R4. Aspecte clinice si terapeutice la un caz de sarcom Kaposi HIV-negativ
Sarcomul Kaposi este o afectiune maligna proliferativa angiofibrioblastica multifocala cu atingere predominent cutanata, caracterizata clinic prin placi infiltrative si noduli rosii-violacei si histopatologic prin proliferari mixte conjunctive si vasculare.
Autorii prezinta aspectele evolutive clinice postterapeutice la u pacient in varsta de 68 de ani cu sarcom Kaposi - forma clasica, HIV-negativ (leziuni simetrice nodulare si sub forma de placi infiltrative la nivelul picioarelor si gambelor, limfedem moderat al membrului inferior stang), diagnostic confirmat histopatologic.
In urma instituirii chimioterapiei (Ciclofosfamida + Vinblastin +Prednison) si a radioterapiei locale X cu raze moi, se produce o explozie a leziunilor cutanate la nivelul trunchiului si fetei si o ulcerare a unui nodul maleolar intern stang. Leziunile raspund favorabil la tratamentul imunostimulator cu Intron A.
Subliniem ineficienta chimioterapiei clasice si a radioterapiei in cazul prezentat, precum si evolutia favorabila la imunoterapie, in ciuda faptului ca pacientul este HIV-negativ (date din literatura recomanda tratamentul cu interferon mai ales in cazurile asociate cu SIDA).
R4. Clinical and Therapeutical Aspects in a Case of HIV-Negative Kaposi Sarcoma
Kaposi sarcoma is an angiofibroblastic multicentric malignant tumor, with prevalent cutaneous involvement. The lesions may present as violaceous or brown-red macules, infiltrative plaques and nodules; the microscopic findings include vascular and spindle cells proliferations.
The authors report the clinical behaviour of a clasic Kaposi sarcoma in a 68 years old patient, after treatment. At the first examination, the patient presented symmetrical nodules and infiltrative plaques on the left leg and was negative for human immunodeficiency virus (HIV).
After chimiotherapy (cyclophosphamide + vinblastine + prednisone) and local radiotherapy with soft X rays, the cutaneous lesions "exploded" on the trunk and face, and the ulceration of an internal left maleolar nodule occurred. The evolution was favorable after immunostimulating therapy with Intron A.
We emphasize the inefficiency of clasical chimiotherapy and radiotherapy in the index case and the favorable course after immunotherapy, in spite of the fact that the patient was HIV-negative. Data in the literature recommend the therapy with interferon especially in AIDS associated Kaposi sarcoma.