Journal of Cancer Research and Therapeutics Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI) ISSN: 0973-1482 EISSN: 1998-4138 Vol. 7, Num. 1, 2011, pp. 92-94

Journal of Cancer Research and Therapeutics, Vol. 7, No. 1, January-March, 2011, pp. 92-94

Case Report

Classic Kaposi's sarcoma in Arabs - Widening ethnic involvement

Pramod Kumar

Department of Dermatology, Saham Hospital, Sultanate of Oman

Correspondence Address: Pramod Kumar, Head of Department, Department of Dermatology, Saham Hospital, PO Box 582, Saham 319, Sultanate of Oman, kumarpramod5@rediffmail.com

Code Number: cr11021

PMID: 21546753

DOI: 10.4103/0973-1482.80456

Abstract

Keywords: Arabs, classic Kaposi′s sarcoma

Introduction

Kaposi′s sarcoma is a spindle-cell tumor thought to be derived from the endothelial cell lineage. Classic Kaposi′s sarcoma (CKS) occurs primarily in elderly men of Mediterranean and eastern European background with a male preponderance. It has been frequently reported in Jews and once in an Israeli Arab ^[1] but has never been reported in non-Israeli and non-Jews. Though CKS after an organ transplant has been reported in the Arab population, ^{[2],[3],[4],[5]} this is the first report presenting the occurrence of CKS in two Arabs, residents of Oman.

Case Reports

Case 1

A 55-year-old male presented with nodules on the left leg, left buttock, and right hand for a duration of 1 month. He was a known case of diabetes mellitus, hypertension, ischemic heart disease and bronchial asthma. The nodules were 5-6 mm in size, pink in color, and turned violaceous later [Figure - 1] and [Figure - 2]. They were painful and tender, and firm in consistency. The lesions blanched on diascopy. Mucous membranes were not involved. Systemic examination, lymph nodes, and routine blood investigations were normal. HIV, VDRL, and stool for occult blood were negative. Chest X-ray did not reveal any abnormality. Excision biopsy from the hand showed spindle cells arranged in fascicles with interspersed vascular channels filled with red blood cells [Figure - 3] and [Figure - 4]. Pleomorphism was minimal but occasional mitosis was observed. Occasional PAS-positive diastase-resistant hyaline globules were seen. Hyaline globules and spindle cells were positive for CD34. Biopsy from other lesions was suggested in view of the ominous diagnosis, which reconfirmed the diagnosis. Patient′s history was reviewed and no history of blood transfusion or organ transplantation or any immunosuppressive therapy was evident. The lesions were treated with liquid nitrogen cryotherapy. In the absence of any clinical reduction in the lesion size after several weeks, he was put on doxorubicin pulse therapy sessions under the care of the oncology unit. The lesions started regressing but 2 months later he died while still on therapy.

Case 2

A 78-year-old male presented with pink nodules on his left leg for a few months. He was a known case of hypertension. The lesions were 3-4 mm in size and tender on touch. Systemic examination did not reveal any hepato- or splenomegaly, and lymph nodes too were not enlarged. All routine investigations including that for HIV were negative. There was no history of transfusion or organ transplantation. Histopathology from a nodule showed features similar to those in case 1. The case history review revealed that he was diagnosed as a case of KS and was treated with chemotherapy 5 years ago; hence this episode was clearly a recurrence. He received doxorubicin therapy again and showed regression of lesions. At the time of writing this manuscript, the patient had developed pain in the lesions and swelling on legs. He has undergone a third cycle of chemotherapy with paclitaxil.

Discussion

CKS is a multifocal, malignant vascular tumor. Human herpes virus 8 (HHV-8) also known as Kaposi sarcoma-associated herpes virus (KSHV) is believed to be a major causative factor for all clinical variants of KS. ^[6],[7] KSHV was not done for both of our patients because of the nonavailability of this facility.

The incidence of CKS has been reported to be high in Jewish populations living in Israel in a population-based incidence study, ^[1] observed over a period of 20 years. The incidence of CKS is also high in populations of Mediterranean countries. ^[8],[9] A report of KS from Turkey ^[10] described 37 cases but did not elaborate on the ethnicity of their cases.

CKS is common in people of Jewish origin. Cases of KS have been reported from Arab countries but all of them have been either associated with organ transplants or immunosuppression. ^{[2],[3],[4],[5]} There is only one report so far documenting CKS in an Arab population living in Israel; ^[1] however, there is no report of CKS in anyone of Arab ethnic background living outside Israel.

Although CKS is said to be common in the Middle East, various studies do make a mention of this in their introduction texts without substantiating it with any reference. We searched Pubmed, Google, Bing, and Google scholar with the search terms "CKS," "Arabs," "Middle East," and "non-Jewish population." This search did not give us any significant result. Hence we presume that the incidence of CKS in the Arab population is underreported. A lone study has reported CKS in Arabs living in Israel, ^[1] where Arabs are a minority. Whereas the incidence of CKS in non-Israeli countries would give a more appropriate incidence and prevalence and whether CKS has racial or geographic influence. The documentation of CKS in Arabs is at the best minimal. This lack of documentation of cases in the Arab ethnic population in the world literature prompted us to publish this report and to contribute to the data on ethnic and geographic areas reporting CKS.

References

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