Determining the Stage of Kaposi Sarcoma Through Histopathological Analysis: Identifying The Most Effective Finding: Effective Histopathological Findings for Staging Kaposi Sarcoma

Muhammad Anique; Humera Akhlaq; Sarah Azhar; Amna Jahan; Jehangir Kazi; Qandeel Abbas Soomro

doi:10.54393/pjhs.v5i07.1864

Authors

Muhammad Anique Department of Pathology, Bhitai Dental and Medical College, Mirpurkhas, Pakistan
Humera Akhlaq Department of Oral Pathology, Sindh Institute of Oral Health Sciences, Karachi, Pakistan
Sarah Azhar Department of Pathology, Baqai Medical University, Karachi, Pakistan
Amna Jahan Department of Pathology, Institute of Medical Sciences, Lahore, Pakistan
Jehangir Kazi Department of Pathology, Sulaiman Roshan Medical College, Tando Adam, Pakistan
Qandeel Abbas Soomro Department of Pathology, Indus Medical College, Tando Muhammad Khan, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i07.1864

Keywords:

Kaposi Sarcoma, Spindle Cell Proliferation, Histopathological Analysis, Inflammatory Infiltrate

Abstract

Kaposi Sarcoma (KS) is a complex disease presenting as vascular tumors affecting the skin, mucous membranes, lymph nodes, and internal organs. It shows variable clinical presentations and forms. Objective: To identify the most effective histopathological indicators for staging Kaposi Sarcoma. Methods: This cross-sectional study was conducted at Bithai Medical and Dental Center, Mirpur Khas, from December 2022 to December 2023. A total of 119 biopsy specimens were analyzed for spindle cell density, arrangement, atypia, vascular space formation (size and morphology), inflammatory cells (lymphocytes, plasma cells), hemosiderin extent and distribution, and mitotic activity. Data analysis was performed using SPSS version 24.0. Results: The study included 38 males (31.93%) and 81 females (68.07%). The nodular stage was most prevalent (72 cases, 60.5%), followed by the patchy stage (29 cases, 24.37%) and plaque stage (18 cases, 15.12%). Significant histopathological findings included spindle cell proliferation in 62 cases (52.11%), vascular space formation in 39 cases (32.77%), inflammatory infiltrate in 31 cases (26.05%), hemosiderin deposits in 43 cases (36.13%), and mitotic activity in 35 cases (29.41%). Conclusions: Spindle cell proliferation and vascular space formation are the most reliable indicators for staging KS. Inflammatory infiltrate composition, hemosiderin deposits, and mitotic activity showed less consistency across different specimens

References

Roy P, Parisapogu A, Agrawal H. Pneumonia or Kaposi Sarcoma: Beneath the Dyspnea with Non-compliance of HIV. Cureus. 2022 Oct; 14(10). doi: 10.7759/cureus.30152. DOI: https://doi.org/10.7759/cureus.30152

Peprah S, Engels EA, Horner MJ, Monterosso A, Hall HI, Johnson AS et al. Kaposi sarcoma incidence, burden, and prevalence in United States people with HIV, 2000-2015. Cancer Epidemiology, Biomarkers & Prevention. 2021 Sep; 30(9): 1627-33. doi: 10.1158/1055-9965.EPI-21-0008. DOI: https://doi.org/10.1158/1055-9965.EPI-21-0008

Vestergaard SV, Birn H, Jensen SK, Sørensen HT, Nitsch D, Christiansen CF. Twenty-four-Year Trends in Incidence and Mortality of Nephrotic Syndrome: A Population-Based Cohort Study. Epidemiology. 2023 May; 34(3): 411-20. doi: 10.1097/EDE.0000000000001576. DOI: https://doi.org/10.1097/EDE.0000000000001576

Esser S, Schöfer H, Hoffmann C, Claßen J, Kreuter A, Leiter U et al. S1 Guidelines for the Kaposi Sarcoma. JDDG: Journal der Deutschen Dermatologischen Gesellschaft. 2022 Jun; 20(6): 892-904. doi: 10.1111/ddg.14788. DOI: https://doi.org/10.1111/ddg.14788

Ohmoto A and Fuji S. Clinical features and treatment strategies for post-transplant and iatrogenic immunodeficiency-associated lymphoproliferative disorders. Blood Reviews. 2021 Sep; 49: 100807. doi: 10.1016/j.blre.2021.100807. DOI: https://doi.org/10.1016/j.blre.2021.100807

Kivai JM, Guantai AN, Mwanda WO, Maitho TE. Pattern of distribution of AIDS-related Kaposi's sarcoma lesions in HIV patients in a referral hospital in Kenya. African Journal of Pharmacology and Therapeutics. 2020 Jan; 9(1).

Uppal T, Sarkar R, Dhelaria R, Verma SC. Role of pattern recognition receptors in KSHV infection. Cancers. 2018 Mar; 10(3): 85. doi: 10.3390/cancers10030085. DOI: https://doi.org/10.3390/cancers10030085

Srkalovic G, Nijim S, Srkalovic MB, Fajgenbaum D. Increase in Vascular Endothelial Growth Factor (VEGF) Expression and the Pathogenesis of iMCD-TAFRO. Biomedicines. 2024 Jun; 12(6): 1328. doi: 10.3390/biomedicines12061328. DOI: https://doi.org/10.3390/biomedicines12061328

Maciolek KA, Abel EJ, Jarrard DF, Downs TM. Kaposi's sarcoma of the Penis and Scrotum. Rare Genitourinary Tumors. 2016 Jun: 323-60. doi: 10.1007/978-3-319-30046-7_22. DOI: https://doi.org/10.1007/978-3-319-30046-7_22

Le Hingrat Q, Sereti I, Landay AL, Pandrea I, Apetrei C. The hitchhiker guide to CD4+ T-cell depletion in lentiviral infection. a critical review of the dynamics of the CD4+ T cells in SIV and HIV infection. Frontiers in Immunology. 2021 Jul; 12: 695674. doi: 10.3389/fimmu.2021.695674. DOI: https://doi.org/10.3389/fimmu.2021.695674

Unger M and Kather JN. A systematic analysis of deep learning in genomics and histopathology for precision oncology. BioMed Central Medical Genomics. 2024 Feb; 17(1): 48. doi: 10.1186/s12920-024-01796-9. DOI: https://doi.org/10.1186/s12920-024-01796-9

Silini AR, Di Pietro R, Lang-Olip I, Alviano F, Banerjee A, Basile M et al. Perinatal derivatives: where do we stand? A roadmap of the human placenta and consensus for tissue and cell nomenclature. Frontiers in Bioengineering and Biotechnology. 2020 Dec; 8: 610544. doi: 10.3389/fbioe.2020.610544. DOI: https://doi.org/10.3389/fbioe.2020.610544

Igrec J and Fuchsjäger MH. Imaging of bone sarcomas and soft-tissue sarcomas. InRöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 2021 Oct; 193(10): 1171-1182. doi: 10.1055/a-1401-0215. DOI: https://doi.org/10.1055/a-1401-0215

Lopes AD, Marinho PD, Medeiros LD, de Paula VS. Human gammaherpesvirus 8 oncogenes associated with Kaposi's sarcoma. International Journal of Molecular Sciences. 2022 Jun; 23(13): 7203. doi: 10.3390/ijms23137203. DOI: https://doi.org/10.3390/ijms23137203

Gervas R and Mgaya E. Histopathological patterns and topographical distribution of Kaposi Sarcoma at Muhimbili National Hospital, Tanzania. African Health Sciences. 2021 Dec; 21(4): 1733-8. doi: 10.4314/ahs.v21i4.29. DOI: https://doi.org/10.4314/ahs.v21i4.29

Motlhale M, Sitas F, Bradshaw D, Chen WC, Singini MG, de Villiers CB et al. Epidemiology of Kaposi's sarcoma in sub-Saharan Africa. Cancer Epidemiology. 2022 Jun; 78: 102167. doi: 10.1016/j.canep.2022.102167. DOI: https://doi.org/10.1016/j.canep.2022.102167

Jary A, Veyri M, Gothland A, Leducq V, Calvez V, Marcelin AG. Kaposi's sarcoma-associated herpesvirus, the etiological agent of all epidemiological forms of Kaposi's sarcoma. Cancers. 2021 Dec; 13(24): 6208. doi: 10.3390/cancers13246208. DOI: https://doi.org/10.3390/cancers13246208

Ethel C, Blossom D, Krown SE, Martin J, Bower M, Whitby D. Kaposi sarcoma (Primer). Nature Reviews: Disease Primers. 2019; 5(1). doi: 10.1038/s41572-019-0060-9. DOI: https://doi.org/10.1038/s41572-019-0060-9

Lamb CA, Saifuddin A, Powell N, Rieder F. The future of precision medicine to predict outcomes and control tissue remodeling in inflammatory bowel disease. Gastroenterology. 2022 Apr; 162(5): 1525-42. doi: 10.1053/j.gastro.2021.09.077. DOI: https://doi.org/10.1053/j.gastro.2021.09.077

Ibrahim Khalil A, Franceschi S, de Martel C, Bray F, Clifford GM. Burden of Kaposi sarcoma according to HIV status: A systematic review and global analysis. International Journal of Cancer. 2022 Jun; 150(12): 1948-57. doi: 10.1002/ijc.33951. DOI: https://doi.org/10.1002/ijc.33951