Kaposi ‘s sarcoma
Kaposi’s sarcoma (full name — multiple hemorrhagic and ideopathic Kaposi’s sarcoma) is a malignant skin lesion of multiple nature. The disease develops from the endothelium of the lymphatic or blood vessels that pass inside it. Most often Kaposi’s sarcoma occurs, affecting the oral mucosa, as well as lymph nodes. The main manifestations of Kaposi’s sarcoma are considered to be spots of bluish-red color, which have a multiple character. Such spots can eventually turn into tumor nodes, the size of which is up to 5 cm (in diameter). Diagnostic methods will be the histology of a biopsy sample taken from the lesion, as well as a blood test for the presence of HIV and other immunity studies. Treatment is carried out by local (or systemic) use of chemotherapy drugs, as well as interferons. Radiation exposure to tumors and cryotherapy are also practiced.
The content of the article:
Causes of Kaposi’s sarcoma
Symptoms of Kaposi’s sarcoma
Diagnosis of Kaposi’s sarcoma
Treatment of Kaposi’s sarcoma
Prognosis of Kaposi’s sarcoma
Kaposi ‘s sarcoma
The name of Kaposi’s sarcoma disease originates from the name of the famous Hungarian dermatologist, who first described the disease back in 1872. If we talk about the spread of Kaposi’s sarcoma, it is not widespread everywhere, but among those with HIV it is about 40%. In such patients, Kaposi’s sarcoma is considered the most common malignant tumor. An interesting fact is that Kaposi’s sarcoma is diagnosed in men much more often than in women (8-9 times more often).
The risk group with the rapid development of Kaposi’s sarcoma includes: people infected with HIV (mostly men), elderly men from the Mediterranean, representatives of Central Africa, people who have had organs transplanted or those who have been undergoing immunosuppressive therapy for a long time.
Causes of Kaposi’s sarcoma
The exact causes of the occurrence and further development of Kaposi’s sarcoma are still reliably unknown. However, it is known that the disease often occurs against the background of already existing processes of malignant genesis. The latter include Hodgkin’s disease, myeloma, fungal mycosis. As modern scientific studies have shown, the disease has a connection with attacks of antibodies in the human body. Such antibodies usually occur during infection with the herpes virus of the eighth type. Usually, infection with the virus occurs sexually or through blood (saliva).
Today, scientists are isolating components that have a stimulating effect on the cellular structure of Kaposi’s sarcoma. Such components are cytokines. These include: 3FGF (an element denoting fibroblast growth factor), TGFp (an element responsible for the transformation of growth factor), IL-6 (interleukin 6). It should be said that when a tumor occurs in those with AIDS, considerable attention is paid to oncostatin.
Kaposi’s sarcoma is considered an unusual malignant tumor. Its weak mitotic activity, as well as its dependence on the patient’s immune index, does not exclude the re-development of tumor foci, multicentric development, lack of atypia of the cellular variety, histology of signs of inflammation only confirm the hypothesis of the occurrence of Kaposi’s sarcoma as a reactive process.
Symptoms of Kaposi’s sarcoma
Kaposi’s sarcoma often begins with purple-blue spots on the skin. Such spots are infiltrated with the further formation of disks and nodes of a rounded shape. Sometimes Kaposhin’s sarcoma originates from the appearance of papules. The latter is very similar to the rashes characteristic of lichen planus. The growth of nodes occurs gradually, reaching the size of a walnut. Such nodes are characterized by a dense and elastic consistency and have a flaky surface. It often happens that such a surface is permeated with small vessels. The nodes cause characteristic pain, which increases with compression. Over time, Kaposi’s sarcoma can resolve on its own, forming scars in the form of hyperpigmentation in the future.
To date, there are four types of Kaposi’s sarcoma: classic, endemic, epidemic and immune-suppressive.
Classic
The classic type of Kaposi’s sarcoma is most often found in Ukraine, Russia and Belarus, as well as in a number of Central European countries. The characteristic localization is considered to be the skin on the lateral surface of the lower leg, hands and feet. Also characteristic will be the exact delineation and symmetry of the tumor foci. Interestingly, the classic Kaposi’s sarcoma is not characterized by obvious symptoms, only in exceptional cases, patients may feel burning or itching. This type of Kaposi’s sarcoma occurs with damage to the mucous membranes. There are three stages of the development of classical Kaposi’s sarcoma: spotted, papular and tumor.
Let’s take a closer look at each stage.
So, the spotted stage represents the beginning of the disease. It is expressed by spots of red-bluish or red-brown color, which have an uneven shape and whose size reaches 0.5 cm. The spots usually have a smooth surface.
If we talk about the papular stage of Kaposi’s sarcoma, then first of all, it should be noted its multiplicity of elements that protrude above the surface of the skin itself and have the appearance of a sphere. Such elements differ in density and elasticity, their diameter ranges from 2 mm to 1 cm. If they merge, they form hemispherical plaques having a rough and smooth surface. Often, individual elements of Kaposi’s sarcoma are distinguished by their isolation at this stage.
Speaking about the tumor stage, it should be said about the formation of tumor nodes, the diameter of which is up to 5 cm. Usually the formed nodes are blue-red or brown in color. They can merge with each other, after which ulceration occurs.
Epidemic
The epidemic type of Kaposi’s sarcoma is associated with AIDS, which is one of the symptoms of the disease. The age of the patients is approximately up to 35 years. The color and brightness of rashes, as well as the location of tumors on the mucous membranes, the tip of the nose, the upper extremities and the hard palate are always the same. In this form, there is a rapid involvement of lymph nodes, as well as internal organs.
Endemic
The endemic type of Kaposi’s sarcoma can usually be found in representatives of Central America. The disease develops in childhood (usually in the first year of a child’s life). The disease is characterized by rapid damage to organs, as well as lymph nodes, various types of skin changes, although they are not clearly expressed.
Immune suppressive
Speaking of immune-suppressive Kaposi’s sarcoma, the first thing to say is about its chronic course, which is usually benign, while without involving internal organs. The disease is formed during the immune-suppressive treatment of patients who have recently undergone an organ transplant. In case of cancellation of medications that depress immunity, a regression of symptoms of ailments is very often observed.
The course of Kaposi’s sarcoma can be acute, chronic or subacute. In the case of an acute form, the disease develops rapidly, and the generalization of malignant processes with pronounced intoxication and cachexia also occurs quickly. With this form, a person can die in the interval from 2 months to 2 years of the course of the disease. The subacute form, if not treated, can last from 2 years. The slow development of the tumor maturation process, if we talk about the chronic form of Kaposi’s sarcoma, contributes to a long course.
Among the complications of Kaposi’s sarcoma are deformity, limited movement (restrictions relate to those parts of the limbs that were affected), as well as bleeding (due to a collapsing tumor), lymphostasis (if the tumor squeezes the lymph nodes). Ulceration of nodes with a tumor carries the risk of rapid infection, which means it can lead to the development of sepsis and cause death.
Diagnosis of Kaposi’s sarcoma
It is possible to diagnose Kaposi’s sarcoma by its clinical manifestations, as well as the results of the biopsy obtained. Histology will help to identify new vessels formed on the skin and to carry out the proliferation of fusiform cells. The presence of hemosiderin or extravasates will help distinguish Kaposi’s sarcoma from, for example, fibrosarcoma.
Patients should conduct various immunological blood tests, as well as take an HIV test. In order to identify violations of internal organs, in the case of Kaposi’s sarcoma, abdominal ultrasound, heart ultrasound, X-ray, gastroscopy, lung X-ray, kidney CT, kidney and adrenal MRI, scintigraphy are practiced.
Differential diagnosis will also be required in order to distinguish Kaposi’s sarcoma from lichen planus, sarcoidosis, fungal mycosis, hemosiderosis, angiosarcoma of a highly differentiated order.
Treatment of Kaposi’s sarcoma
It is very important that in the treatment of Kaposi’s sarcoma, therapy of the cause that caused it, that is, the underlying disease, is carried out. This is done in order to increase immunity. If we talk about systemic treatment, it is prescribed to those people who have a favorable immunological background (in the case of asymptomatic course of the disease). Systemic treatment consists of intensive polychemotherapy.
However, there is a risk of using this therapy and it is associated with the toxic effects of drugs on the bone marrow, especially if combined with medications for the treatment of HIV. At the first and second stages, monotherapy by means of a prospidinoma, characterized by the absence of an inhibitory factor on the immune system or blood, will be more effective. Interferons that prevent the proliferation of fibroblasts are used to treat epidemic and classical varieties of Kaposi’s sarcoma. They are able to initiate the apostosis of cancer cells.
Local therapy includes cryotherapy, the use of chemotherapeutic drugs, interferon, applications of dinitrochlorobenzene, ointments of prospidine. In the case of the presence of large lesions and for the best cosmetic effect, local irradiation is carried out.
Prognosis of Kaposi’s sarcoma
The prognosis of the disease depends on the nature of the course and is associated with the state of the immune system. In the case of high levels of immunity, the disease may be reversible. Systemic treatment will allow you to get a good effect and will allow you to achieve remission.
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