Kaposi's sarcoma of an intraparotid lymph node leading to a diagnosis of HIV

OBJECTIVE: Kaposi's sarcoma is a common malignancy in patients infected with HIV but is rarely seen in the major salivary glands. If a patient is known to be HIV-positive, however, Kaposi's sarcoma must be considered in the differential diagnosis of salivary gland masses in addition to the benign and malignant neoplasms that occur in immunocompetent patients. We present a unique case in which an otherwise healthy patient was diagnosed with HIV after resection of his enlarged parotid gland revealed Kaposi's sarcoma. STUDY DESIGN: Case report. METHODS: A 58-year-old man presented with slowly enlarging bilateral parotid masses of approximately 3 years' duration. The patient's presentation, workup, and final diagnosis of Kaposi's sarcoma are discussed. RESULTS: A magnetic resonance imaging scan of the neck showed two right parotid lesions and one left parotid mass. The patient underwent a right superficial parotidectomy for a suspected diagnosis of Warthin's tumor, given the bilaterality of the lesions. Histologic evaluation of the surgical specimen revealed spindle-shaped cells with extravasated erythrocytes typical of Kaposi's sarcoma. After discussion of the results with the patient, HIV risk factors were elucidated, and subsequent testing revealed the patient to be HIV-positive. CONCLUSIONS: Although Kaposi's sarcoma is common in AIDS patients, there are few case reports of this malignancy arising in the salivary glands. Previously reported cases include salivary gland Kaposi's sarcoma in known HIV-positive patients and a handful of reports in patients without confirmed immunocompromise. The patient presented here is unique because the diagnosis of parotid gland Kaposi's sarcoma led to a new diagnosis of HIV. This interesting case reiterates the need for complete history taking and the inclusion of Kaposi's sarcoma in the differential diagnosis of salivary gland masses in the appropriate patient population.     

Kaposi's sarcoma of the head and neck in patients with AIDS

Over a 40 month period, 219 patients with AIDS were seen at St. Mary's Hospital, London. Kaposi's sarcoma, one of the criteria for diagnosing the syndrome, was the presenting feature in 62 patients. Eighty four patients developed Kaposi's sarcoma at some stage of their disease and the head and neck region was involved in 56 of them. Although Kaposi's sarcoma is rarely life threatening in AIDS, potential airway obstruction, pain or cosmetic disfigurement may justify treating the lesion. Whilst cutaneous tumours may be managed by using radiotherapy (16 Gray in four fractions over four days), this treatment produces a sever mucositis when used to treat mucosal disease; we, therefore use a combination of vincristine and bleomycin for this.     

Kaposi's sarcoma of the intra-parotid lymph nodes in AIDS

Kaposi's sarcoma is the most frequent malignancy associated with AIDS. The occurrence of Kaposi's sarcoma in the parotid region is extremely rare. In this publication we present a case of a 47-year-old male patient who developed a swelling of the left parotid tail that proved to be Kaposi's sarcoma of an intra parotid lymph node. A discussion of the etiological factors, clinical staging and management of KS, as well as the differential diagnosis of the parotid enlargement in AIDS patients, is presented.     

AIDS-related Kaposi's sarcoma of the sphenoid sinus.

The head and neck region is frequently involved by AIDS-related Kaposi's sarcoma, the oral cavity being the most common site of occurrence. We report on the first case of AIDS-related Kaposi's sarcoma involving the sphenoid sinus where radionuclide bone scanning and MRI were effective in suggesting the diagnosis.     

Erythrophagocytosis in Kaposi's sarcoma in acquired immune deficiency syndrome

The ultrastructural morphology of Kaposi's sarcoma of the oral mucosa in patients with acquired immune deficiency syndrome (AIDS) was examined electron-microscopically. Neoplastic spindle cells and vascular endothelial tumor cells are frequently involved in the phagocytosis of extravasated erythrocytes. Pericytes, fibroblasts, macrophages and other phagocytic cells of the tumor stroma also participate in this process. Erythrocytes are also phagocytized by some of the keratinocytes belonging to the intact surface epithelium covering the Kaposi's sarcoma lesion. Both the phenomenon of erythrophagocytosis and the presence of tubuloreticular structures in the cytoplasm of Kaposi's sarcoma cells in patients with AIDS seem to be prominent ultrastructural markers and thus of diagnostic value.     

艾滋病的耳鼻咽喉表现

目的总结艾滋病患者在耳鼻咽喉的临床表现.方法10例艾滋病的临床资料回顾性分析.结果10例艾滋病患者,有卡波氏肉瘤8例,颈部肿块8例,皮肤、口腔咽喉黏膜溃疡4例,上呼吸道梗阻行气管切开术2例,单侧慢性化脓性中耳炎者1例.结论艾滋病患者以咽喉、口腔部卡波氏肉瘤及黏膜溃疡出现最早,应引起高度警惕及重视.     

Parotid mass as an early sign of Kaposi's sarcoma associated with human herpesvirus 8 infection

Kaposi's sarcoma of an intraparotid lymph node is extremely rare in non-immunocompromised human immuno-1 deficiency virus (HIV)-negative patients. We report a case of a left parotid mass as an early sign of Kaposi's sarcoma-associated human herpesvirus 8 (HHV-8) infection in a 57-year-old patient. After subtotal parotidectomy and histopathological diagnosis of lymph node localization of Kaposi's sarcoma, an accurate dermatological investigation revealed a solitary small lesion in the left foot. Chemotherapy with five cycles of vincristine gave a temporary response of the cutaneous lesion. Seven months later, a few small, firm, purplish-red lesions appeared in different areas of the body, but no adjuvant treatment was accepted by the patient since the lesions occasionally disappeared or remained stable in size. At four years follow-up, there has been no recurrence in the parotid region, and the patient is alive with cutaneous disease but in good general health. The problems related to the diagnosis, the management strategy of such a rare condition and the prognosis are also discussed.     

Oropharyngeal Kaposi's sarcoma. Report of two cases and review of the literature

Two cases of Kaposi's sarcoma involving the oropharynx are described. The pathology of the condition is reviewed and the problems of treatment outlined.     

Nasopharyngeal cyst simulating Kaposi's sarcoma in an HIV-infected patient

A case of nasopharyngeal cyst in a 30-year-old male homosexual intravenous drug user infected with the human immunodeficiency virus (HIV) is presented. The similarity in clinical presentation of nasopharyngeal cyst and Kaposi's sarcoma is discussed.     

Kaposi's sarcoma. Then and now. Nodular lesion of palate as the only manifestation of the disease in a 70 year old heterosexual woman

Kaposi's sarcoma is a transmissible disease, possibly associated with a virus, characterized by multiple pigmented lesions. Its epidemiology has dramatically changed in the last 4-5 years and has been the focus of considerable attention and controversy.     

Cystic parotid lesions in patients at risk for the acquired immunodeficiency syndrome

Twenty-three patients at risk for the acquired immunodeficiency syndrome presented with cystic lesions of the parotid gland. Fourteen patients had unilateral parotid cysts and nine had bilateral enlargement. Ten patients were positive for antibodies to the human immunodeficiency virus (HIV), three were negative for antibodies to the human immunodeficiency virus, and ten refused testing. Fine-needle aspiration cytology and computed tomography were helpful in making the diagnosis of benign lymphoepithelial cyst. Superficial parotidectomy confirmed the diagnosis. Concurrent malignancy (Kaposi's sarcoma) was diagnosed in one patient from a parotid specimen. Follow-up has ranged from four months to five years.     

Mycobacterial spindle cell pseudotumor (MSP) of the nasal septum clinically mimicking Kaposi's sarcoma: case report

Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterised by local proliferation of spindle--shaped histiocytes containing acid--fast atypical mycobacteria, clinically resembling Kaposi's sarcoma. Most cases of MSP reported so far affected immunodeficient patients or patients receiving immunosuppressive medication. We report a case of MSP affecting the nasal septum of a 76-year-old man, a location that has not been published so far concerning the manifestation of MSP. In conclusion, our case report points toward MSP as a very rare pseudomalignant lesion that should be included into deliberations concerning the differential diagnosis of circumscribed expansile nodular proliferations of the nasal septum clinically mimicking Kaposis's sarcoma or other mesenchymal neoplasms.     

Auditory brain stem responses in patients with human immunotropic virus infection of different stages.

Thirty patients (26 men, 4 women) with human immunotropic virus infection of different stages were examined. Eleven patients had a history of i.v. drug abuse, nine patients had a history of treated lues infection, and one patient suffered from Kaposi's sarcoma. At the time of the examination, opportunistic infections or acute encephalitis were not apparent in any patient. All patients underwent otoneurological examinations, including pure-tone audiometry, caloric vestibular testing, and recording of the auditory brain stem responses (ABR). Six patients reported onset of hearing impairment during the last 3 yr. Two of them had flat sensorineural hearing loss; in the other cases, pure-tone audiometry showed high tone hearing loss with negative recruitment. ABRs were normal in 19 cases, with the latencies for waves III and V and for the I-V interpeak latency significantly delayed when compared to the values of the control group. The frequency of abnormal ABR findings did not correlate to the stage of the disease. The results of the study indicate that auditory and, more specifically, ABR abnormalities commonly occur in human immunotropic virus disease. More studies are necessary to prove whether the ABR is suitable to monitor therapeutic effects.     

Classification of angiodysplasias and vascular tumors

Numerous vascular dysplasiae belong to the group of genodysplasiae. Most arteriovenous dysplasiae (cirsoid, racemosum aneurysms,...) are the substratum of various regional "angiomatosis". Stenotic or ectatic arterial dysplasiae can be associated with genodysplasiae. In addition, lymphatic dysplasiae (congenital elephantiasis, etc...) also exist. Among benign tumours, angiomas are sometimes hardly distinguishable from dysplasiae. Some tumors with intermediate malignancy have an uncertain prognosis: chemodectoma, hemangiopericytoma. As for malignant vascular tumours, they fall into 3 varieties: angiosarcoma, Kaposi's sarcoma and sarcoma of vascular walls.     

Paranasal sinus Burkitt's lymphoma in a human immunodeficiency virus (HIV) positive male

Patients infected with the HIV virus have been reported to develop several malignant neoplasms, the most frequent of which is Kaposi's sarcoma. Although an increasing number of lymphomas, primarily non-Hodgkin's lymphomas, have been described who are HIV seropositive, few cases of Burkitt's lymphoma have been reported in patients. We report a case of an HIV-seropositive man who had paranasal sinus Burkitt's lymphoma underlying chronic maxillary sinusitis. Successful remission was achieved with chemotherapy.     

Scared atrophy of the cervical part of trachea as an effect of prolongated intubation

Tracheal intubation is presently one of the basic medical procedures. It is connected with many different complications. One of them is tracheal stenosis, which occurs in 6-21 percent of patients after intubation of the trachea. In contrast to this high frequency of tracheal stenosis we didn't find any publications about complete atrophy of a big part of trachea after prolongated intubation and we describe a first case of such complication. The reasons and the possibilities of treatment in such situation are discussed.     

Oral manifestations of human immunodeficiency virus infection

It is important that both physicians and dentists recognize the earliest signs of HIV infection in order that a timely diagnosis and patient referral can be made for counseling and treatment. Candidiasis, hairy leukoplakia, and Kaposi's sarcoma are the most common oral manifestations, but there are other important lesions as well. They include severe necrotizing periodontitis, bacterial and viral infections, lymphomas, and carcinomas. The various oral lesions seen in patients with the acquired immunodeficiency syndrome are reviewed and managements are discussed.     

Upper airway obstruction due to tonsillar lymphadenopathy in human immunodeficiency virus infection

Head and neck manifestations of human immunodeficiency virus (HIV) infection are common and include diffuse cervical lymphadenopathy, cutaneous and mucosal Kaposi's sarcoma, mucosal herpes simplex infection, upper aerodigestivetractcandidiasis, and parotidlymphadenopathy and cysts. Recurrent otitis media and chronic sinusitis have been noted in the pediatric HIV population. We describe a patient with HIV-associated tonsillar and adenoid lymphadenopathy and upper airway obstruction. Pathologic analysis of the tonsillar tissue revealed severe lymphofollicular hyperplasia similar to that of other lymphoid tissue in HIV infection. The importance of symptomatic treatment of the airway obstruction is stressed.     

The recognition and management of the otolaryngological manifestations of AIDS

Between October 1984 and December 1987, 219 patients who fulfilled the criteria for Acquired Immune Deficiency Syndrome (AIDS), as set out by the Centers for Disease Control, Georgia, were seen at St. Mary's Hospital, London. The most common otolaryngological manifestations of the disease in these patients were oral candidiasis (60%), oesophageal candidiasis (16%), persistent generalized lymphadenopathy (27%) and Kaposi's sarcoma (26%). Our management of the patients is described.     

Maxillofacial manifestations of acquired immunodeficiency syndrome

46 cases of acquired immunodeficiency syndrome permit the authors to detail the particular aspects of the oral and facial lesions in AIDS. In patients at risk, a lymphadenopathic syndrome is thought to represent a prodromic phase of the illness. The authors insist upon the differences between the classic Kaposi's sarcoma and that associated with the AIDS (mean age and initial sites of tumor). One third of these sarcomas is completed by a digestive candidiasis. The review of the literature reveals squamous cell carcinoma and Burkitt's lymphoma with the AIDS. We must be aware of early diagnosis and transmission factors in the individuals at risk with tumors and opportunistic infection.