J Korean Surg Soc.  2009 Jan;76(1):52-55. 10.4174/jkss.2009.76.1.52.

Kaposi's Sarcoma on Mediastinum after Renal Retransplantation

• Yoon KJ
• Kim SJ
• Park CJ
• Park SG
• Kim JS
• Oh JE
• Nam ES
• Lee S

• KMID: 2040605
• DOI: http://doi.org/10.4174/jkss.2009.76.1.52

Abstract

Kaposi's sarcoma occurs in higher rates in the setting of immunosuppression, especially in patients with acquired immunodeficiency syndrome (AIDS), immunosuppressive therapy or posttransplantation, commonly involving the skin, visceral, oral cavity or respiratory tract. Of the de novo malignancies in transplantation patients, the incidence of Kaposi's sarcoma is increasing steadily. We report a case of a 37-year-old male patient who was diagnosed with Kaposi's sarcoma 16 years after his first renal transplantation and 5 months after his second transplantation. He presented with lymphoproliferative lesions in the mediastinum and supraclavicular area without showing any typical cutaneous lesions. Diagnosis was confirmed by gun biopsy of the enlarged axillary lymph nodes. Tacrolimus, the initial immunosuppressive drug, was tapered while sirolimus therapy and chemotherapy with vincristine was initiated. The enlarged lymph nodes decreased in size and the patient has been treated with vincristin and conversion of tacrolimus to sirolimus.

Keyword

Renal transplantation; Kaposi's sarcoma; Sirolimus

MeSH Terms

Acquired Immunodeficiency Syndrome
Adult
Biopsy
Humans
Immunosuppression
Incidence
Kidney Transplantation
Lymph Nodes
Male
Mediastinum
Mouth
Respiratory System
Sarcoma, Kaposi
Sirolimus
Skin
Tacrolimus
Transplants
Vincristine
Sirolimus
Tacrolimus
Vincristine

Figure

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  Fig. 1 POD #60, no active lesion.

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  Fig. 2 POD #150, prominent hilum, bulging contour in right paratracheal area.

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  Fig. 3 Severely enlarged lymph nodes in the paraaortic space and mesenteric space. And multiple and massive lymph nodes in the celiac axis region around the pancreas and SMA.

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  Fig. 4 Extensive lymph node enlargement in all mediastinum including both hilum, interlobar and subcarinal areas are demonstrated. Tracheal compression also noted due to extensive lymphadenopathy.

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  Fig. 5 Tumor composed of spindle cell proliferation show mitosis. Slit-like spaces between the spindle tumor cells contain RBCs and hyaline globules (H&E, ×400).

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  Fig. 6 The spindle tumor cells are diffusely reactive for CD34 antibody on immunohistochemical stain (ABC method, ×200).

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