Part 4: AIDS Related Tumours  

 

Kaposi’s Sarcoma  

 
Cause:                                    

Vascular tumours: cell of origin unknown but tumours consist of slit like vascular channels formed by endothelial cells and fibroblasts                                            
Caused by infection with Human Herpes Virus (HHV) 8

Transmitted sexually and by mother to child  

 

Clinical presentation:      

 

Pink to purple plaques or nodules
Non-tender

 
Early disease:  skin only  

 
Later disease:    

mouth lesions (especially gums & roof of mouth suggest visceral involvement:                  GI tract                                                                                                 
Pulmonary                                                                                                    
All other organs except brain  

 
Diagnosis:                             Biopsy of skin lesion  

 
Other investigations:          None  

 

Treatment:                           

 

Only curative treatment is HAART

Most patients may not be affected by advanced disease

                                                                                                    
Early disease: 

Often untreated, masking with make-up may be helpful                         
If cosmetic or symptomatic problem

Vinblastine injected into KS (if <1cm)

Or

Radiotherapy if lesion >1cm  

 
  Later disease:  

Intravenous chemotherapy e.g. vincristine & bleomycin  

Or  

Radiotherapy

 

Complications:                   

 

Lymphatic obstruction leads to painful limb or facial oedema

Haemorrhage:                   pulmonary                                                                                                               
                                        Gastro-intestinal

Lung involvement leads to pleural effusions or respiratory failure  

 
Infectious risk to others: None  

 
Non-Hodgkin Lymphoma  

 

Cause:                                   

 

Malignant transformation of B cells
HHV4 (Epstein-Barr Virus) +ve in  

                    100% of Primary Cerebral Lymphoma                                           
                   50% of other Lymphomas  

 
Clinical presentation:       Aggressive lymph node tumours
GI tract tumours common  

 
Diagnosis:                               Biopsy    

 
Other investigations:             As required to plan treatment: Bone marrow, CT Head and trunk, LP  

 
Treatment:                               Chemotherapy: seek expert advice

 

Complications:                   

 

Meningeal involvement common with Burkitt's types or if disease involves base of skull or sinuses

Use of chemotherapy increases immune suppression: start PCP prophylaxis and watch for infections  

 
Infectious risk to others:   None