S. Fossati

Human herpesvirus 8 DNA in the skin and blood of patients with Mediterranean Kaposi's sarcoma: clinical correlations

Background: Kaposi’s sarcoma is a multifocal lympho-angioproliferative disease that appears in elderly subjects of Mediterranean origin (classical form), young Africans and immunodepressed patients (as a result of organ transplantation or AIDS). In 1994, DNA sequences of a new human herpesvirus, called HHV-8, were detected in skin lesions and peripheral blood of patients with AIDS-related Kaposi’s sarcoma by confirmational display analysis and polymerase chain reaction. Objective: As HHV-8 in peripheral blood mononuclear cells is detected in about 50% of Mediterranean Kaposi’s sarcoma patients and its presence fluctuates in time in the same patient, maybe its detection correlates with the clinical behaviour of the disease. Methods: By using routine and nested polymerase chain reaction we evaluated the presence of HHV-8-specific DNA sequences in the skin lesions, perilesional healthy skin and peripheral blood mononuclear cells of a group of 40 HIV-negative patients with Mediterranean Kaposi’s sarcoma. Results: HHV-8 DNA sequences have been found in 40/40 (100%) lesional skin of Mediterranean Kaposi’s sarcoma, in 35/40 (85%) perilesional apparently normal skin and in 24/40 (60%) peripheral blood monuclear cell samples. The results of polymerase chain reaction on peripheral blood monuclear cells were positive in 41% of the patients with slowly evolving disease as opposed to 74% of those with rapidly evolving disease, and in 47.6% of the patients with stage I–II disease as opposed to 73.6% of those with stage III–IV. Conclusion: The detection of HHV-8 in peripheral blood monuclear cells seems to correlate with the more aggressive stages and the rapid evolution behaviour of Mediterranean Kaposi’s sarcoma.

Human immunodeficiency virus negative Kaposi sarcoma and lymphoproliferative disorders

The concomitant occurrence of more than one primary neoplasm in the same individual has led researchers to seek possible common etiopathogenetic factors. Kaposi sarcoma (KS) is a multicentric neoplasm of vascular origin and perhaps viral etiology. Four forms of KS are known: classic or Mediterranean, endemic or African, posttransplant, and epidemic or acquired immunodeficiency syndrome‐associated KS. In its classic form KS mainly affects elderly people and often has a long and indolent course that occasionally allows other malignancies to appear. Previous studies of the possible association between human immunodeficiency virus (HIV) negative KS and lymphoproliferative disorders (LDs) have produced discordant results.

Oral etoposide for Kaposi's Mediterranean sarcoma.

22 patients affected by locally aggressive or generalized form of Kaposis Mediterranean sarcoma were treated with oral etoposide (VP16) as single-drug therapeutic regimen. Of the 17 evaluable patients, 10 were pretreated with other chemotherapeutic regimens. VP16 was administered at the dose of 100 mg daily for 3-5 days every 3 weeks for 3 times during induction, then every 4 weeks for 10-12 times during maintenance. Hematological (35.2%) and gastrointestinal (64.7%) toxicities were always mild and swiftly reversible. Good percentages of objective responses were achieved in both nonpretreated (85.6%) and pretreated (70%) patients. The chemotherapeutic regimen employed, the way of drug administration, the results as well as the comparison to another study with vinblastine are discussed.

Allergic reactions to topical desoxymethasone and oral triamcinolone.

Associated immediate and delayed contact allergy has been reported to nickel, cinnamon, para-aminophenylarnine, epoxy resin, penicillin and protein, to caterpillar bite, and to fish and chicken meat, but not previously to mercuric chloride (2, 3, 6, 7). In the histological examinations previously reported (4, 5), eczematous changes (subcorneal vesicle, spongiosis, lymphocytic infiltration) were seen as early as 30 min. Skin reactions on the symptom-free skin of our patient showed a more observable continuity from urticaria to eczema, with vasculitis seen in clinicallyeczematous skin after 48 h, suggesting that mixed sensitivity involves IgG as well as IgE antibodies (8, 9), perhaps together with a cytolytic effect (3). The histological signs of immediate urticarial reactions are followed by histological characteristics of delayed hypersensitivity reactions, mixed with vascular involvement. SHORT COMMUNICATIONS

Vinorelbine therapy for Kaposi's sarcoma in a kidney transplant patient

We report the case of a patient with Kaposis sarcoma after kidney transplantation. Despite the discontinuation of azathioprine and a reduction in the cyclosporin dosage, the disease continued to evolve, and antineoplastic treatment became necessary. After 14 cycles of vinorelbine chemotherapy, there was a 75% regression of the initial lesions, despite the continuation of cyclosporin A.

PERSISTENTLY RECURRING MEDITERRANEAN KAPOSI'S SARCOMA ON SKIN GRAFTS

In May of 1985, we first saw a 79-year-old woman with Mediterranean Kaposis sarcoma (KS). It had first appeared in 1983 on the left leg and thigh. In March 1984, the lesions were treated with high-velocity electrons (9MeV) to four contiguous fields (25 x 30 cm, 25 x 30 cm, 12 x 14 cm, and 11x14 cm), a total dose of 60 Gy per field, to the left extremity (3rd distal pretibial region, dorsal foot and region of the Achilles tendon). When we first saw the patient, she had a chronic radiodermatitis on the lower third of the left leg, with an extensive and deep ulcer (10 x 15 cm), exposing the tendon insertion of the anterior tibial muscle (Fig. 1). Karposis sarcoma which had previously regressed after radiotherapy, had also recurred in the form of nodules on the pretibial region along the edge of the ulcer and on the left plantar region. The nodules were treated with intralesional infiltration of vincristine (VCR) according to our usual schedule^^ and complete remission (CR) of all lesions was obtained within 3 months. After the KS nodules disappeared, a successful total-thickness graft for the ulcer was performed. In April 1987, some biopsy-proven nodules of KS (Fig. 2) appeared on the site of the graft; they regressed within 2 months after local infiltration of VCR. After about 18 months, there were ulcerating flourishing lesions of KS that had developed at the same site (Fig. 3). At this time the lesions were resistant to intralesional treatment, but sensitive to vinblastine (VLB), 9 mg iv, every 4 weeks, with complete remission in March, 1990. In January 1990, a second radiodermatitis ulcer appeared (Fig. 4), confined to the upper margin of the first graft; this required another graft in which a new Kaposis nodule arose 3 months later (Fig. 5); the nodules regressed after intralesional treatment with VCR. In December 1990, a third ulcer appeared in the region of the left Achilles heel; it was covered with a skin graft that did not survive. In September 1991, the patient was given another graft at the same site with partially favorable results. Three months after the procedure, there was again a KS recurrence in the graft site; this is at present in CR after intralesional treatment with VCR.