Carmo Joana, Marques Susana Chaves, Bispo Miguel, Pinto Daniel, Chagas Cristina
Department of Gastroenterology, Hospital de Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
Department of Pathology, Hospital de Egas Moniz - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
GE Port J Gastroenterol. 2017 Sep;24(5):219-226. doi: 10.1159/000461592. Epub 2017 Apr 11.
Kaposi sarcoma (KS) is an angioproliferative tumor caused by human herpesvirus 8 (HHV-8). Gastrointestinal (GI) involvement by KS is a rare endoscopic finding, scarcely characterized in the literature.
To characterize clinical and endoscopic features of patients with GI KS.
This is a single-center retrospective study of GI KS cases confirmed by immunohistochemistry in the last decade (2006-2015). The following variables were analyzed: demographic data; clinical data (extraintestinal involvement, symptoms, presence and stage of HIV infection, immunosuppressive therapy); endoscopic data; stage-stratified therapeutic approach; and mortality (at 3 and 6 months).
Thirteen patients with GI KS were identified: 77% were men, the mean age was 55 years, and 62% of them were Native Africans. In most cases ( = 10, 77%), KS was associated with HIV. A total of 90% of the HIV patients had a CD4+ count of <200/μL (C3, CDC classification), and 80% of them had KS as the initial manifestation of HIV infection. Thirty percent of the cases had other AIDS-defining illnesses, and only 20% received antiretroviral therapy. In the remaining 3 patients (23%), KS was associated with immunosuppressive therapy. Most patients (85%) had cutaneous lesions and 15% lung involvement. In most cases (85%), the lesions were diagnosed in the upper digestive tract in asymptomatic patients (7 stomach; 2 stomach and duodenum; 2 esophagus). Colonic involvement occurred in 2 patients presenting with hematochezia. Nearly half of the patients had more than 3 endoscopic lesions and the most frequent morphologic type was polypoid/nodular (62%). Treatment was based on antiretroviral therapy or reduction of immunosuppression and in 39% of the patients on administration of doxorubicin. Survival at 3 and 6 months was 46 and 39%, respectively.
GI KS is mostly found in nontreated, stage 3, HIV patients, and particularly in men from areas where HHV-8 is endemic. Involvement of the upper digestive tract is often asymptomatic. The endoscopic appearance is variable and these patients have a poor prognosis.
卡波西肉瘤（KS）是一种由人疱疹病毒8型（HHV-8）引起的血管增殖性肿瘤。KS累及胃肠道（GI）是一种罕见的内镜检查发现，在文献中鲜有描述。
描述胃肠道KS患者的临床和内镜特征。
这是一项单中心回顾性研究，研究对象为过去十年（2006 - 2015年）经免疫组化确诊的胃肠道KS病例。分析了以下变量：人口统计学数据；临床数据（肠道外受累情况、症状、HIV感染的存在及分期、免疫抑制治疗）；内镜数据；按分期分层的治疗方法；以及死亡率（3个月和6个月时）。
共确定了13例胃肠道KS患者：77%为男性，平均年龄55岁，其中62%为非洲原住民。在大多数病例（n = 10，77%）中，KS与HIV相关。90%的HIV患者CD4 + 细胞计数<200/μL（C3，疾病控制中心分类），其中80%以KS作为HIV感染的初始表现。30%的病例有其他艾滋病界定疾病，只有20%接受了抗逆转录病毒治疗。其余3例患者（23%）中，KS与免疫抑制治疗相关。大多数患者（85%）有皮肤病变，15%有肺部受累。在大多数病例（85%）中，病变在无症状患者的上消化道被诊断出（7例在胃；2例在胃和十二指肠；2例在食管）。2例出现便血的患者有结肠受累。近一半的患者有超过3个内镜下病变，最常见的形态学类型是息肉样/结节样（62%）。治疗基于抗逆转录病毒治疗或减少免疫抑制，39%的患者使用了阿霉素。3个月和6个月时的生存率分别为46%和39%。
胃肠道KS多见于未经治疗的3期HIV患者，尤其是来自HHV-8流行地区的男性。上消化道受累通常无症状。内镜表现多样，这些患者预后较差。
