Isolated Gastric Involvement of Kaposiʼs Sarcoma

Purpose: Kaposi's sarcoma (KS) was a rare neoplasm that comprised close to 0.1% of all malignancies worldwide. However, due to the increasing prevalence of patients with human immunodeficiency virus (HIV) or those on immunosuppression, the incidence of KS is steadily on the rise. Purple nodular lesions that can involve the skin, mucous membranes, or viscera characterize cutaneous disease. Extracutaneous manifestations of KS include gastrointestinal manifestations characterized by diarrhea, weight loss, protein loosing enteropathy and bleeding. It is rare to find gastric KS without primary skin involvement. A 35-year-old man was evaluated for 40-pound weight loss, diarrhea and intermittent epigastric pain. Self-therapy with histamine receptor-2 blockers did not result in significant improvement. Review of systems was negative for dysphagia, odynophagia, melena, hematemesis, or hematochezia. He further denied any family or personal history of cancer. Physical examination was remarkable for generalized muscle wasting. Examination of oral cavity and skin was normal. Laboratory examination was remarkable for WBC of 3.0 g/dL. Esophagogastroduodenoscopy revealed two areas of intense erythema and edema in fundus extending along the gastric rugae in serpiginous fashion measuring 2.5-3cm in diameter along the greater curve/anterior wall - with one area of 4-5mm central ulceration. Erythema and erosions were seen in the antrum suspicious for gastritis. Histologic examination of the lesion revealed Spindle-shaped cells and neovascularization with small-vessel proliferation consistent with KS. Patient was subsequently diagnosed with HIV/AIDS (CD4 count 8, Viral load 85,000) and started on liposomal doxorubicin along with antiretroviral therapy. Gastrointestinal KS is accompanied by cutaneous form of the disease. Among the locations along the gastrointestinal tract, involvement of the gastric site is rare. Untreated gastrointestinal Kaposi sarcoma is associated with serious complications such as severe hemorrhage and perforation. Our case describes isolated gastric Kaposi's sarcoma in a patient with diarrhea and weight loss without involvement of the skin.Figure