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Kaposi's sarcoma and Non-Hodgkin's lymphoma in AIDS

Kaposi's sarcoma (KS) is a presenting feature in 16% ofpatients, though the incidence has fallen over recent years.It is commoner in homosexual men than in the othe rgroups at risk. The Kaposi's sarcoma of AIDS differs from classic Kaposi's sarcoma in that widespread skin , mucous membrane (particularly the oral cavity andpalate), visceral and lymph node disease occurs. Visceral,particularly gastrointestinal, lesions are present in as manyas half of all patients at presentation.Nodules of Kaposi's sarcoma also occur in the lungs.Chest X-ray appearances vary from confluent irregularmasses to interstitial nodularity and are better illustratedon a CT scan of the thorax. CT of the thorax may be useful in differential diagnosis. At bronchoscopy,endobronchial lesions may be seen. Kaposi's sarcoma consistsof spindle-shaped cells arranged in nodules and broadbands, and contains vascular slits filled with extravasated erythrocytes.

The diagnosis of Kaposi's sarcoma in very early skin lesions may be extremely difficult, as little moremay be seen than a few irregular dilated vascular channelsin the mid dermis and a mild inflammatory cell infiltrate.A herpes virus, kaposi sarcoma-associated herpes virus 8(KSHV8), has been identified in kaposi sarcoma lesions ofall forms, including both classic and AIDS associated. Theincidence of positive serology to KSHV8 in different HIVinfectedpatient populations reflects the incidence of KS inthese patient groups. The presence of KSHV8 in bloodis predictive of the subsequent risk of developing KS.These observations suggest a causal role for KSHV8 in thedevelopment of KS.

Non-Hodgkin's lymphoma As in other chronically immunosuppressed patients, thereis a greatly increased risk of non-Hodgkin's lymphoma.Although the tumour typically affects lymph nodes, extranodaldisease is common and affects the central nervoussystem, bone marrow and gastrointestinal tract. The diagnosisshould also be considered in patients with weight loss,constitutional symptoms and anaemia. These are B-celllymphomas of high or intermediate grade. Response tocytotoxic drugs occurs, but treatment is difficult and usuallyunsuccessful because of profound immune suppression. Inaddition to secondary involvement of the CNS a proportionof AIDS associated Non-Hodgkin's lymphomapresents as primary CNS lymphoma; tumours which areintracranial parenchyma lesions limited to the CNS.Patients usually present with single large mass lesions inthe brain.

Other tumours Squamous carcinomas of the mouth and anorectum occurin homosexual men with antibodies to HIV. Human papillomavirusmay play a part. There is a higher proportion ofcervical intraepithelial neoplasia (CIN) in HIV infectedwomen and a higher rate of progression from lower to highgrade CIN.

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