Hepatic Kaposi sarcoma: A case report and review of the literature

Table 1 MeSH search terms

Liver

Hepatopathy

Hepatitis

Hepatology

Cholestatic injury

Hepatocellular injury

Kaposi sarcoma

Herpesvirus 8, human

AIDS-related Kaposi sarcoma

Non-AIDS-related Kaposi sarcoma

Liver neoplasms

AIDS: Acquired immune deficiency syndrome.

Table 2 Outcomes in patients with clinically symptomatic hepatic Kaposi sarcoma

Age (yr)	Sex	HIV status	CD4 count (cells/mm3)	Liver chemistry profile	Pathology	Treatment	Hospital course + complications
45[63]	M	(+)	192	T Bil 19.35 ALP 1309 AST 204 ALT 188 GGT 827	HHV-8 PCR VL (+) 24000 copies/mL. Liver biopsy revealed features of KS with spindle cells, extravasation of red blood cells and haemosiderin deposition. IHC staining HHV8 (+)	Paclitaxel, Montelukast	Continued on chemotherapy. Subsequently developed respiratory and renal failure, anemia and thrombocytopenia from aggressive metastatic KS
36[64]	M	(+)	17	PTT 70 (s) ALT 185 T Bil 23	Necroscopy showed bile duct proliferation with diffuse fibrosis with lymphohistiocytic infiltration	Liposomal doxorubicin	Jaundice, renal failure, fulminant liver failure
28[65]	M	(+)	NR	NR	Biopsy residues of spindle cells lining portal tracts. Immunoperoxidase staining factor VIII (+)	Palliative care	Liver function continued to decline and patient died from respiratory failure two weeks later
38[66]	M	(+)	< 2001	AST 147 ALT 180 ALP 573	Gross specimen with fibrous thickening of portal tracts and dark red nodules in periportal areas and diffusely infiltrating liver parenchyma	Chemotherapy, NOS	Partial cutaneous response, died several weeks later
40[4]	M	(+)	NR	Reportedly, “normal”	KS present on biopsy of lymph nodes. US with three 7-12 mm hyperechoic nodules. Periportal groups of dilated blood filled cavernous spaces lined by flat endothelial cells and interspersed of spindle cells. Extravasated erythrocytes and minimal hemosiderin deposits	Combination Chemotherapy, NOS	Complete remission of cutaneous lesions and reduction in size of two of the lesions with the third not visible. Readmitted six months later for severe relapse of cutaneous KS. Reinitiated chemotherapy with rapid deterioration and death within one month
48[67]	M	(+)	8	TBili 20.0 ALP 947 AST 186 ALT 155 INR 1.9	Liver biopsy was Cytokeratin-7 and HHV-8 staining positive	Ganciclovir and Rituximab	Presented with jaundice and acute liver injury with a cholestatic pattern, progressed to fulminant hepatic failure and ultimately death
44[68]	M	(+)	CD4/CD8 ratio 0.08	AST 153 ALT 124 ALP 1228	Laproscopy demonstrated enlarged liver with multiple purple 2-3 mm nodules Biopsy demonstrated spindle cells, vascular slits, extravasated red cells and lymphocytic infiltration	Platinum based chemotherapy, NOS	Primary hepatic manifestations without cutaneous lesions. Persistent abdominal pain after treatment. Progressed to cutaneous lesions six weeks after treatment. Lost to follow-up

¹Less than 200, not otherwise reported. M: Male; F: Female; TBili: Total Bilirubin (units, mg/dL); ALP: Alkaline phosphatase (units, IU/L); AST: Aspartate transaminase (IU/L); ALT: Alanine transaminase (IU/L); GGT: Gamma glutamyl transpeptidase (units, IU/L); HHV-8: Human herpes virus-8; PCR: Polymerase chain reaction; VL: Viral load; IHC: Immunohistochemistry; NR: Not reported; NOS: Not otherwise specified; US: Ultrasound; KS: Kaposi sarcoma.