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Visceral Kaposi's Sarcoma Related to Human Herpesvirus-8 in Liver Transplant Recipient: Case Report and Literature Review.

Benhammane H, Mentha G, Tschanz E, El Mesbahi O, Dietrich PY - Case Rep Oncol Med (2012)

Bottom Line: The optimal approach to managing posttransplantation KS is to reduce or discontinue immunosuppressive therapy but this strategy carries a risk of the acute rejection of the graft.Case Report.Therapeutic approaches are complex and require a multidisciplinary team.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco.

ABSTRACT
Background. Kaposi's sarcoma (KS) in transplant recipients is about 400 to 500 times rate in the general population. It is strongly associated to Human herpesvirus-8 (HHV-8) infection which has been found in 95% of KS lesions. The optimal approach to managing posttransplantation KS is to reduce or discontinue immunosuppressive therapy but this strategy carries a risk of the acute rejection of the graft. Recently, the use of an mTOR inhibitor has added new opportunities for KS treatment and prevention. Case Report. We report a case of 24 years-old Turkish woman with visceral HHV-8-associated Kaposi's sarcoma after orthotopic liver transplantation. Conclusion. Posttransplantation KS is considered an experimental model of virus induced tumor suggesting the usefulness of HHV-8 screening in transplant recipient and donor. Therapeutic approaches are complex and require a multidisciplinary team.

No MeSH data available.


Related in: MedlinePlus

Microscopic findings of small bowel specimen showing atypical spindle cells with extravasated erythrocytes and capillaries (HES ×100).
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fig2: Microscopic findings of small bowel specimen showing atypical spindle cells with extravasated erythrocytes and capillaries (HES ×100).

Mentions: A 24 years-old Turkish woman underwent OLT in November 2008 for cirrhosis related to Von Gierke disease. Her immunosuppressive regimen consisted of tacrolimus and mycophenolate mofetil. Three years later, she was readmitted because of a cholestasis due to the stenosis of the biliobiliary anastomosis. Endoscopic Retrograde Cholangiopancreatography with placement of biliary stent was performed, but the procedure was complicated by pancreatitis and duodenal ulcer; therefore, a biliary repair surgery was decided. A computed tomography performed preoperatively allowed to fortuitous detection of several pulmonary nodules and multiple intraperitoneal lymph nodes (Figure 1). The patient underwent laparotomy which demonstrated the presence of multiple lymph nodes of variable size, associated with a 3 cm sized lesion of small bowel; principal bile duct was dilated secondary to a biliary nevrome. Segmental resection of small bowel with lymphadenectomy was performed; biliary stenosis was treated by hepaticojejunal anastomosis on Roux-en-Y. Histological analysis confirmed the diagnosis of kaposi's sarcoma of small bowel with lymph nodes extension (Figure 2); tumoral cells showed strong positivity in the nuclei for HHV-8, CD34 and CD31 (Figure 3). Antibody testing for HHV-8 was reactive on the serum bank collected on day 5 of OLT excluding a donor related infection. The serum HHV-8 viral load was 989 copies/Ml. other viral serology (HIV, hepatitis B and C virus, Epstein-Barr virus and cytomegalovirus) was negative. The immunosuppressive regimen was initially reduced, by stopping mycophenolate mofetil and halving the oral tacrolimus daily dose from 5 to 2 mg during 1 month then it was converted to everolimus at a daily dose of 2 mg. Currently, the patient remains well without sign of progression disease 9 months after surgery and with a good tolerance of treatment.


Visceral Kaposi's Sarcoma Related to Human Herpesvirus-8 in Liver Transplant Recipient: Case Report and Literature Review.

Benhammane H, Mentha G, Tschanz E, El Mesbahi O, Dietrich PY - Case Rep Oncol Med (2012)

Microscopic findings of small bowel specimen showing atypical spindle cells with extravasated erythrocytes and capillaries (HES ×100).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539345&req=5

fig2: Microscopic findings of small bowel specimen showing atypical spindle cells with extravasated erythrocytes and capillaries (HES ×100).
Mentions: A 24 years-old Turkish woman underwent OLT in November 2008 for cirrhosis related to Von Gierke disease. Her immunosuppressive regimen consisted of tacrolimus and mycophenolate mofetil. Three years later, she was readmitted because of a cholestasis due to the stenosis of the biliobiliary anastomosis. Endoscopic Retrograde Cholangiopancreatography with placement of biliary stent was performed, but the procedure was complicated by pancreatitis and duodenal ulcer; therefore, a biliary repair surgery was decided. A computed tomography performed preoperatively allowed to fortuitous detection of several pulmonary nodules and multiple intraperitoneal lymph nodes (Figure 1). The patient underwent laparotomy which demonstrated the presence of multiple lymph nodes of variable size, associated with a 3 cm sized lesion of small bowel; principal bile duct was dilated secondary to a biliary nevrome. Segmental resection of small bowel with lymphadenectomy was performed; biliary stenosis was treated by hepaticojejunal anastomosis on Roux-en-Y. Histological analysis confirmed the diagnosis of kaposi's sarcoma of small bowel with lymph nodes extension (Figure 2); tumoral cells showed strong positivity in the nuclei for HHV-8, CD34 and CD31 (Figure 3). Antibody testing for HHV-8 was reactive on the serum bank collected on day 5 of OLT excluding a donor related infection. The serum HHV-8 viral load was 989 copies/Ml. other viral serology (HIV, hepatitis B and C virus, Epstein-Barr virus and cytomegalovirus) was negative. The immunosuppressive regimen was initially reduced, by stopping mycophenolate mofetil and halving the oral tacrolimus daily dose from 5 to 2 mg during 1 month then it was converted to everolimus at a daily dose of 2 mg. Currently, the patient remains well without sign of progression disease 9 months after surgery and with a good tolerance of treatment.

Bottom Line: The optimal approach to managing posttransplantation KS is to reduce or discontinue immunosuppressive therapy but this strategy carries a risk of the acute rejection of the graft.Case Report.Therapeutic approaches are complex and require a multidisciplinary team.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Oncology, Hassan II University Hospital, Fez, Morocco.

ABSTRACT
Background. Kaposi's sarcoma (KS) in transplant recipients is about 400 to 500 times rate in the general population. It is strongly associated to Human herpesvirus-8 (HHV-8) infection which has been found in 95% of KS lesions. The optimal approach to managing posttransplantation KS is to reduce or discontinue immunosuppressive therapy but this strategy carries a risk of the acute rejection of the graft. Recently, the use of an mTOR inhibitor has added new opportunities for KS treatment and prevention. Case Report. We report a case of 24 years-old Turkish woman with visceral HHV-8-associated Kaposi's sarcoma after orthotopic liver transplantation. Conclusion. Posttransplantation KS is considered an experimental model of virus induced tumor suggesting the usefulness of HHV-8 screening in transplant recipient and donor. Therapeutic approaches are complex and require a multidisciplinary team.

No MeSH data available.


Related in: MedlinePlus