Kaposi's sarcoma
What is Kaposi's sarcoma?
Kaposi's sarcoma is a type of multiple malignant neoplasms on the skin. The disease was first described in the writings of the Hungarian dermatologist Moritz Kaposi, on whose behalf it got its name.
Due to the appearance of the neoplasms, the disease is sometimes called hemorrhagic Kaposi's sarcoma. Localization of tumors is not limited to the skin, often affecting internal organs, mucous membranes and lymph nodes.
Content:
- Reasons for the development of Kaposi's sarcoma
- Possible complications of the disease
- Common symptoms of Kaposi's sarcoma
- Typical varieties of Kaposi's sarcoma
- Diagnosis of the disease
- Kaposi's sarcoma treatment
- Forecast for Kaposi's sarcoma
- Prevention of Kaposi's sarcoma
Reasons for the development of Kaposi's sarcoma
This disease is not very common among the population, but in HIV-infected people, especially men, it manifests itself in almost half of the cases.
The reasons for the appearance of such neoplasms are not known for certain. But scientists with a high degree of probability assume that the disease can develop against the background of the human herpesvirus type 8, which itself has not yet been sufficiently studied.
Also, Kaposi's sarcoma often accompanies other malignant processes, including:
- fungal mycosis
- Hodgkin's lymphoma (lymphogranulomatosis)
- lymphosarcoma
- multiple myeloma
- leukemia
For the onset of pathology, a significant decrease in human immunity is necessary due to various reasons. In addition, some groups of people have a much higher risk of developing Kaposi's sarcoma than others. For example, the disease is more common in men than in women.
The risk group includes:
- HIV-infected persons
- elderly men of the Mediterranean race
- persons who are native to equatorial Africa
- persons with transplanted organs from donors (especially a kidney)
Medical scientists are unanimous in one thing: most often, especially in the initial stages of development, this disease is more likely a reactive process (that is, arising in response to an infectious lesion) than a true sarcoma.
Possible complications of the disease
The occurrence of complications of Kaposi's sarcoma depends on the stage of development of the disease and the location of the tumors. The following complications may appear:
- limitation of limb motor activity and their deformation
- bleeding from decaying tumors
- intoxication of the body caused by the disintegration of neoplasms
- lymphatic edema, elephantiasis due to compression of the lymph nodes
- bacterial infection of damaged tumors
- malfunction of internal organs when neoplasms are localized on them
Some complications lead to life-threatening conditions.
Common symptoms of Kaposi's sarcoma
The development of Kaposi's sarcoma can be suspected when the first neoplasms appear on the skin. Usually they are characterized by:
- The color is often bright burgundy, but it is possible from red to blue-violet (by this sign it looks like a bruise), the color does not change when pressed. The spots have a glossy surface, sometimes slightly peeling.
- Form - in the form of a spot, flat or slightly raised above the surface of the skin. Multiple rashes are characteristic. When the spots merge, the center of the neoplasm can sink and turn into an ulcer.
- Sensations - neoplasms practically do not manifest themselves with this sign. Itching, tingling, and swelling of surrounding tissues can appear only when merging into large foci.
- With the localization of malignant tumors on the mucous membranes, there may be signs that depend on the specific site of the lesion (diarrhea, vomiting of blood, cough with bloody sputum, pain when chewing and swallowing food). The development of tumors in the gastrointestinal tract and respiratory organs is a great danger to life.
The course of the disease is slow, but steadily progressing. If the spots are damaged, bleeding is possible, since they are mainly a network of blood vessels. The symptomatology of the disease depends on its subtype.
Typical varieties of Kaposi's sarcoma
Kaposi's sarcoma can proceed according to one of the types classified by doctors depending on the symptoms, territory of distribution and prognosis.
There are 4 typical varieties of this disease:
Classic type
Typical for European countries. Tumor spots with clear boundaries are localized on the feet, legs, hands. Rarely accompanied by itching or burning.
The disease current according to this type goes through several stages:
- spotty (characterized by the appearance of smooth spots with uneven edges up to 5 mm in diameter)
- papular (spots take the shape of a sphere, become dense to the touch, increase in size up to 1 cm, can merge, forming a flattened focus with a rough surface)
- tumor (characterized by the formation of purple nodes, which may be more or less dense, ulcerate)
Endemic type
Distributed among the inhabitants of Central Africa. It is distinguished by its occurrence in infancy (in children under 1 year of age), localization on the tissues of internal organs and lymph nodes, and the practical absence of skin lesions.
Epidemic type
Associated with HIV infection. Sufficient for the diagnosis of AIDS. It affects people of fairly young age (up to 40 years). Spots of bright red color, localization sites: nose, upper limbs, upper palate in the mouth, lesions of the mucous membranes, lymph nodes and internal organs are always present. This is the fastest and most life-threatening form of Kaposi's sarcoma.
Immunosuppressive type
Has a positive prognosis. Most often occurs after a donor kidney transplant due to the intake of specific medications - immunosuppressants. With the abolition of drugs, the disease regresses.
In addition, the disease can occur in acute, subacute and chronic forms. In the acute course, there is rapid progress and frequent adverse outcomes. The course of the subacute form depends on the effectiveness of the therapeutic effect. The most favorable prognosis is observed in chronic forms of the disease, when the patient can do without therapeutic measures for more than 10 years.
The type of Kaposi's sarcoma is determined as a result of diagnostic measures.
Diagnosis of the disease
Often, an accurate diagnosis of Kaposi's sarcoma can be established without various studies, this disease has such vivid clinical manifestations. A careful examination by a specialist of the skin, mucous membranes of the oral cavity and genitals is enough. In addition, as a result of a biopsy, bleeding may open, since the tumor consists of overgrown vessels.
But if a specialist has doubts and for the differentiation of this disease, diagnostic measures are prescribed:
- Using the method of laboratory tests (PCR), it is possible to detect the presence in the body of the herpes simplex virus type 8 and antibodies to it. This method will not reliably indicate the presence of Kaposi's sarcoma or the possibility of its development, but when confirming the diagnosis, it will help to more accurately prescribe medication measures.
- It is mandatory for patients to be tested for HIV infection.
- Histological examination will help differentiate this disease from fibrosarcoma, showing, among other things, the presence of a hemorrhagic component.
- If there is a suspicion of localization of neoplasms in the respiratory tract, the gastrointestinal tract (which the patient's complaints may indicate), a study of these systems is prescribed by suitable methods (bronchoscopy or radiography of the lungs, gastroscopy and colonoscopy - for examining the digestive system).
- Perhaps the appointment of an immunogram with the determination of the status of cellular immunity, since the disease occurs against the background of its significant decrease.
- Additional measures may be required in the form of ultrasound examination of the abdominal cavity, computed tomography of the kidneys, MRI of the adrenal glands, and bone scintigraphy. Thus, the doctor can get the most complete picture of the lesions of the internal organs.
Sometimes the doctor may need to differentiate Kaposi's sarcoma from diseases similar in manifestations: lichen planus, fungal mycosis, sarcoidosis, hemosiderosis, microvenular hemangioma, melanoma, etc.
Diagnostic results are used in the selection of therapeutic measures.
Kaposi's sarcoma treatment
Specific treatment for Kaposi's sarcoma is often not carried out. Acting directly on the tumor rarely yields positive results. Basically, therapeutic measures are aimed at the disease that accompanies the sarcoma, and at relieving symptoms and alleviating the patient's general well-being.
The tumor is directly affected in the following cases:
- very large tumor
- if the patient is in pain, severe burning
- if the tumor threatens the patient's life, located on the mucous membranes of the respiratory tract or gastrointestinal tract
- the swelling is a serious cosmetic defect
In these cases, the effect on the tumor can be of two types:
- Local exposure - the use of radiation therapy, cryotherapy, local application of drugs (Panretin, Prospidin, Dinitrochlorobenzene), the introduction of drugs directly into the tumor. If the tumor is single, then a surgical operation is performed - its excision. About 40% of such operations have consequences as long-term remission, so the method can be called quite effective.
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Systemic impact, which, in turn, is conducted in several directions:
- chemotherapy - has side effects, sometimes requires a combination with hormonal therapy, it is necessary to conduct up to 4 courses per year
- antiretroviral therapy - helps to increase the immune status while suppressing viral activity, a fairly long-term effect (at least a year), but sometimes gives good results
- interferon therapy - also carried out for long courses, has an immunomodulatory effect
Local therapy is performed on an outpatient basis, mostly without causing side effects. It is indicated for not very large and single tumors. The main danger of treatment is the opening of bleeding from the tumor or the formation of ulcers on it, which can lead to infection, since the immune status is very low. In addition, a damaged tumor provokes the appearance of new foci.
Systemic exposure is more often used if the patient does not experience severe symptoms and does not have significant immunodeficiency. But in cases where the tumor is life-threatening or causes physical suffering, this treatment option is also used.
All the methods of treatment used for Kaposi's sarcoma give only hope for recovery, but not a guarantee. Even a decrease in tumor size, its blanching or the absence of new formations is considered as a positive result of treatment.
Forecast for Kaposi's sarcoma
The prognosis of this disease depends on its form, characteristics of the course and the state of the patient's immunity. With a sufficiently high immune status, tumor-like formations can be reversible, therapeutic measures give a positive result, allowing you to achieve long-term remission.
In other cases, the prognosis is extremely poor. More than 50% of patients die in a short time (from 2-3 months to 2 years). The faster the sarcoma progresses, the less chances of successfully combating it. Conversely, a slow flow gives more opportunities to choose an effective method of exposure.
A positive treatment for Kaposi's sarcoma does not increase the chances of recovering from AIDS. But for an AIDS patient, a complication in the form of Kaposi's sarcoma can be fatal.
This does not apply to the facts of immunosuppressive sarcoma, which have a benign course and, in most cases, a favorable outcome.
Prevention of Kaposi's sarcoma
Preventive measures mainly boil down to the prevention of type 8 herpes, immunodeficiency conditions and diseases that may be accompanied by Kaposi's sarcoma.
The main thing in the prevention of this disease is a strong immune status. This also applies to cases when a disease has already arisen, which may be accompanied by the appearance of Kaposi's sarcoma. Thus, in HIV-infected patients, therapy with antiretroviral drugs gives good results, allowing you to maintain the immune system in an active form and prevent the manifestations of Kaposi's sarcoma.
For patients whose disease is in remission, regular monitoring is required in the form of examination of the mucous membranes and skin (1 time in 3 months), studies of the respiratory tract and the gastrointestinal tract (at least 1 time in six months). This will make it possible to notice a relapse of the disease in time.
Kaposi's sarcoma is in many cases a life-threatening disease. Strong immunity is a natural and reliable protector of the body against many diseases. Therefore, it is necessary to take care of maintaining the body's defenses, and they, in turn, are able to save you from many problems.
The author of the article: Bykov Evgeny Pavlovich | Oncologist, surgeon
Education: graduated from residency at the Russian Scientific Oncological Center. N. N. Blokhin "and received a diploma in the specialty" Oncologist"
