Case and Research Letters
Kaposi Sarcoma, De Novo, in a Kidney Transplant Surgical Scar
Sarcoma de Kaposi, de novo, en una cicatriz quirúrgica de transplante de riñón
L.F. Santos Silva
, A. Miroux Catarino, C. Sordo Amaro, I. Faro Viana
Corresponding author
Departamento de Dermatología, Hospital de Egas Moniz, Centro Hospitalario de Lisboa Occidental, Lisboa, Portugal
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On the left, hematoxylin–eosin (H-E) staining with images from smallest to largest magnification under an optical microscope, showing the histological characteristics of cutaneous follicle center B-cell lymphoma: lymphocyte infiltrate located in the middle and deep dermis with a mixed (nodular/diffuse) growth pattern and presence of cells of centrocytic and centroblastic appearance. On the right, immune-staining panel compatible with primary cutaneous center follicle lymphoma. The panel shows positive staining for CD10, CD20, Bcl-2, and Bcl-6 (hematoxylin–eosin, x2, x4, x10, x20, x20; IHQ, x2, x2, x2, x4).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Sarriugarte Aldecoa-Otalora, J. Mitxelena Eceiza, A. Córdoba Iturriagagoitia, M.C. Viguria Alegría" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Sarriugarte Aldecoa-Otalora" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Mitxelena Eceiza" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Córdoba Iturriagagoitia" ] 3 => array:2 [ "nombre" => "M.C." "apellidos" => "Viguria Alegría" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157821902100175X?idApp=UINPBA000044" "url" => "/15782190/0000011200000007/v1_202107020822/S157821902100175X/v1_202107020822/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Kaposi Sarcoma, De Novo, in a Kidney Transplant Surgical Scar" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "671" "paginaFinal" => "672" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L.F. Santos Silva, A. Miroux Catarino, C. Sordo Amaro, I. Faro Viana" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L.F." "apellidos" => "Santos Silva" "email" => array:1 [ 0 => "leandrofilipe@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Miroux Catarino" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Sordo Amaro" ] 3 => array:2 [ "nombre" => "I." "apellidos" => "Faro Viana" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Dermatología, Hospital de Egas Moniz, Centro Hospitalario de Lisboa Occidental, Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Sarcoma de Kaposi, <span class="elsevierStyleItalic">de novo</span>, en una cicatriz quirúrgica de transplante de riñón" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1074 "Ancho" => 1074 "Tamanyo" => 265677 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological examination characteristic of Kaposi sarcoma (hematoxylin-eosin stain; x400 magnification) and immunohistochemical staining for HHV8 (x400 magnification).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56 years old Caucasian man presented to our Dermatology consultation with a slow-growing solitary skin lesion on the abdomen of 3-4 months of evolution, accompanied of slight burning sensation. He had a medical history of hypertension, chronic kidney disease and secondary hyperparathyroidism, that had undergone kidney transplantation 5 months before. He was being treated with tacrolimus, mycophenolate mofetil, prednisolone, nifedipine, carvedilol and cotrimoxazole.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Clinical examination revealed a 20 cm large purple plaque located at the inferior extremity of the abdominal surgical scar with no other skin or mucosal lesions (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A punch biopsy demonstrated dermal proliferation of spindle shaped cells with mild cytologic atypia, which formed slit-like channels and stained positive for human herpesvirus 8. These features are characteristic of Kaposi sarcoma in plaque/nodular stage (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After the diagnosis of Kaposi sarcoma, tacrolimus was replaced by everolimus and he was referred to the Oncology department, to proceed with exclusion of extra-cutaneous manifestations, that proved to be negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Gradually the skin plaque on the patient scar disappeared and was replaced by an hyperpigmented brown patch (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Kaposi sarcoma (KS) is an angioproliferative disorder that is associated with infection with human herpes virus 8 (HHV-8).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Iatrogenic, immunosuppressive drug-associated KS is frequent among renal transplant recipients, accounting for < 3-4% of all neoplasms.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The incidence of KS among solid organ transplant recipients is 500 times greater as compared with the general population’s, suggesting a role for immunosuppression in the development of the disease.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Iatrogenic Kaposi sarcoma presents mainly with cutaneous manifestations.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A presentation of Kaposi sarcoma, de novo, in a scar is extremely rare, and this location can be explained by the Koebner’s phenomenon. The Koebner phenomenon is the localization of skin disease to a site of trauma in an individual who is susceptible to that disease.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> A key role has been suggested for basic fibroblast growth factor (b-FGF), a mitogen for endothelial cells and keratinocytes. Trauma, like surgical intervention, to susceptible skin may cause the release of this and other cytokines (interleukin-1, interleukin- 6, tumour necrosis factor-alfa, vascular endothelial growth factor, platelet-derived growth factor, granulocyte–macrophage colony-stimulating factor) triggering angiogenesis. The increased angiogenesis and the reactivation of the HHV-8 would contribute to the development of Kaposi sarcoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The advent of inhibitors of the mammalian target of rapamycin (mTOR inhibitors), such as sirolimus and everolimus, represents an alternative for the antirejection maintenance therapy. Furthermore, they can have a role in the treatment of Kaposi’s sarcoma, since they also decrease the production of VEGF and inhibit the response of vascular endothelial cells to stimulation by VEGF. Therefore, mTOR inhibitors, not only inhibit the growth of certain vascularized tumors, while maintaining a lower risk of losing the renal graft.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the present case the patient presented only with a cutaneous lesion due to Kaposi Sarcoma, that resolved with the switch from tacrolimus to everolimus. This fact supports that mTOR inhibitors represent an alternative that allows the preservation of the renal graft, while treating Kaposi sarcoma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos Silva LF, Miroux Catarino A, Sordo Amaro C, Faro Viana I. Sarcoma de Kaposi, <span class="elsevierStyleItalic">de novo,</span> en una cicatriz quirúrgica de transplante de riñón. Actas Dermosifiliogr. 2021;112:671–672.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1012 "Ancho" => 1074 "Tamanyo" => 113056 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Cutaneous Kaposi sarcoma in the surgical scar.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1074 "Ancho" => 1074 "Tamanyo" => 265677 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological examination characteristic of Kaposi sarcoma (hematoxylin-eosin stain; x400 magnification) and immunohistochemical staining for HHV8 (x400 magnification).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1429 "Ancho" => 1074 "Tamanyo" => 144087 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Regression of Kaposi sarcoma after switch of tacrolimus to everolimus.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "KSHV antibodies among Americans, Italians and Ugandans with and without Kaposi’s sarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. 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Naesens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/tid.12357" "Revista" => array:6 [ "tituloSerie" => "Transpl Infect Dis" "fecha" => "2015" "volumen" => "17" "paginaInicial" => "303" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25645490" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000011200000007/v1_202107020822/S1578219021001517/v1_202107020822/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000011200000007/v1_202107020822/S1578219021001517/v1_202107020822/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021001517?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 11 | 25 |
| 2024 October | 76 | 47 | 123 |
| 2024 September | 76 | 37 | 113 |
| 2024 August | 120 | 60 | 180 |
| 2024 July | 97 | 43 | 140 |
| 2024 June | 101 | 44 | 145 |
| 2024 May | 86 | 41 | 127 |
| 2024 April | 75 | 34 | 109 |
| 2024 March | 117 | 36 | 153 |
| 2024 February | 88 | 32 | 120 |
| 2024 January | 101 | 43 | 144 |
| 2023 December | 58 | 22 | 80 |
| 2023 November | 92 | 35 | 127 |
| 2023 October | 81 | 43 | 124 |
| 2023 September | 48 | 35 | 83 |
| 2023 August | 52 | 19 | 71 |
| 2023 July | 69 | 31 | 100 |
| 2023 June | 67 | 30 | 97 |
| 2023 May | 69 | 19 | 88 |
| 2023 April | 40 | 30 | 70 |
| 2023 March | 52 | 34 | 86 |
| 2023 February | 46 | 34 | 80 |
| 2023 January | 44 | 27 | 71 |
| 2022 December | 55 | 43 | 98 |
| 2022 November | 34 | 24 | 58 |
| 2022 October | 38 | 24 | 62 |
| 2022 September | 45 | 37 | 82 |
| 2022 August | 71 | 36 | 107 |
| 2022 July | 28 | 35 | 63 |
| 2022 June | 40 | 28 | 68 |
| 2022 May | 30 | 41 | 71 |
| 2022 April | 44 | 33 | 77 |
| 2022 March | 54 | 60 | 114 |
| 2022 February | 72 | 38 | 110 |
| 2022 January | 71 | 48 | 119 |
| 2021 December | 49 | 52 | 101 |
| 2021 November | 68 | 61 | 129 |
| 2021 October | 128 | 71 | 199 |
| 2021 September | 97 | 53 | 150 |
| 2021 August | 71 | 39 | 110 |
| 2021 July | 93 | 33 | 126 |
| 2021 June | 60 | 70 | 130 |
| 2021 May | 68 | 35 | 103 |
| 2021 April | 127 | 71 | 198 |
| 2021 March | 85 | 110 | 195 |
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