. Pegylated (Stealth) liposomal doxorubicin hydrochloride (SL-DOX) has been demonstrated specifically to deliver high concentrations of doxorubicin to Kaposi''s sarcoma (KS) lesions. This phase II study was performed to evaluate the efficacy and safety of SL-DOX in the treatment of moderate to severe AIDS-KS. Patients were treated biweekly with 10, 20, or 40 mg m-2 SL-DOX. Tumour response was assessed according to AIDS Clinical Trials Groups (ACTG) criteria before each cycle. Best response was determined for 238 patients and was achieved after a mean of 2.3 cycles (range 1-20). Fifteen patients (6.3%) had a complete response to SL-DOX, 177 (74.4%) had a partial response, 44 (18.5%) had stable disease and two (0.8%) had disease progression. SL-DOX was well tolerated: ten patients discontinued therapy because of adverse events, in four cases because of neutropenia. Grade 3 or 4 neutropenia occurred after 281 of 2023 cycles (13.9%) but involved 137 of 240 patients (57.1%) for whom data were available. SL-DOX has substantial activity in AIDS-KS. Best response is typically seen after fewer than three cycles of chemotherapy and in some cases may be prolonged. The most important adverse event is neutropenia, which occurs after a minority of cycles but which may occur in over half of all patients.     

Kaposi's sarcoma in Uganda: geographic and ethnic distribution

Over the quinquennium 1964-68 the crude annual incidence of Kaposi''s sarcoma in Uganda per million of the population was 7·9 overall, 14·6 for males and 1·1 for females. Statistical analysis indicates that the disease is most prevalent in highland areas to the west and among the indigenous Bantu tribes. There was no correlation with the distribution of squamous cell carcinoma of the lower leg, and Kaposi''s sarcoma was not seen in an Indian or European during the period under review.     

Kaposi's Sarcoma in AIDS: The Role of Radiation Therapy

Radiotherapy can provide good palliation for AIDS patients with symptomatic Kaposi's sarcoma. We have retrospectively reviewed the treatment of 13 lesions in 5 patients. All treated tumours demonstrated significant regression with moderate doses of radiation. Side effects were acceptable and treatment provided good pain relief, functional improvement, and restoration of cosmesis. Our experience confirms that radiotherapy has a meaningful role in the management of AIDS-related Kaposi's sarcoma.     

High incidence of classical Kaposi's sarcoma in Iceland and the Faroe Islands.

We have examined the incidence of non-AIDS-related Kaposi''s sarcoma in Iceland (1955-79) and the Faroe Islands (1974-95). In Iceland, 19 cases, nine in men and ten in women, were identified, and in the Faroe Islands four cases in men and three cases in women were found. This corresponded to surprisingly high incidence rates. In men, world standardized rates (per 100000 person-years) were 0.4 and 0.6 in Iceland and the Faroe Islands, respectively, and for women, the figures were 0.3 (Iceland) and 0.5 (the Faroe Islands). These are among the highest rates ever reported. No explanation for the high rates of Kaposi''s sarcoma in these two North Atlantic communities could be identified.     

Superficial cancer in the Sudan. A study of 1225 primary malignant superficial tumours

Superficial cancer in the Sudan accounted for 17·2% of all malignant tumours examined histologically during the period 1962-72 inclusive. Of the 4 pathological types studied, squamous cell carcinoma was the commonest (63·3% of all superficial cancers) followed by malignant melanoma (18·8%) and basal cell carcinoma (14·9%) whilst Kaposi''s sarcoma formed only 3% of the total. Generally, twice as many cases occurred in males as in females, with the exception of Kaposi''s sarcoma where all the patients were males. Although a relatively high proportion of cases occurred in the young age groups, the age-specific incidence was noted to increase with age. Similarities and differences in the anatomical site of tumours compared with European and African series were noted. Certain differences emerged in the geographical distribution of these tumours in the Northern and Southern regions of the Sudan—regions which differ both ethnologically and geographically—thus suggesting possible roles played by racial and environmental factors in this respect.     

Squamous Cell Carcinomas of the Tongue and Oral Cavity as Secondary Malignancies: What Factors Are Implicated?

The pegylated liposomal doxorubicin (PLD) was introduced clinically in the 1990s and won FDA approvals for the treatment of Kaposi''s sarcoma (1995) and ovarian cancer (2000). At present, it seems prudent to engage patients in a discussion of risks (of a secondary cancer) versus benefits.     

The geographical distribution of Kaposi's sarcoma and of lymphomas in Africa before the AIDS epidemic.

Estimated incidence rates are presented for three human immunodeficiency virus (HIV)-associated cancers [Kaposi''s sarcoma (KS), Burkitt''s lymphoma (BL) and other non-Hodgkin''s lymphomas (NHLs)] from across the African continent, based on data collected before the HIV epidemic. Mapping of the rates and comparisons with a range of geographical variables indicate completely different distributions for KS and BL but a degree of similarity in the occurrence of Burkitt''s lymphoma and other NHLs. Comparisons with rates elsewhere in the world suggest, most notably, that KS was as common in some regions of sub-Saharan Africa as was cancer of the colon in much of Western Europe. Comparison with data from the era of AIDS indicates 20-fold increases in the occurrence of Kaposi''s sarcoma in Uganda and Zimbabwe. The highest rates for BL were three to four times the rates for leukaemia at young ages in Western populations, but the general incidence of other NHL was no higher than in the West and very low rates were indicated for much of southern Africa.     

Survival of classic Kaposi's sarcoma and risk of second cancer.

In order to elucidate survival rates and risk of second primary cancer, we assessed 204 patients with histologically confirmed classic Kaposi''s sarcoma (KS) who were identified in 11 Italian population-based cancer registries. One hundred and thirty-nine were men (median age 70 years) and 65 were women (median age 72). One, 5 and 10 year survival rates were 0.92, 0.69 and 0.46 respectively. Median survival was 9.4 years (i.e. not different from the Italian general population of the same sex and age). Survival did not vary according to sex and tumour site (i.e. lower limbs only or other). Eleven second primary cancers, including two lung and two kidney cancers, were reported after KS diagnosis (not different from the expected number).     

Attempts to detect virus-specific DNA in human tumors. II. Nucleic acid hybridizations with complementary RNA of human herpes group viruses

DNA derived from various human malignant and non-malignant tissues was hybridized with radioactive complementary RNA (cRNA) synthetized in vitro with the aid of E.coli-RNA-polymerase by using DNA of human herpes group viruses as templates. Epstein-Barr virus (EBV)-specific cRNA annealed significantly with DNA from nasopharyngeal carcinoma biopsies as well as with DNA preparations from leukocytes, bone marrow, lymph node and spleen of some patients with infectious mononucleosis. No significant hybridization was observed with either herpes simplex type 2 or type 1 cRNA and DNA from ten cervical carcinoma biopsies. cRNA of human cytomegalovirus and varicellazoster virus did not hybridize with DNA from Kaposi's sarcoma or DNA from heavily infiltrated spleens of patients with Hodgkin's disease. These data do not exclude a role of these herpes viruses in the etiology of cervical carcinoma, Kaposi's sarcoma and Hodgkin's disease. They show, however, that such a relationship (if it exists) must differ quantitatively to a considerable extent from the one observed with EBV in EBV-associated tumors.     

Kaposi's sarcoma and its relationship to cytomegalovirus (CMV) III. CMV DNA and CMV early antigens in Kaposi's sarcoma

DNA-DNA reassociation kinetics, anti-complement immunofluorescence (ACIF) and ACIF-blocking tests were used to search for cytomegalovirus (CMV) gene products in Kaposi's sarcoma (KS) biopsies and early cell cultures deriving from them. Three of eight tumor biopsies were positive for CMV DNA; two of them at 0.35 genome/cell and one at one copy of 25% genome/cell. CMV-related antigens, mainly localized in the nucleus, were found in cryostat sections of seven of 31 tumor biopsies and four of 12 KS cell lines at early passage level. It appears that the antigen is present in a high number of tumor cells, like the Epstein-Barr virus nuclear antigen (EBNA) in EBV-transformed cells. Inevitably, the increasing data concerning the oncogenic potential of CMV lead on to consideration of the increasing evidence of its association with Kaposi's sarcoma, a multiple hemorrhagic sarcoma with an epidemiologic distribution in Africa similar to that of Burkitt's lymphoma.