Kaposi's sarcoma on the foot

NewsBot · Dec 11, 2014

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Evaluation of treatment plans using various treatment techniques for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of feet.
Park JM1, Kim IH, Ye SJ, Kim K.
J Appl Clin Med Phys. 2014 Nov 8;15(6):4970. doi: 10.1120/jacmp.v15i6.4970.

The purpose of this study was to investigate the plan qualities of various treatment modalities for the radiotherapy of cutaneous Kaposi's sarcoma developed on the skin of the foot. A total of six virtual targets were generated on the skin of the foot in CT images. Five types of treatment plans were generated using photon beams (PB), electron beams (EB), high-dose-rate (HDR) brachytherapy with a Freiburg flap applicator, intensity-modulated radiation therapy (IMRT), and volumetric- modulated arc therapy (VMAT) techniques. Plans for each of the six targets (single-target plans) and also for the combined target consisting of the six single targets combined (multitarget plans) were generated. Dose-volumetric analysis was performed for the targets and normal tissues. The averaged conformity index (CI) and homogeneity index (HI) values for each single target using PB, EB, HDR, IMRT, and VMAT techniques were 1.97, 2.39, 1.60, 4.60, and 0.80 and 1.05, 1.11, 1.52, 1.04, and 1.04, respectively. For the multitarget, the CI values were 3.99, 5.08, 1.38, 1.95, and 0.84, and the values of HI were 1.10, 1.36, 1.43, 1.06, and 1.04, respectively. The averaged mean doses to normal tissue were 2.5, 2.7, 3.6, 1.7, and 2.9 Gy for single-target plans, and 21.3, 14.6, 14.2, 14.3, and 13.0 Gy for the multitarget plans, respectively. The VMAT demonstrated dosimetric advantages and better treatment efficiency over other techniques for the radiotherapy of multifocal skin disease of the feet.
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NewsBot · Feb 21, 2015

An interesting case of ‘diabetic foot ulcer’ in an HIV-positive patient
Venkat Sivaprakasam; Catherine Chima-Okereke
Int J STD AIDS March 2015 vol. 26 no. 4 285-287

Kaposi sarcoma is a highly vascularised tumour affecting the skin, lymph nodes and viscera. Kaposi sarcoma is most common in HIV-infected homosexual or bisexual men. We present here a 70-year-old white British male patient, who was under the care of the podiatric team for longstanding ‘diabetic foot ulcers’. He was later referred to the Dermatology team who took a biopsy; this revealed features of Kaposi sarcoma which prompted an HIV test which was positive. This patient had previously presented to several healthcare professionals with symptoms suggestive of HIV infection. He was started on antiretroviral therapy and the HIV and human herpesvirus-8 viral loads became undetectable in the blood within weeks and he showed significant clinical improvement. This case report is a reminder to clinicians to have a high index of suspicion in patients presenting with symptoms and signs suggestive of HIV infection.
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NewsBot · Aug 10, 2018

Toe web intertrigo in Kaposi's sarcoma patients: a microbiological study in a large cohort of patients.
Nazzaro G et al
Eur J Clin Microbiol Infect Dis. 2018 Feb;37(2):301-303

Kaposi 's sarcoma (KS) is a rare multifocal angioproliferative disease associated with human herpes virus 8 (HHV-8) infection, characterized by cutaneous nodules or plaques especially on the lower limbs. Some skin modifications, such as chronic lymphedema, plantar hyperkeratosis and interdigital desquamation, may be associated with consequent impairment of the local immunosurveillance and increased risk of some bacterial or mycotic infections. With the objective of evaluating if bacterial or mycotic infections in KS patients are supported by different microorganisms compared to control patients, we performed an observational retrospective study, comparing positive cultural swabs of interdigital intertrigo of KS patients with positive cultural swabs of interdigital intertrigo of patients admitted to our dermatologic unit during the last 10 years. One hundred KS patients and 84 control patients were admitted to this study. Some of the skin swabs from interdigital spaces were positive for more than one microorganism, and therefore we found 187 microorganisms among the KS group and 182 microorganisms in the control group. The most common microrganisms among KS patients were T. mentagrophytes (16%), S. aureus (14.9%), P. aeruginosa (13.9%), S. marcescens (5,9%), while among non-KS patients were S. aureus (26,9%), C. albicans (22%), S. agalactiae (7.7%) and E. coli (9.9%). These differences are statistically significant (p < 0.01). KS patients may be more affected by toe web intertrigo due to other bacteria and dermatophytes than the general population. During clinical examination, a careful inspection is necessary for an early diagnosis of toe web intertrigo, in order to prevent serious complications, such as cellulitis and sepsis. Consequently, a cultural examination with antibiogram is required to identify the causative agent of intertrigo and guide antimicrobial therapy
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NewsBot · Nov 20, 2023

An Atypical Heel Pain
Marie-Charlotte Trojani et al
J Rheumatol. 2023 Nov 15

Kaposi sarcoma (KS) is an angioproliferative neoplasm induced by human herpesvirus 8 (HHV8) targeting the cutaneous and lymphatic systems, with possible involvement of other organs such as lower limb bones.1A 72-year-old male patient of Senegalese origin with a 10-year history of rheumatoid arthritis (RA) taking methotrexate (MTX) consulted regarding a 1-year history of chronic mechanical pain of the left heel.
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NewsBot · Jan 22, 2024

Clinicopathologic Characterization of Kaposi Sarcoma on the Foot and Ankle: Analysis of 11 Patients Seen in Our Clinics
Xingpei Hao et al
J Am Podiatr Med Assoc. 2023 Nov-Dec;113(6):21-175. doi: 10.7547/21-175.

Background: Kaposi sarcoma (KS) has multiple clinical variants, and most frequently presents on the lower extremities. Anti-human immunodeficiency virus (HIV) therapy has significantly reduced the incidence of KS. However, KS is still prevalent in both HIV-infected and HIV-uninfected patients. This case series analysis aims to reveal the clinical presentations, differential diagnosis, and treatment options of KS on the foot and ankle.

Methods: Eleven cases of KS involving the foot and ankle were retrieved from our patient database, and their clinicopathologic features were analyzed.

Results: All patients were men, aged 29 to 85 years. Two types of KS were found: classic and acquired immunodeficiency syndrome-associated epidemic. The average ages of classic and epidemic KS were 65.7 and 41.8 years, respectively. Clinically, three patients manifested multiple erythematous or deep violaceous, or blue-violaceous macules on either the dorsal or plantar surfaces of both feet. Eight patients showed exophytic, pyogenic granuloma-like nodules on the plantar surface, heels, and toes. Histologically, all KSs had uniform intervening fascicles of elongated spindle cells with slit-like vascular spaces filled with red blood cells and immunoreactivity with human herpesvirus-8. The patients were treated according to HIV infection status. Human immunodeficiency virus-infected patients were treated with anti-HIV therapy after primary surgical excision or biopsy. Human immunodeficiency virus-negative patients were treated with either surgical excision, Mohs surgery, or a combination of surgical excision and local radiotherapy according to individual patient clinical presentation.

Conclusions: Kaposi sarcoma is still prevalent in both HIV-infected and HIV-uninfected patients with a variety of clinical presentations. Biopsy, with histologic evaluation, in combination with immunohistochemistry is essential for the differential diagnosis. The patient should be treated according their clinical manifestation, staging, comorbidity, and immune function.
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