Massive vulval Kaposi’s sarcoma in pregnancy: case report
Identifieur interne : 002281 ( Pmc/Corpus ); précédent : 002280; suivant : 002282Massive vulval Kaposi’s sarcoma in pregnancy: case report
Auteurs : Solwayo NgwenyaSource :
- International Medical Case Reports Journal [ 1179-142X ] ; 2016.
Abstract
The complications of HIV/AIDS can produce grossly abnormal pathology. In low-resourced settings, women can present late with huge lesions. Massive vulval pathology copresenting in pregnancy produces difficulties in managing the patients and may lead to poor maternal or fetal outcomes.
A 27-year-old P1 G2 (second pregnancy one live birth) patient presented at 30 weeks gestation with a massive vulval lesion. She was HIV seropositive and taking anti-retroviral therapy. She was anemic with a hemoglobin level of 5.9 and was transfused 4.0 of packed cells. She underwent examination under anesthesia and vulval biopsy. She went into preterm labor and was delivered by cesarean section. Unfortunately, the baby had died while receiving corticosteroid therapy. The histopathological report confirmed a Kaposi’s sarcoma, and she was referred to oncologists for chemotherapy.
Kaposi’s sarcoma can occur in pregnancy in both seropositive and seronegative patients. Kaposi’s sarcoma causes significant fetal and maternal health complications.
Url:
DOI: 10.2147/IMCRJ.S111171
PubMed: 27536163
PubMed Central: 4973725
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Massive vulval Kaposi’s sarcoma in pregnancy: case report</title><author><name sortKey="Ngwenya, Solwayo" sort="Ngwenya, Solwayo" uniqKey="Ngwenya S" first="Solwayo" last="Ngwenya">Solwayo Ngwenya</name><affiliation><nlm:aff id="af1-imcrj-9-227">Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Mzilikazi</nlm:aff></affiliation><affiliation><nlm:aff id="af2-imcrj-9-227">Royal Women’s Clinic, Bulawayo, Matabeleland, Zimbabwe</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27536163</idno><idno type="pmc">4973725</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973725</idno><idno type="RBID">PMC:4973725</idno><idno type="doi">10.2147/IMCRJ.S111171</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">002281</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002281</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Massive vulval Kaposi’s sarcoma in pregnancy: case report</title><author><name sortKey="Ngwenya, Solwayo" sort="Ngwenya, Solwayo" uniqKey="Ngwenya S" first="Solwayo" last="Ngwenya">Solwayo Ngwenya</name><affiliation><nlm:aff id="af1-imcrj-9-227">Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Mzilikazi</nlm:aff></affiliation><affiliation><nlm:aff id="af2-imcrj-9-227">Royal Women’s Clinic, Bulawayo, Matabeleland, Zimbabwe</nlm:aff></affiliation></author></analytic><series><title level="j">International Medical Case Reports Journal</title><idno type="eISSN">1179-142X</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The complications of HIV/AIDS can produce grossly abnormal pathology. In low-resourced settings, women can present late with huge lesions. Massive vulval pathology copresenting in pregnancy produces difficulties in managing the patients and may lead to poor maternal or fetal outcomes.</p></sec><sec><title>Case report</title><p>A 27-year-old P1 G2 (second pregnancy one live birth) patient presented at 30 weeks gestation with a massive vulval lesion. She was HIV seropositive and taking anti-retroviral therapy. She was anemic with a hemoglobin level of 5.9 and was transfused 4.0 of packed cells. She underwent examination under anesthesia and vulval biopsy. She went into preterm labor and was delivered by cesarean section. Unfortunately, the baby had died while receiving corticosteroid therapy. The histopathological report confirmed a Kaposi’s sarcoma, and she was referred to oncologists for chemotherapy.</p></sec><sec><title>Conclusion</title><p>Kaposi’s sarcoma can occur in pregnancy in both seropositive and seronegative patients. Kaposi’s sarcoma causes significant fetal and maternal health complications.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mcgarvey, Me" uniqKey="Mcgarvey M">ME McGarvey</name></author><author><name sortKey="Tulpule, A" uniqKey="Tulpule A">A Tulpule</name></author><author><name sortKey="Cai, J" uniqKey="Cai J">J Cai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bagni, R" uniqKey="Bagni R">R Bagni</name></author><author><name sortKey="Whitby, D" uniqKey="Whitby D">D Whitby</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Goedert, Jj" uniqKey="Goedert J">JJ Goedert</name></author><author><name sortKey="Charurat, M" uniqKey="Charurat M">M Charurat</name></author><author><name sortKey="Blattner, Wa" uniqKey="Blattner W">WA Blattner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sitas, F" uniqKey="Sitas F">F Sitas</name></author><author><name sortKey="Newton, R" uniqKey="Newton R">R Newton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pantanowitz, L" uniqKey="Pantanowitz L">L Pantanowitz</name></author><author><name sortKey="Dezube, Bj" uniqKey="Dezube B">BJ Dezube</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bryant, Ae" uniqKey="Bryant A">AE Bryant</name></author><author><name sortKey="Genc, M" uniqKey="Genc M">M Genc</name></author><author><name sortKey="Hurtado, Rm" uniqKey="Hurtado R">RM Hurtado</name></author><author><name sortKey="Chen, Kt" uniqKey="Chen K">KT Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rajaratnam, K" uniqKey="Rajaratnam K">K Rajaratnam</name></author><author><name sortKey="Desai, S" uniqKey="Desai S">S Desai</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brunet Possenti, F" uniqKey="Brunet Possenti F">F Brunet-Possenti</name></author><author><name sortKey="Pages, C" uniqKey="Pages C">C Pages</name></author><author><name sortKey="Rouzier, R" uniqKey="Rouzier R">R Rouzier</name></author><author><name sortKey="Dupin, N" uniqKey="Dupin N">N Dupin</name></author><author><name sortKey="Bagot, M" uniqKey="Bagot M">M Bagot</name></author><author><name sortKey="Lebbe, C" uniqKey="Lebbe C">C Lebbe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rawlison, Kf" uniqKey="Rawlison K">KF Rawlison</name></author><author><name sortKey="Zubrow, Ab" uniqKey="Zubrow A">AB Zubrow</name></author><author><name sortKey="Harris, Ma" uniqKey="Harris M">MA Harris</name></author><author><name sortKey="Jackson, Uc" uniqKey="Jackson U">UC Jackson</name></author><author><name sortKey="Chao, S" uniqKey="Chao S">S Chao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Adeyemo, A" uniqKey="Adeyemo A">A Adeyemo</name></author><author><name sortKey="Wood, C" uniqKey="Wood C">C Wood</name></author><author><name sortKey="Govind, A" uniqKey="Govind A">A Govind</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccarty, Ka" uniqKey="Mccarty K">KA McCarty</name></author><author><name sortKey="Bungu, Z" uniqKey="Bungu Z">Z Bungu</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int Med Case Rep J</journal-id><journal-id journal-id-type="iso-abbrev">Int Med Case Rep J</journal-id><journal-id journal-id-type="publisher-id">International Medical Case Reports Journal</journal-id><journal-title-group><journal-title>International Medical Case Reports Journal</journal-title></journal-title-group><issn pub-type="epub">1179-142X</issn><publisher><publisher-name>Dove Medical Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27536163</article-id><article-id pub-id-type="pmc">4973725</article-id><article-id pub-id-type="doi">10.2147/IMCRJ.S111171</article-id><article-id pub-id-type="publisher-id">imcrj-9-227</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Massive vulval Kaposi’s sarcoma in pregnancy: case report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ngwenya</surname><given-names>Solwayo</given-names></name><xref ref-type="aff" rid="af1-imcrj-9-227">1</xref><xref ref-type="aff" rid="af2-imcrj-9-227">2</xref><xref ref-type="corresp" rid="c1-imcrj-9-227"></xref></contrib></contrib-group><aff id="af1-imcrj-9-227"><label>1</label>Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Mzilikazi</aff><aff id="af2-imcrj-9-227"><label>2</label>Royal Women’s Clinic, Bulawayo, Matabeleland, Zimbabwe</aff><author-notes><corresp id="c1-imcrj-9-227">Correspondence: Solwayo Ngwenya, Royal Women’s Clinic, 52A Cecil Avenue, Hillside, Bulawayo, Matabeleland, Zimbabwe, Tel +263 772 292 391, Email <email>drsolngwe@yahoo.co.uk</email></corresp></author-notes><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>29</day><month>7</month><year>2016</year></pub-date><volume>9</volume><fpage>227</fpage><lpage>229</lpage><permissions><copyright-statement>© 2016 Ngwenya. This work is published and licensed by Dove Medical Press Limited</copyright-statement><copyright-year>2016</copyright-year><license><license-p>The full terms of this license are available at <ext-link ext-link-type="uri" xlink:href="https://www.dovepress.com/terms.php">https://www.dovepress.com/terms.php</ext-link> and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p></license></permissions><abstract><sec><title>Introduction</title><p>The complications of HIV/AIDS can produce grossly abnormal pathology. In low-resourced settings, women can present late with huge lesions. Massive vulval pathology copresenting in pregnancy produces difficulties in managing the patients and may lead to poor maternal or fetal outcomes.</p></sec><sec><title>Case report</title><p>A 27-year-old P1 G2 (second pregnancy one live birth) patient presented at 30 weeks gestation with a massive vulval lesion. She was HIV seropositive and taking anti-retroviral therapy. She was anemic with a hemoglobin level of 5.9 and was transfused 4.0 of packed cells. She underwent examination under anesthesia and vulval biopsy. She went into preterm labor and was delivered by cesarean section. Unfortunately, the baby had died while receiving corticosteroid therapy. The histopathological report confirmed a Kaposi’s sarcoma, and she was referred to oncologists for chemotherapy.</p></sec><sec><title>Conclusion</title><p>Kaposi’s sarcoma can occur in pregnancy in both seropositive and seronegative patients. Kaposi’s sarcoma causes significant fetal and maternal health complications.</p></sec></abstract><kwd-group><title>Keywords</title><kwd>Vulval mass</kwd><kwd>Kaposi’s sarcoma</kwd><kwd>HIV</kwd><kwd>AIDS</kwd><kwd>anemia</kwd><kwd>pregnancy</kwd></kwd-group></article-meta></front><body><sec sec-type="intro"><title>Introduction</title><p>This is the first time a case of vulval Kaposi’s sarcoma in pregnancy has been described in the literature. Kaposi’s sarcoma is an opportunistic tumor that develops with increased frequency (100,000-fold) after HIV infection.<xref rid="b1-imcrj-9-227" ref-type="bibr">1</xref> It is one of the commonest cancers in HIV-infected patients.<xref rid="b2-imcrj-9-227" ref-type="bibr">2</xref> Herpes virus also known as herpes virus 8 is a tumorigenic casual agent of Kaposi’s sarcoma.<xref rid="b2-imcrj-9-227" ref-type="bibr">2</xref>–<xref rid="b4-imcrj-9-227" ref-type="bibr">4</xref></p></sec><sec><title>Case report</title><p>A 27-year-old P1 G2 (second pregnancy one live birth) patient presented at 30 weeks gestation with a massive vulval lesion. The lesion had been present since the past year in a smaller form. She said that it had rapidly progressed within the last 2 months to a massive form. She was HIV seropositive and taking antiretroviral therapy. Her last CD4 count was 107 cells/mm<sup>3</sup>. She was able to pass stool and urine but complained of vulval pain and discomfort.</p><p>On examination, she was found to have a huge foul-smelling vulval mass. The mass was occupying the whole vulva, perineum, and anal region. The mass was partly necrotic and with vesicular round lesions. The perineal organs were not visible. There were no other suspicious lesions seen in her mouth or skin. She was pale, with a gravid uterus of 30 weeks gestation and a positive fetal heart by Pinard auscultation. There were no other alternative instruments for fetal heart rate monitoring in this low-resourced clinical setting. The use of electronic fetal heart rate monitoring is yet to be introduced in these settings.</p><p>The investigations done showed an Hb of 5.9 g/dL, white blood cell of 7.29×10<sup>9</sup>/L, and platelet count 144×10<sup>9</sup>/L. The repeat CD4 count was 345 cells/mm<sup>3</sup>. An ultrasound scan showed a live fetus of 29 weeks 6 days gestation. She was transfused 4.0 units of packed cells. The posttransfusion Hb was 9.7. The chest X-ray was normal. She underwent examination under anesthesia and vulval biopsy. The findings observed in the operation theater can be seen in <xref ref-type="fig" rid="f1-imcrj-9-227">Figure 1</xref>. There was palpable bilateral lymphadenopathy. The urethra was not visible. There were no areas that appeared to be infested around the lesion. The plan was to deliver her by cesarean section after giving her corticosteroid treatment for lung maturation. This mode of delivery was the better one as achieving a normal delivery would be difficult.</p><p>She was referred to oncologists for chemotherapy. She went into preterm labor and was delivered by cesarean section. Unfortunately, the baby had died while receiving corticosteroid therapy for fetal lung maturation. The baby’s birth weight was 1,300 g. No postmortem examination for the baby was done. She had wound sepsis, which was treated with intravenous broad-spectrum antibiotics. Postoperatively she recovered well. The histopathological report described “proliferating vasoformative spindle cells with red cell extravasation exhibiting a sieve-like pattern, features consistent with Kaposi’s sarcoma”. There are no facilities for testing for herpes virus 8 in this low-resourced setting. The placenta did not undergo virology or histological testing. The patient was referred to oncologists for chemotherapy, where is undergoing their care. Written informed consent was obtained from the patient.</p></sec><sec sec-type="discussion"><title>Discussion</title><p>Kaposi’s sarcoma causes significant morbidity from mucocutaneous involvement and mortality from complications of visceral sites of disease such as the gastrointestinal tract and liver.<xref rid="b1-imcrj-9-227" ref-type="bibr">1</xref> In pregnancy, it compromises both maternal and fetal health, leading to poor or adverse outcomes.</p><p>Kaposi’s sarcoma has been described in pregnancy to be occurring in the lung<xref rid="b5-imcrj-9-227" ref-type="bibr">5</xref>,<xref rid="b6-imcrj-9-227" ref-type="bibr">6</xref> and trachea.<xref rid="b7-imcrj-9-227" ref-type="bibr">7</xref> It can present as skin lesions, lymphadenopathy, or respiratory compromise.<xref rid="b5-imcrj-9-227" ref-type="bibr">5</xref>–<xref rid="b7-imcrj-9-227" ref-type="bibr">7</xref> There have been rare cases of HIV-seronegative patients with Kaposi’s sarcoma.<xref rid="b8-imcrj-9-227" ref-type="bibr">8</xref></p><p>The treatment for Kaposi’s sarcoma is chemotherapy, and the tumor is potentially responsive.<xref rid="b6-imcrj-9-227" ref-type="bibr">6</xref> Patients with advanced disease such as widespread mucocutaneous disease, lymphedema, and visceral involvement are treated most effectively with cytotoxic agents.<xref rid="b1-imcrj-9-227" ref-type="bibr">1</xref> Cytotoxic agents used include a combination of doxorubicin, bleomycin, and vinblastine, which have been given during pregnancy, resulting in a live growth-restricted baby.<xref rid="b9-imcrj-9-227" ref-type="bibr">9</xref> Conservative management has also been described with good outcomes.<xref rid="b10-imcrj-9-227" ref-type="bibr">10</xref> A rare case of Kaposi’s sarcoma in a 2-week-old infant born to a mother with Kaposi’s sarcoma/AIDS has been reported in the literature.<xref rid="b11-imcrj-9-227" ref-type="bibr">11</xref> Kaposi’s sarcoma in an HIV-seropositive patient presenting as a massive vulval mass in pregnancy complicates the pregnancy, even further affecting the vaginal mode of delivery. A cesarean section being done with a dirty vulva risks complicating with sepsis as happened in this case.</p></sec><sec><title>Conclusion</title><p>Kaposi’s sarcoma can occur in pregnancy in both seropositive and seronegative patients. Therefore, any suspicious lesions must have early recourse to a biopsy to obtain histopatho-logical diagnosis and early treatment. Kaposi’s sarcoma causes significant fetal and maternal health complications. In low-resourced settings, when the clinician is faced with a heavy disease burden, with little recourse to advanced medical equipment, the only target remains to prevent maternal morbidity and mortality.</p></sec></body><back><fn-group><fn><p><bold>Disclosure</bold></p><p>The author reports no conflicts of interest in this work.</p></fn></fn-group><ref-list><title>References</title><ref id="b1-imcrj-9-227"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McGarvey</surname><given-names>ME</given-names></name><name><surname>Tulpule</surname><given-names>A</given-names></name><name><surname>Cai</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Emerging treatments for epidemic (AIDS related) Kaposi’s sarcoma</article-title><source>Curr Opin Oncol</source><year>1988</year><volume>10</volume><issue>5</issue><fpage>413</fpage><lpage>421</lpage><pub-id pub-id-type="pmid">9800111</pub-id></element-citation></ref><ref id="b2-imcrj-9-227"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bagni</surname><given-names>R</given-names></name><name><surname>Whitby</surname><given-names>D</given-names></name></person-group><article-title>Kaposi’s sarcoma-associated herpes virus transmission and primary infection</article-title><source>Curr Opin HIV AIDS</source><year>2009</year><volume>4</volume><issue>1</issue><fpage>22</fpage><lpage>26</lpage><pub-id pub-id-type="pmid">19339936</pub-id></element-citation></ref><ref id="b3-imcrj-9-227"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Goedert</surname><given-names>JJ</given-names></name><name><surname>Charurat</surname><given-names>M</given-names></name><name><surname>Blattner</surname><given-names>WA</given-names></name><etal></etal></person-group><article-title>Risk factors for Kaposi’s sarcoma-associated herpes virus infection amongst HIV-1 infected pregnant women in the USA</article-title><source>AIDS</source><year>2003</year><volume>17</volume><issue>3</issue><fpage>425</fpage><lpage>433</lpage><pub-id pub-id-type="pmid">12556697</pub-id></element-citation></ref><ref id="b4-imcrj-9-227"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sitas</surname><given-names>F</given-names></name><name><surname>Newton</surname><given-names>R</given-names></name></person-group><article-title>Kaposi’s sarcoma in South Africa</article-title><source>J Natl Cancer Inst Monogr</source><year>2001</year><issue>28</issue><fpage>1</fpage><lpage>4</lpage><pub-id pub-id-type="pmid">11158199</pub-id></element-citation></ref><ref id="b5-imcrj-9-227"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pantanowitz</surname><given-names>L</given-names></name><name><surname>Dezube</surname><given-names>BJ</given-names></name></person-group><article-title>Kaposi’s sarcoma and pregnancy</article-title><source>Am J Perinatol</source><year>2005</year><volume>22</volume><issue>8</issue><fpage>457</fpage><pub-id pub-id-type="pmid">16283606</pub-id></element-citation></ref><ref id="b6-imcrj-9-227"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bryant</surname><given-names>AE</given-names></name><name><surname>Genc</surname><given-names>M</given-names></name><name><surname>Hurtado</surname><given-names>RM</given-names></name><name><surname>Chen</surname><given-names>KT</given-names></name></person-group><article-title>Pulmonary Kaposi’s sarcoma in pregnancy</article-title><source>Am J Perinatol</source><year>2004</year><volume>21</volume><issue>6</issue><fpage>355</fpage><lpage>363</lpage><pub-id pub-id-type="pmid">15311373</pub-id></element-citation></ref><ref id="b7-imcrj-9-227"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rajaratnam</surname><given-names>K</given-names></name><name><surname>Desai</surname><given-names>S</given-names></name></person-group><article-title>Kaposi’s sarcoma of the trachea</article-title><source>J Laryngol Otol</source><year>1988</year><volume>102</volume><issue>10</issue><fpage>951</fpage><lpage>953</lpage><pub-id pub-id-type="pmid">3199020</pub-id></element-citation></ref><ref id="b8-imcrj-9-227"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brunet-Possenti</surname><given-names>F</given-names></name><name><surname>Pages</surname><given-names>C</given-names></name><name><surname>Rouzier</surname><given-names>R</given-names></name><name><surname>Dupin</surname><given-names>N</given-names></name><name><surname>Bagot</surname><given-names>M</given-names></name><name><surname>Lebbe</surname><given-names>C</given-names></name></person-group><article-title>Kaposi’s sarcoma and pregnancy: case report and literature review</article-title><source>Dermatology</source><year>2013</year><volume>226</volume><issue>4</issue><fpage>311</fpage><lpage>314</lpage><pub-id pub-id-type="pmid">23838298</pub-id></element-citation></ref><ref id="b9-imcrj-9-227"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rawlison</surname><given-names>KF</given-names></name><name><surname>Zubrow</surname><given-names>AB</given-names></name><name><surname>Harris</surname><given-names>MA</given-names></name><name><surname>Jackson</surname><given-names>UC</given-names></name><name><surname>Chao</surname><given-names>S</given-names></name></person-group><article-title>Disseminated Kaposi’s sarcoma in pregnancy: a manifestation of acquired immune deficiency syndrome</article-title><source>Obstet Gynecol</source><year>1984</year><volume>63</volume><issue>3 suppl</issue><fpage>2S</fpage><lpage>6S</lpage><pub-id pub-id-type="pmid">6700876</pub-id></element-citation></ref><ref id="b10-imcrj-9-227"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Adeyemo</surname><given-names>A</given-names></name><name><surname>Wood</surname><given-names>C</given-names></name><name><surname>Govind</surname><given-names>A</given-names></name></person-group><article-title>Kaposi’s sarcoma in pregnancy after initiation of highly active antiretroviral therapy: a manifestation of immune reconstitution syndrome</article-title><source>Int J STD AIDS</source><year>2012</year><volume>23</volume><issue>12</issue><fpage>905</fpage><lpage>906</lpage><pub-id pub-id-type="pmid">23258835</pub-id></element-citation></ref><ref id="b11-imcrj-9-227"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McCarty</surname><given-names>KA</given-names></name><name><surname>Bungu</surname><given-names>Z</given-names></name></person-group><article-title>Kaposi’s sarcoma in a two week old infant born to a mother with Kaposi’s sarcoma/AIDS</article-title><source>Cent Afr J Med</source><year>1995</year><volume>41</volume><issue>10</issue><fpage>330</fpage><lpage>331</lpage><pub-id pub-id-type="pmid">8556781</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="f1-imcrj-9-227" position="float"><label>Figure 1</label><caption><p>A photo taken during examination under anesthesia showing a massive vulval mass.</p><p><bold>Notes:</bold> Lesions are hemorrhagic (A), necrotic (B), and friable (C).</p></caption><graphic xlink:href="imcrj-9-227Fig1"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a LymphedemaV1
| This area was generated with Dilib version V0.6.31. |  |