AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?
Identifieur interne : 004056 ( Pmc/Corpus ); précédent : 004055; suivant : 004057AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?
Auteurs : Francesco M. Solivetti ; Fulvia Elia ; Alessandra Latini ; Carlo Cota ; Paola Cordiali-Fei ; Aldo Di CarloSource :
- Journal of Experimental & Clinical Cancer Research : CR [ 0392-9078 ] ; 2011.
Abstract
Kaposi Sarcoma (KS) is a malignancy of endothelial skin cells with multifocal localization on the skin, lymph nodes and visceral organs. Although all clinical variants are associated with HHV-8 infection, specific differences in the clinical onset and in the natural history of AIDS-KS and Classic-KS have been described. The present randomised prospective-observational study aimed to investigate whether the ultrasound pattern and color Doppler flow imaging of vascularisation of skin lesions of patients with Classic KS (CKS) or AIDS-KS could provide useful information to the evaluation of clinical activity of the disease.
Cutaneous lesions of 24 patients with histologically confirmed KS were investigated using very high frequency ultrasound probes; 16 patients had CKS and 8 had AIDS-KS. HHV-8 infection was confirmed in all patients by investigating the specific humoral response to viral antigens. Immunological and virological parameters were also assessed to monitor HIV or HHV-8 viral infection. For each patient, a target skin lesion was selected on the basis of size (diameter from 0.4 to 2 cm). Each lesion was analyzed in terms of size, depth and color Doppler pattern.
The B-mode ultrasound patterns of skin lesions did not differ when comparing CKS patients to AIDS-KS patients, whereas the color Doppler signal, which is associated with vascular activity, was detected in the KS lesions of 6/8 AIDS-KS patients (75.0%) and in 2/16 CKS (16,7%); the latter two patients showed a clinically progressive and extensive disease stage (IV B).
Our preliminary results suggest that small cutaneous KS lesions - in both CKS and AIDS-KS patients- display similar B-mode ultrasound patterns ( hypoechoic, well defined, superficial lesions). However, the color Doppler signal, which is associated with endothelial activity and angiogenesis, which play a substantial role in KS progression, could constitute a useful tool for evaluating disease activity.
Url:
DOI: 10.1186/1756-9966-30-40
PubMed: 21489270
PubMed Central: 3095540
Links to Exploration step
PMC:3095540Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?</title><author><name sortKey="Solivetti, Francesco M" sort="Solivetti, Francesco M" uniqKey="Solivetti F" first="Francesco M" last="Solivetti">Francesco M. Solivetti</name><affiliation><nlm:aff id="I1">Radiology Department, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Elia, Fulvia" sort="Elia, Fulvia" uniqKey="Elia F" first="Fulvia" last="Elia">Fulvia Elia</name><affiliation><nlm:aff id="I1">Radiology Department, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Latini, Alessandra" sort="Latini, Alessandra" uniqKey="Latini A" first="Alessandra" last="Latini">Alessandra Latini</name><affiliation><nlm:aff id="I2">Infective Dermatology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Cota, Carlo" sort="Cota, Carlo" uniqKey="Cota C" first="Carlo" last="Cota">Carlo Cota</name><affiliation><nlm:aff id="I3">Dermatopathology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Cordiali Fei, Paola" sort="Cordiali Fei, Paola" uniqKey="Cordiali Fei P" first="Paola" last="Cordiali-Fei">Paola Cordiali-Fei</name><affiliation><nlm:aff id="I4">Clinical Pathology and Microbiology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Di Carlo, Aldo" sort="Di Carlo, Aldo" uniqKey="Di Carlo A" first="Aldo" last="Di Carlo">Aldo Di Carlo</name><affiliation><nlm:aff id="I5">Scientific Director, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21489270</idno><idno type="pmc">3095540</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095540</idno><idno type="RBID">PMC:3095540</idno><idno type="doi">10.1186/1756-9966-30-40</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">004056</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004056</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?</title><author><name sortKey="Solivetti, Francesco M" sort="Solivetti, Francesco M" uniqKey="Solivetti F" first="Francesco M" last="Solivetti">Francesco M. Solivetti</name><affiliation><nlm:aff id="I1">Radiology Department, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Elia, Fulvia" sort="Elia, Fulvia" uniqKey="Elia F" first="Fulvia" last="Elia">Fulvia Elia</name><affiliation><nlm:aff id="I1">Radiology Department, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Latini, Alessandra" sort="Latini, Alessandra" uniqKey="Latini A" first="Alessandra" last="Latini">Alessandra Latini</name><affiliation><nlm:aff id="I2">Infective Dermatology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Cota, Carlo" sort="Cota, Carlo" uniqKey="Cota C" first="Carlo" last="Cota">Carlo Cota</name><affiliation><nlm:aff id="I3">Dermatopathology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Cordiali Fei, Paola" sort="Cordiali Fei, Paola" uniqKey="Cordiali Fei P" first="Paola" last="Cordiali-Fei">Paola Cordiali-Fei</name><affiliation><nlm:aff id="I4">Clinical Pathology and Microbiology Division, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author><author><name sortKey="Di Carlo, Aldo" sort="Di Carlo, Aldo" uniqKey="Di Carlo A" first="Aldo" last="Di Carlo">Aldo Di Carlo</name><affiliation><nlm:aff id="I5">Scientific Director, San Gallicano Dermatology Institute - Rome - Italy</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Experimental & Clinical Cancer Research : CR</title><idno type="ISSN">0392-9078</idno><idno type="eISSN">1756-9966</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Kaposi Sarcoma (KS) is a malignancy of endothelial skin cells with multifocal localization on the skin, lymph nodes and visceral organs. Although all clinical variants are associated with HHV-8 infection, specific differences in the clinical onset and in the natural history of AIDS-KS and Classic-KS have been described. The present randomised prospective-observational study aimed to investigate whether the ultrasound pattern and color Doppler flow imaging of vascularisation of skin lesions of patients with Classic KS (CKS) or AIDS-KS could provide useful information to the evaluation of clinical activity of the disease.</p></sec><sec><title>Methods</title><p>Cutaneous lesions of 24 patients with histologically confirmed KS were investigated using very high frequency ultrasound probes; 16 patients had CKS and 8 had AIDS-KS. HHV-8 infection was confirmed in all patients by investigating the specific humoral response to viral antigens. Immunological and virological parameters were also assessed to monitor HIV or HHV-8 viral infection. For each patient, a target skin lesion was selected on the basis of size (diameter from 0.4 to 2 cm). Each lesion was analyzed in terms of size, depth and color Doppler pattern.</p></sec><sec><title>Results</title><p>The B-mode ultrasound patterns of skin lesions did not differ when comparing CKS patients to AIDS-KS patients, whereas the color Doppler signal, which is associated with vascular activity, was detected in the KS lesions of 6/8 AIDS-KS patients (75.0%) and in 2/16 CKS (16,7%); the latter two patients showed a clinically progressive and extensive disease stage (IV B).</p></sec><sec><title>Conclusions</title><p>Our preliminary results suggest that small cutaneous KS lesions - in both CKS and AIDS-KS patients- display similar B-mode ultrasound patterns ( hypoechoic, well defined, superficial lesions). However, the color Doppler signal, which is associated with endothelial activity and angiogenesis, which play a substantial role in KS progression, could constitute a useful tool for evaluating disease activity.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mesri, Ea" uniqKey="Mesri E">EA Mesri</name></author><author><name sortKey="Cesarman, E" uniqKey="Cesarman E">E Cesarman</name></author><author><name sortKey="Boshoff, C" uniqKey="Boshoff C">C Boshoff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tornesello, Ml" uniqKey="Tornesello M">ML Tornesello</name></author><author><name sortKey="Biryahwaho, B" uniqKey="Biryahwaho B">B Biryahwaho</name></author><author><name sortKey="Downing, R" uniqKey="Downing R">R Downing</name></author><author><name sortKey="Hatzakis, A" uniqKey="Hatzakis A">A Hatzakis</name></author><author><name sortKey="Alessi, E" uniqKey="Alessi E">E Alessi</name></author><author><name sortKey="Cusini, M" uniqKey="Cusini M">M Cusini</name></author><author><name sortKey="Ruocco, V" uniqKey="Ruocco V">V Ruocco</name></author><author><name sortKey="Katongole Mbidde, E" uniqKey="Katongole Mbidde E">E Katongole-Mbidde</name></author><author><name sortKey="Loquercio, G" uniqKey="Loquercio G">G Loquercio</name></author><author><name sortKey="Buonaguro, L" uniqKey="Buonaguro L">L Buonaguro</name></author><author><name sortKey="Buonaguro, Fm" uniqKey="Buonaguro F">FM Buonaguro</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Lanternier, F" uniqKey="Lanternier F">F Lanternier</name></author><author><name sortKey="Lebbe, C" uniqKey="Lebbe C">C Lebbé</name></author><author><name sortKey="Schartz, N" uniqKey="Schartz N">N Schartz</name></author><author><name sortKey="Farhi, D" uniqKey="Farhi D">D Farhi</name></author><author><name sortKey="Marcelin, Ag" uniqKey="Marcelin A">AG Marcelin</name></author><author><name sortKey="Kerob, D" uniqKey="Kerob D">D Kérob</name></author><author><name sortKey="Agbalika, F" uniqKey="Agbalika F">F Agbalika</name></author><author><name sortKey="Verola, O" uniqKey="Verola O">O Vérola</name></author><author><name sortKey="Gorin, I" uniqKey="Gorin I">I Gorin</name></author><author><name sortKey="Janier, M" uniqKey="Janier M">M Janier</name></author><author><name sortKey="Avril, Mf" uniqKey="Avril M">MF Avril</name></author><author><name sortKey="Dupin, N" uniqKey="Dupin N">N. Dupin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Giuliani, M" uniqKey="Giuliani M">M Giuliani</name></author><author><name sortKey="Cordiali Fei, P" uniqKey="Cordiali Fei P">P Cordiali-Fei</name></author><author><name sortKey="Castilletti, C" uniqKey="Castilletti C">C Castilletti</name></author><author><name sortKey="Di Carlo, A" uniqKey="Di Carlo A">A Di Carlo</name></author><author><name sortKey="Palamara, G" uniqKey="Palamara G">G Palamara</name></author><author><name sortKey="Boros, S" uniqKey="Boros S">S Boros</name></author><author><name sortKey="Rezza, G" uniqKey="Rezza G">G Rezza</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gessain, A" uniqKey="Gessain A">A Gessain</name></author><author><name sortKey="Duprez, R" uniqKey="Duprez R">R Duprez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sullivan, Rj" uniqKey="Sullivan R">RJ Sullivan</name></author><author><name sortKey="Pantanowitz, L" uniqKey="Pantanowitz L">L Pantanowitz</name></author><author><name sortKey="Casper, C" uniqKey="Casper C">C Casper</name></author><author><name sortKey="Stebbing, J" uniqKey="Stebbing J">J Stebbing</name></author><author><name sortKey="Dezube, Bj" uniqKey="Dezube B">BJ Dezube</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brambilla, L" uniqKey="Brambilla L">L Brambilla</name></author><author><name sortKey="Boneschi, V" uniqKey="Boneschi V">V Boneschi</name></author><author><name sortKey="Taglioni, M" uniqKey="Taglioni M">M Taglioni</name></author><author><name sortKey="Ferrucci, S" uniqKey="Ferrucci S">S Ferrucci</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kriegel, Rl" uniqKey="Kriegel R">RL Kriegel</name></author><author><name sortKey="Laubenstein, Lj" uniqKey="Laubenstein L">LJ Laubenstein</name></author><author><name sortKey="Muggia, Fm" uniqKey="Muggia F">FM Muggia</name></author><author><name sortKey="Kaposi S, Sarcoma" uniqKey="Kaposi S S">sarcoma Kaposi's</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stebbing, J" uniqKey="Stebbing J">J Stebbing</name></author><author><name sortKey="Sanitt, A" uniqKey="Sanitt A">A Sanitt</name></author><author><name sortKey="Nelson, M" uniqKey="Nelson M">M Nelson</name></author><author><name sortKey="Pawles, T" uniqKey="Pawles T">T Pawles</name></author><author><name sortKey="Gazzard, B" uniqKey="Gazzard B">B Gazzard</name></author><author><name sortKey="Bower, M" uniqKey="Bower M">M Bower</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boneschi, V" uniqKey="Boneschi V">V Boneschi</name></author><author><name sortKey="Brambilla, L" uniqKey="Brambilla L">L Brambilla</name></author><author><name sortKey="Berti, E" uniqKey="Berti E">E Berti</name></author><author><name sortKey="Ferrucci, S" uniqKey="Ferrucci S">S Ferrucci</name></author><author><name sortKey="Corbellino, M" uniqKey="Corbellino M">M Corbellino</name></author><author><name sortKey="Parravicini, C" uniqKey="Parravicini C">C Parravicini</name></author><author><name sortKey="Fossati, S" uniqKey="Fossati S">S Fossati</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brambilla, L" uniqKey="Brambilla L">L Brambilla</name></author><author><name sortKey="Labianca, R" uniqKey="Labianca R">R Labianca</name></author><author><name sortKey="Ferrucci, Sm" uniqKey="Ferrucci S">SM Ferrucci</name></author><author><name sortKey="Taglioni, M" uniqKey="Taglioni M">M Taglioni</name></author><author><name sortKey="Boneschi, V" uniqKey="Boneschi V">V Boneschi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brambilla, L" uniqKey="Brambilla L">L Brambilla</name></author><author><name sortKey="Boneschi, V" uniqKey="Boneschi V">V Boneschi</name></author><author><name sortKey="Fossati, S" uniqKey="Fossati S">S Fossati</name></author><author><name sortKey="Melotti, E" uniqKey="Melotti E">E Melotti</name></author><author><name sortKey="Clerici, M" uniqKey="Clerici M">M Clerici</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lauriola, C" uniqKey="Lauriola C">C Lauriola</name></author><author><name sortKey="Bergonzini, R" uniqKey="Bergonzini R">R Bergonzini</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mahoney, Se" uniqKey="Mahoney S">SE Mahoney</name></author><author><name sortKey="Paddock, Sw" uniqKey="Paddock S">SW Paddock</name></author><author><name sortKey="Smith, Lc" uniqKey="Smith L">LC Smith</name></author><author><name sortKey="Lewis, De" uniqKey="Lewis D">DE Lewis</name></author><author><name sortKey="Duvic, M" uniqKey="Duvic M">M Duvic</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schmid Wendtner, Mh" uniqKey="Schmid Wendtner M">MH Schmid-Wendtner</name></author><author><name sortKey="Dill Muller, D" uniqKey="Dill Muller D">D Dill-Müller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong, S" uniqKey="Wong S">S Wong</name></author><author><name sortKey="Kaur, A" uniqKey="Kaur A">A Kaur</name></author><author><name sortKey="Back, M" uniqKey="Back M">M Back</name></author><author><name sortKey="Lee, Km" uniqKey="Lee K">KM Lee</name></author><author><name sortKey="Baggarley, S" uniqKey="Baggarley S">S Baggarley</name></author><author><name sortKey="Lu, Jj" uniqKey="Lu J">JJ Lu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bogner, Jr" uniqKey="Bogner J">JR Bogner</name></author><author><name sortKey="Zietz, C" uniqKey="Zietz C">C Zietz</name></author><author><name sortKey="Held, M" uniqKey="Held M">M Held</name></author><author><name sortKey="Spatling, S" uniqKey="Spatling S">S Spatling</name></author><author><name sortKey="Sandor, P" uniqKey="Sandor P">P Sandor</name></author><author><name sortKey="Kronawitter, U" uniqKey="Kronawitter U">U Kronawitter</name></author><author><name sortKey="Goebel, Fd" uniqKey="Goebel F">FD Goebel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, Y" uniqKey="Wang Y">Y Wang</name></author><author><name sortKey="Dan, Hj" uniqKey="Dan H">HJ Dan</name></author><author><name sortKey="Fan, Jh" uniqKey="Fan J">JH Fan</name></author><author><name sortKey="Wen, S B" uniqKey="Wen S">S-B Wen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bertolini, F" uniqKey="Bertolini F">F Bertolini</name></author><author><name sortKey="Mancuso, P" uniqKey="Mancuso P">P Mancuso</name></author><author><name sortKey="Shaked, Y" uniqKey="Shaked Y">Y Shaked</name></author><author><name sortKey="Kerbel, Rs" uniqKey="Kerbel R">RS Kerbel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kalof, An" uniqKey="Kalof A">AN Kalof</name></author><author><name sortKey="Cooper, K" uniqKey="Cooper K">K Cooper</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rezza, G" uniqKey="Rezza G">G Rezza</name></author><author><name sortKey="Lennette, Et" uniqKey="Lennette E">ET Lennette</name></author><author><name sortKey="Giuliani, M" uniqKey="Giuliani M">M Giuliani</name></author><author><name sortKey="Pezzotti, P" uniqKey="Pezzotti P">P Pezzotti</name></author><author><name sortKey="Caprilli, F" uniqKey="Caprilli F">F Caprilli</name></author><author><name sortKey="Monini, P" uniqKey="Monini P">P Monini</name></author><author><name sortKey="Butt, S" uniqKey="Butt S">S Buttò</name></author><author><name sortKey="Lodi, G" uniqKey="Lodi G">G Lodi</name></author><author><name sortKey="Di Carlo, A" uniqKey="Di Carlo A">A Di Carlo</name></author><author><name sortKey="Levi, Ja" uniqKey="Levi J">JA Levi</name></author><author><name sortKey="Ensoli, B" uniqKey="Ensoli B">B Ensoli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cammarota, T" uniqKey="Cammarota T">T Cammarota</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barillari, G" uniqKey="Barillari G">G Barillari</name></author><author><name sortKey="Ensoli, B" uniqKey="Ensoli B">B Ensoli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pyakurel, P" uniqKey="Pyakurel P">P Pyakurel</name></author><author><name sortKey="Pak, F" uniqKey="Pak F">F Pak</name></author><author><name sortKey="Mwakigonja, Ar" uniqKey="Mwakigonja A">AR Mwakigonja</name></author><author><name sortKey="Kaaya, E" uniqKey="Kaaya E">E Kaaya</name></author><author><name sortKey="Biberfeld, P" uniqKey="Biberfeld P">P Biberfeld</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Exp Clin Cancer Res</journal-id><journal-title-group><journal-title>Journal of Experimental & Clinical Cancer Research : CR</journal-title></journal-title-group><issn pub-type="ppub">0392-9078</issn><issn pub-type="epub">1756-9966</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21489270</article-id><article-id pub-id-type="pmc">3095540</article-id><article-id pub-id-type="publisher-id">1756-9966-30-40</article-id><article-id pub-id-type="doi">10.1186/1756-9966-30-40</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Solivetti</surname><given-names>Francesco M</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>solivetti@ifo.it</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Elia</surname><given-names>Fulvia</given-names></name><xref ref-type="aff" rid="I1">1</xref><email>elia@ifo.it</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Latini</surname><given-names>Alessandra</given-names></name><xref ref-type="aff" rid="I2">2</xref><email>a.latini@ifo.it</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Cota</surname><given-names>Carlo</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>cota@ifo.it</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Cordiali-Fei</surname><given-names>Paola</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>cordiali-fei@ifo.it</email></contrib><contrib contrib-type="author" id="A6"><name><surname>Di Carlo</surname><given-names>Aldo</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>dicarlo@ifo.it</email></contrib></contrib-group><aff id="I1"><label>1</label>Radiology Department, San Gallicano Dermatology Institute - Rome - Italy</aff><aff id="I2"><label>2</label>Infective Dermatology Division, San Gallicano Dermatology Institute - Rome - Italy</aff><aff id="I3"><label>3</label>Dermatopathology Division, San Gallicano Dermatology Institute - Rome - Italy</aff><aff id="I4"><label>4</label>Clinical Pathology and Microbiology Division, San Gallicano Dermatology Institute - Rome - Italy</aff><aff id="I5"><label>5</label>Scientific Director, San Gallicano Dermatology Institute - Rome - Italy</aff><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>13</day><month>4</month><year>2011</year></pub-date><volume>30</volume><issue>1</issue><fpage>40</fpage><lpage>40</lpage><history><date date-type="received"><day>16</day><month>2</month><year>2011</year></date><date date-type="accepted"><day>13</day><month>4</month><year>2011</year></date></history><permissions><copyright-statement>Copyright ©2011 Solivetti et al; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2011</copyright-year><copyright-holder>Solivetti et al; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.jeccr.com/content/30/1/40"></self-uri><abstract><sec><title>Background</title><p>Kaposi Sarcoma (KS) is a malignancy of endothelial skin cells with multifocal localization on the skin, lymph nodes and visceral organs. Although all clinical variants are associated with HHV-8 infection, specific differences in the clinical onset and in the natural history of AIDS-KS and Classic-KS have been described. The present randomised prospective-observational study aimed to investigate whether the ultrasound pattern and color Doppler flow imaging of vascularisation of skin lesions of patients with Classic KS (CKS) or AIDS-KS could provide useful information to the evaluation of clinical activity of the disease.</p></sec><sec><title>Methods</title><p>Cutaneous lesions of 24 patients with histologically confirmed KS were investigated using very high frequency ultrasound probes; 16 patients had CKS and 8 had AIDS-KS. HHV-8 infection was confirmed in all patients by investigating the specific humoral response to viral antigens. Immunological and virological parameters were also assessed to monitor HIV or HHV-8 viral infection. For each patient, a target skin lesion was selected on the basis of size (diameter from 0.4 to 2 cm). Each lesion was analyzed in terms of size, depth and color Doppler pattern.</p></sec><sec><title>Results</title><p>The B-mode ultrasound patterns of skin lesions did not differ when comparing CKS patients to AIDS-KS patients, whereas the color Doppler signal, which is associated with vascular activity, was detected in the KS lesions of 6/8 AIDS-KS patients (75.0%) and in 2/16 CKS (16,7%); the latter two patients showed a clinically progressive and extensive disease stage (IV B).</p></sec><sec><title>Conclusions</title><p>Our preliminary results suggest that small cutaneous KS lesions - in both CKS and AIDS-KS patients- display similar B-mode ultrasound patterns ( hypoechoic, well defined, superficial lesions). However, the color Doppler signal, which is associated with endothelial activity and angiogenesis, which play a substantial role in KS progression, could constitute a useful tool for evaluating disease activity.</p></sec></abstract></article-meta></front><body><sec><title>Background</title><p>Kaposi's Sarcoma (KS) is a tumour affecting mainly the skin, with multifocal expression and possible lymph nodal and visceral involvement [<xref ref-type="bibr" rid="B1">1</xref>]. Classically, it consists of four clinical variants: Classic KS (CKS) - or Mediterranean KS-, iatrogenic KS, African KS, and AIDS-KS. All four variants are associated with Human Herpesvirus-8 (HHV-8), and they show a similar histological pattern. HHV-8 infection of endothelial cells or circulating endothelial and/or haematopoietic progenitors leads to changes in their morphology, glucose metabolism, growth rate, lifespan and gene expression, resulting in the precipitation of KS [<xref ref-type="bibr" rid="B2">2</xref>].</p><p>In Italy, the most commonly observed clinical variants are CKS, typically found in persons over 60 years of age, and the epidemic form, AIDS-KS, which affects younger persons with HIV infection. In HIV-positive persons, KS constitutes an AIDS-defining condition [<xref ref-type="bibr" rid="B3">3</xref>]. Another subvariant of KS (termed "gay Kaposi") has also been described in HIV-negative homosexuals [<xref ref-type="bibr" rid="B4">4</xref>] and is possibly related to the sexual transmission of HHV-8 infection [<xref ref-type="bibr" rid="B5">5</xref>].</p><p>The clinical onset of KS is characterised by violaceous macules and papules, which over the course of months or years tend to merge into plaques and nodules (in some cases ulcerated), which are associated with a characteristic oedema, particularly evident in the lower limbs. However, definitive diagnosis is based on histopathological evidence of spindle cell and the presence of HHV-8 latency associated nuclear antigen (LANA), in spindle cells and vascular or lymphatic endothelial cells [<xref ref-type="bibr" rid="B6">6</xref>].</p><p>The clinical progression of CKS is generally slow and not very aggressive, although cases with rapidly growing lesions, with signs of local invasiveness, can be observed, as well as forms that fail to respond to physical or systemic treatment. By contrast, the natural history of AIDS-KS, which can affect mucous membranes, lymph nodes, the gastrointestinal tract, and the lungs, is more aggressive, particularly in untreated HIV-infected individuals [<xref ref-type="bibr" rid="B7">7</xref>].</p><p>Diverse classification methods have been proposed, based on the clinical aspects and localization of lesions, which can also be assessed by roentgen-ray study, gastroscopy, and total body TC [<xref ref-type="bibr" rid="B8">8</xref>-<xref ref-type="bibr" rid="B10">10</xref>]. To define KS accurately, additional aspects can be considered, including immunological and virological parameters of HHV-8 and HIV infection, which could also be used to evaluate prognostic aspects and therapeutic indications [<xref ref-type="bibr" rid="B11">11</xref>-<xref ref-type="bibr" rid="B13">13</xref>].</p><p>Other non-invasive diagnostic techniques, in particular, telethermography and confocal microscopy, could be complementary to traditional staging instruments [<xref ref-type="bibr" rid="B14">14</xref>,<xref ref-type="bibr" rid="B15">15</xref>]. Recently, several studies have demonstrated useful applications of ultrasound in dermatology, particularly as an indicator of cutaneous fibrosis or to evaluate melanoma lesions [<xref ref-type="bibr" rid="B16">16</xref>,<xref ref-type="bibr" rid="B17">17</xref>]. Our experience suggests that skin ultrasonology, particularly when performed with an extremely high frequency probes, could be important for both the diagnosis and therapy management of KS, in association with color power Doppler flow imaging, to detect the vascular activity of the cutaneous lesions [<xref ref-type="bibr" rid="B18">18</xref>,<xref ref-type="bibr" rid="B19">19</xref>].</p><p>Over many years of ultrasound activity, we observed that skin lesions in patients with CKS were structurally more homogeneous and with a lower signal at the color power Doppler, compared to similar lesions in patients with AIDS-KS, which were less homogeneous and showed more intensive signals. Based on these observations, and after having obtained the consensus of the Ethics Committee, we conducted a randomised prospective-observational study, in which we used ultrasound to evaluate the morphology and vascularisation of erythematous-papular-angiomatous skin lesions in outpatients of the Infective Dermatology Division of the San Gallicano Institute, who we subsequently referred to the Radiology Department.</p></sec><sec sec-type="methods"><title>Methods</title><p>The study population consisted of patients - with final diagnosis of KS - who presented at the San Gallicano Dermatology Institute in Rome- Italy - for the first time in 2010 and who had not been previously diagnosed or undergone to any treatment.</p><p>A total of 24 patients with a final diagnosis of KS were included in the study, of whom 16 had CKS (13 males and 4 females; median age: 70 years) and 8 had AIDS-KS (all males; median age: 47 years). All patients underwent complete clinical staging. For HIV-negative patients, we used the clinical classification criteria of Brambilla [<xref ref-type="bibr" rid="B8">8</xref>,<xref ref-type="bibr" rid="B13">13</xref>], whereas for HIV-positive patients we use a modified version of the staging of Kriegel [<xref ref-type="bibr" rid="B9">9</xref>] and that of Stebbing [<xref ref-type="bibr" rid="B10">10</xref>], based on a score from 1 to 15 (patients with a score of > 12 generally have a worse prognosis and require systemic chemotherapy, in addition to HAART). Among patients with CKS, 14 were in stage I-II-III A/B, with non-aggressive disease and slow clinical progression. The other two CKS patients were in stage IV B, showing angiomatous plaques and nodules, which were prevalently localized on the lower limbs, rapidly evolving, and associated with local complications (lymphedema and bleeding). All patients with AIDS-KS belonged to the class C, with a score of >12.</p><p>Histological examination of all of the lesions studied by ultrasound was performed on hematoxylin/eosin-stained tissue sections (4 μm) of biopsy samples, fixed in 10% buffered formaline and embedded in paraffin. Sections were also processed for immunohistochemical analysis of the expression of the endothelial associated antigens CD31, CD34 and podoplanin, a transmembrane mucoprotein described in a variety of lymphovascular neoplasms, including KS [<xref ref-type="bibr" rid="B20">20</xref>,<xref ref-type="bibr" rid="B21">21</xref>] (D2-40 MoAb, Nichirei Bioscience, Tokyo, Japan) and HHV-8 LANA (anti-HHV-8 ORF73,LNA-1, Advanced Biotechnologies Inc, USA). Testing for the immunologic condition included immunophenotyping of peripheral lymphocytes by flow cytometry. In patients with AIDS-KS, the CD3+/CD4+ lymphocyte count ranged from 125 to 1980 n/mmc (median value: 677 n/mmc). All patients were positive for HHV-8 infection, assessed by the presence of specific antibodies directed to antigens associated with the lytic and/or latent phases of infection [<xref ref-type="bibr" rid="B22">22</xref>]. The anti-HHV-8 antibody titers ranged from 1:80 to 1: 5120, with a median value of 1:1280. Testing for virologic parameters of HHV-8 infection was performed both on the lesion tissue and on peripheral blood. In fact, several studies have reported a correlation between HHV-8 viral load and clinical disease progression, especially for AIDS-KS [<xref ref-type="bibr" rid="B11">11</xref>]. The presence of HHV-8 viral genomes in plasma was evaluated and quantified using quantitative PCR (HHV-8Q real time PCR, Nanogen, Torino, Italia), with viral loads ranging from lower than 125 to 840 genome equivalents/ml). In 9 patients, viral DNA was not detectable (Table <xref ref-type="table" rid="T1">1</xref>).</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Patient's characteristics and ultrasound results</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center">Diagnosis</th><th align="center">Age</th><th align="center">Sex</th><th align="center">Clinical<break></break>Stage</th><th align="center">Lesion<break></break>(mm)</th><th align="center">HHV8-DNA<break></break>(copies/mL)</th><th align="center">Ultrasound<break></break>Pattern</th><th align="center">Color-Doppler<break></break>Signals</th></tr></thead><tbody><tr><td align="center">1.CKS</td><td align="center">70</td><td align="center">M</td><td align="center">III A</td><td align="center">6</td><td align="center">652</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">2.CKS</td><td align="center">80</td><td align="center">M</td><td align="center"><italic>I A</italic></td><td align="center">20</td><td align="center"><125</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">3.CKS</td><td align="center">56</td><td align="center">M</td><td align="center">I A</td><td align="center">10</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">4.CKS</td><td align="center">88</td><td align="center">M</td><td align="center">IV B</td><td align="center">10</td><td align="center"><125</td><td align="center">HOMOG.</td><td align="center">50%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">5.CKS</td><td align="center">70</td><td align="center">M</td><td align="center">II A</td><td align="center">20</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">6.CKS</td><td align="center">71</td><td align="center">M</td><td align="center">IV B</td><td align="center">10</td><td align="center">250</td><td align="center">HOMOG.</td><td align="center">25%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">7.CKS</td><td align="center">87</td><td align="center">F</td><td align="center">III A</td><td align="center">7</td><td align="center">520</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">8.CKS</td><td align="center">56</td><td align="center">F</td><td align="center">II A</td><td align="center">5</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">9.CKS</td><td align="center">61</td><td align="center">M</td><td align="center">I A</td><td align="center">6</td><td align="center"><125</td><td align="center">DISHOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">10.CKS</td><td align="center">58</td><td align="center">M</td><td align="center">I A</td><td align="center">10</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">11.CKS</td><td align="center">74</td><td align="center">M</td><td align="center">I A</td><td align="center">10</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">12.CKS</td><td align="center">43</td><td align="center">M</td><td align="center">I A</td><td align="center"><5</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">13.CKS</td><td align="center">88</td><td align="center">F</td><td align="center">III A</td><td align="center">7</td><td align="center">633</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">14.CKS</td><td align="center">56</td><td align="center">M</td><td align="center">III A</td><td align="center">8</td><td align="center">750</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">15.CKS</td><td align="center">70</td><td align="center">M</td><td align="center">III A</td><td align="center">4</td><td align="center">450</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">16.CKS</td><td align="center">70</td><td align="center">M</td><td align="center">II A</td><td align="center">10</td><td align="center"><125</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">17.AIDS-KS</td><td align="center">41</td><td align="center">M</td><td align="center">>12</td><td align="center">6</td><td align="center">Undetectable</td><td align="center">HOMOG.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">18.AIDS-KS</td><td align="center">47</td><td align="center">M</td><td align="center">>12</td><td align="center">4</td><td align="center"><125</td><td align="center">HOMOG.</td><td align="center">25%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">19.AIDS-KS</td><td align="center">38</td><td align="center">M</td><td align="center">>12</td><td align="center">4</td><td align="center">Undetectable</td><td align="center">CALCIF.</td><td align="center">NO</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">20.AIDS-KS</td><td align="center">59</td><td align="center">M</td><td align="center">>12</td><td align="center">11</td><td align="center">840</td><td align="center">DISHOMOG.</td><td align="center">50%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">21.AIDS-KS</td><td align="center">74</td><td align="center">M</td><td align="center">>12</td><td align="center">9</td><td align="center"><125</td><td align="center">DISHOMOG.</td><td align="center">50%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">22.AIDS-KS</td><td align="center">46</td><td align="center">M</td><td align="center">>12</td><td align="center">7</td><td align="center">230</td><td align="center">HOMOG.</td><td align="center">25%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">23.AIDS-KS</td><td align="center">49</td><td align="center">M</td><td align="center">>12</td><td align="center">7</td><td align="center"><125</td><td align="center">HOMOG.</td><td align="center">25%</td></tr><tr><td colspan="8"><hr></hr></td></tr><tr><td align="center">24.AIDS-KS</td><td align="center">31</td><td align="center">M</td><td align="center">>12</td><td align="center">10</td><td align="center">Undetectable</td><td align="center">DISHOMOG.</td><td align="center">25%</td></tr></tbody></table></table-wrap><p>To obtain a sample that was as homogeneous as possible, we only studied those lesions with a maximum diameter between 0.4 and 2 cm and which morphologically could be defined as plaques or nodular. All patients were evaluated with ultrasound by two experts in diagnostic dermatological ultrasound (FMS and FE), under blind conditions. The images were stored on digital support and then re-evaluated in consensus by both. The ultrasound examination was performed with My-Lab 70 XVG (Esaote, Genova, Italia), using a high-frequency linear array probe (18 Mhz); for lesions with a diameter of less than 1 cm, a MyLabOne (Esaote, Genova, Italia) was also used, with a linear array probe of 22 Mhz. The settings of the devices were optimized for slow flows and superficial lesions. Written informed consent was obtained from patients. A copy of written consent is available for review by the Editor-in-chief of this journal.</p></sec><sec><title>Results</title><p>A total of 24 lesions (one per patient) were clinically observed and successively evaluated with ultrasound; of these, 16 were CKS, localised on the lower limbs (Figure <xref ref-type="fig" rid="F1">1</xref>). The lesions from the 8 patients with AIDS-KS were also localised in areas other than the lower limbs (Figure <xref ref-type="fig" rid="F2">2</xref>). All of the lesions studied by ultrasound appeared to be localized between the epidermis and the dermis, although in some cases they were also subcutaneous ( Figure <xref ref-type="fig" rid="F3">3</xref>, <xref ref-type="fig" rid="F4">4</xref>).</p><fig id="F1" position="float"><label>Figure 1</label><caption><p><bold>Lesion of Classic KS</bold>. Protruding erythemal-cyanotic nodule, with slow evolution, in a patient with Classic Kaposi Sarcoma.</p></caption><graphic xlink:href="1756-9966-30-40-1"></graphic></fig><fig id="F2" position="float"><label>Figure 2</label><caption><p><bold>Lesion of AIDS-KS</bold>. Rapidly growing nodule, in a patient with AIDS-KS and severe immunodeficiency.</p></caption><graphic xlink:href="1756-9966-30-40-2"></graphic></fig><fig id="F3" position="float"><label>Figure 3</label><caption><p><bold>Histology of Classic Kaposi Sarcoma (hematoxylin and eosin, 4X)</bold>. Evident nodular proliferation of spindle cells, with hyperchromic nuclei and rare mitotic figures; presence of multiple, small, diffused and morphologically irregular vascular spaces.</p></caption><graphic xlink:href="1756-9966-30-40-3"></graphic></fig><fig id="F4" position="float"><label>Figure 4</label><caption><p><bold>Ultrasound image of a nodule in a patient with Classic Kaposi Sarcoma</bold>. The formation is homogeneous, hypoechoic, with clear and well-defined contours. It involves the epidermis and derma and it is associated to ectasia of local-regional vessels in adipose sub-cutaneous tissue.</p></caption><graphic xlink:href="1756-9966-30-40-4"></graphic></fig><p>According to the ultrasound, in 15 of the 16 patients with CKS, the lesions, whether plaque-like or nodular, appeared to be solid and homogeneously hypoechoic, whereas in 3 of the 8 patients with AIDS-KS, the lesions were hypoechoic yet dishomogeneous (Table <xref ref-type="table" rid="T1">1</xref>).</p><p>According to the color power Doppler, in 6 of the 8 patients with AIDS-KS (75%), there were internal signals (Figure <xref ref-type="fig" rid="F5">5</xref>). In three of these patients, the signals were evident (Figure <xref ref-type="fig" rid="F6">6</xref>); in two of them they were present in at least 50% of the region of interest (ROI); in the remaining patient it was not possible to accurately evaluate the signal, because of the presence of considerable calcification and fibrosis. Only in 2 (16%) of the patients with CKS was there a color power Doppler signal.</p><fig id="F5" position="float"><label>Figure 5</label><caption><p><bold>Vascular aspects of Classic KS</bold>. Classic Kaposi Sarcoma lesion, with slight vascularisation (only one vascular pole), in a small superficial hypoechoic lesion, is evident.</p></caption><graphic xlink:href="1756-9966-30-40-5"></graphic></fig><fig id="F6" position="float"><label>Figure 6</label><caption><p><bold>Vascular aspects of AIDS-KS</bold>. AIDS-KS lesion, with evident vascularisation; the monochromatic color power Doppler indicates marked vascularisation of the periphery of the nodule, with a ring-like pattern and a hypovascular central area.</p></caption><graphic xlink:href="1756-9966-30-40-6"></graphic></fig><p>According to the ultrasound, in all patients the contours of the lesions were regular, also in depth. Histologically, all of the lesions showed vascular proliferation, consisting of irregularly dilated canals, which to varying degrees were associated with bundles of spindle cells. These cells delimited irregular vascular spaces, present in the derma, at various levels, in a nodular or plaque-like state. In some patients there were telangiectasias which extended to the subcutaneous layer and which were more evident in larger lesions. An inflammatory lymphoplasmacellular infiltrate was present in all patients (Figure <xref ref-type="fig" rid="F3">3</xref>). There were no histological differences between the two KS variants.</p><p>According to the immunophenotypic analyses, all of the patients studied were positive for CD31, CD34, podoplanin and HHV8, with no differences in expression between the two variants.</p></sec><sec><title>Discussion</title><p>In the literature there are few studies on ultrasound analyses of KS, and those that have been published report conflicting results. According to one study [<xref ref-type="bibr" rid="B23">23</xref>], the typical ultrasound pattern is a solid not homogeneous nodule, with contours that are not well-delimited and evident vascularisation according to the color power Doppler, whereas in another study [<xref ref-type="bibr" rid="B18">18</xref>] the lesions were reported to be hypoechoic, with a homogeneous structure and well defined contours.</p><p>Our experience is based on observations performed with very high frequency probes and a high-resolution color power Doppler, which are technologically superior to the instruments used in the past. In our study, all of the lesions were hypoechoic, with a very homogeneous structure for CKS lesions and a less homogeneous structure for AIDS-KS ones. In all cases, the contours were well defined but in many cases multi-lobulated, with good ultrasound transmission.</p><p>According to the color power Doppler, internal vascularisation was rare in CKS lesions (Table <xref ref-type="table" rid="T1">1</xref>), whereas it was almost always present in AIDS-KS. For the AIDS-KS patients, it can be hypothesized that vascularization was related to an intense neo-angiogenesis, sustained by the HIV virus, as suggested by experimental studies [<xref ref-type="bibr" rid="B24">24</xref>,<xref ref-type="bibr" rid="B25">25</xref>]. In the two patients with CKS with a color power Doppler signal, the internal vascular signal was present in less than 25% of the ROI in one patient and in about 50% in the other. Although both patients were affected by CKS, the clinical progression was very aggressive (stage IV B), and the HHV-8 viral load was significantly higher than the mean viral load for CKS patients.</p><p>It is also possible that the relative structural homogeneity of the lesions in our study was related to the small size of most lesions and that the structural dishomogeneity was actually produced by phenomena such as fibrosis and intra-neoplastic degeneration with areas of necrosis, which is typical of larger neoplasia, in which the blood intake becomes in some way inadequate. This is evident in Figure <xref ref-type="fig" rid="F6">6</xref>, where the central areas of tumor lesion are clearly hypovascular, in the presence of a rich peripheral vascular ring; however, this observation should need to be confirmed by studies on larger number of subjects. The finding that the contours of the lesions were regular, even deep down, is instead surprising for the aggressive forms of AIDS-KS; nonetheless, this could be attributable to the relatively small size of the lesions, which were perhaps observed in an initial pre-infiltrative phase of the disease.</p></sec><sec><title>Conclusions</title><p>Although the ultrasonography of KS lesions is not pathognomonic (similar findings can been found in other flogistic and non-flogistic pathologies), we can conclude that it allows clinically similar pathologies (such as angiomas and artero-venous malformations in the growth phase) to be excluded. Moreover, the ultrasound pattern observed in this study differs from that reported in previous studies. Although we evaluated a limited number of patients in a single clinical centre, our results show that small CKS lesions are relatively uniform, superficially, hypo echoic, and with well defined contours; they are usually located between the epidermis and the dermis and lack color power doppler signals in the less aggressive forms, whereas vascularisation is evident in the rapidly evolving forms.</p><p>In patients with AIDS-KS, the ultrasound pattern in B-mode was similar to that for the other group, although, according to the color power Doppler, the lesions were all hypervascular. This finding is consistent with the presence of marked neoangiogenesis in the HIV-related variants, which is closely related to the activity of the HIV-1 virus on the endothelial cells [<xref ref-type="bibr" rid="B24">24</xref>,<xref ref-type="bibr" rid="B25">25</xref>]. However, we cannot draw definitive conclusions regarding the prognostic significance of hyper vascularisation in this group, given the brevity of the follow-up for these patients and the immediate starting of antiretroviral therapy.</p><p>Thus in our opinion, in patients with CKS, ultrasound evaluation of lesions with the color power Doppler study could be used as a non-invasive diagnostic technique for distinguishing between forms with rapid clinical progression - thus requiring therapy - and less aggressive forms, requiring only follow-up. Although this proposal needs to be evaluated with additional studies, including larger number of patients, given its low cost and non-invasiveness, this technique could be immediately used, at least in experienced centres, and included in the diagnostic-therapeutic course for KS.</p></sec><sec><title>Competing interests</title><p>The authors declare that they have no competing interests.</p></sec><sec><title>Authors' contributions</title><p>FMS conceived of the study and participated in its design and coordination. AL made the clinical diagnosis and the follow up of patients. FE performed the ultrasound and color Doppler analysis.</p><p>PCF carried out the immunological and virological determinations. CC performed the histological diagnosis. ADC coordinated the study. All authors read and approved the final manuscript</p></sec></body><back><ref-list><ref id="B1"><mixed-citation publication-type="journal"><name><surname>Mesri</surname><given-names>EA</given-names></name><name><surname>Cesarman</surname><given-names>E</given-names></name><name><surname>Boshoff</surname><given-names>C</given-names></name><article-title>Kaposi's sarcoma and its associated herpesvirus</article-title><source>Nat rev cancer</source><year>2010</year><volume>10</volume><fpage>707</fpage><lpage>719</lpage><pub-id pub-id-type="doi">10.1038/nrc2888</pub-id><pub-id pub-id-type="pmid">20865011</pub-id></mixed-citation></ref><ref id="B2"><mixed-citation publication-type="journal"><name><surname>Tornesello</surname><given-names>ML</given-names></name><name><surname>Biryahwaho</surname><given-names>B</given-names></name><name><surname>Downing</surname><given-names>R</given-names></name><name><surname>Hatzakis</surname><given-names>A</given-names></name><name><surname>Alessi</surname><given-names>E</given-names></name><name><surname>Cusini</surname><given-names>M</given-names></name><name><surname>Ruocco</surname><given-names>V</given-names></name><name><surname>Katongole-Mbidde</surname><given-names>E</given-names></name><name><surname>Loquercio</surname><given-names>G</given-names></name><name><surname>Buonaguro</surname><given-names>L</given-names></name><name><surname>Buonaguro</surname><given-names>FM</given-names></name><article-title>Human herpesvirus type 8 variants circulating in Europe, Africa and North America in classic, endemic and epidemic Kaposi's sarcoma lesions during pre-AIDS and AIDS era</article-title><source>Virology</source><year>2010</year><volume>398</volume><fpage>280</fpage><lpage>289</lpage><pub-id pub-id-type="doi">10.1016/j.virol.2009.12.005</pub-id><pub-id pub-id-type="pmid">20079510</pub-id></mixed-citation></ref><ref id="B3"><mixed-citation publication-type="journal"><collab>CDC</collab><article-title>Revision of the case definition of AIDS for national reporting</article-title><source>MMWR</source><year>1985</year><volume>4</volume><fpage>373</fpage><lpage>374</lpage></mixed-citation></ref><ref id="B4"><mixed-citation publication-type="journal"><name><surname>Lanternier</surname><given-names>F</given-names></name><name><surname>Lebbé</surname><given-names>C</given-names></name><name><surname>Schartz</surname><given-names>N</given-names></name><name><surname>Farhi</surname><given-names>D</given-names></name><name><surname>Marcelin</surname><given-names>AG</given-names></name><name><surname>Kérob</surname><given-names>D</given-names></name><name><surname>Agbalika</surname><given-names>F</given-names></name><name><surname>Vérola</surname><given-names>O</given-names></name><name><surname>Gorin</surname><given-names>I</given-names></name><name><surname>Janier</surname><given-names>M</given-names></name><name><surname>Avril</surname><given-names>MF</given-names></name><name><surname>Dupin</surname><given-names>N.</given-names></name><article-title>Kaposi's sarcoma in HIV-negative men having sex with men</article-title><source>AIDS</source><year>2008</year><volume>22</volume><fpage>1163</fpage><lpage>1168</lpage><pub-id pub-id-type="doi">10.1097/QAD.0b013e3283031a8a</pub-id><pub-id pub-id-type="pmid">18525262</pub-id></mixed-citation></ref><ref id="B5"><mixed-citation publication-type="journal"><name><surname>Giuliani</surname><given-names>M</given-names></name><name><surname>Cordiali-Fei</surname><given-names>P</given-names></name><name><surname>Castilletti</surname><given-names>C</given-names></name><name><surname>Di Carlo</surname><given-names>A</given-names></name><name><surname>Palamara</surname><given-names>G</given-names></name><name><surname>Boros</surname><given-names>S</given-names></name><name><surname>Rezza</surname><given-names>G</given-names></name><article-title>Incidence of human herpesvirus 8 (HHV-8) infection among HIV-uninfected individuals at high risk for sexually transmitted infections</article-title><source>BMC Infect Dis</source><year>2007</year><volume>7</volume><fpage>143</fpage><lpage>151</lpage><pub-id pub-id-type="doi">10.1186/1471-2334-7-143</pub-id><pub-id pub-id-type="pmid">18053246</pub-id></mixed-citation></ref><ref id="B6"><mixed-citation publication-type="journal"><name><surname>Gessain</surname><given-names>A</given-names></name><name><surname>Duprez</surname><given-names>R</given-names></name><article-title>Spindle cells and their role in Kaposi's sarcoma</article-title><source>Int J Biochem Cell Biol</source><year>2005</year><volume>37</volume><fpage>2457</fpage><lpage>2465</lpage><pub-id pub-id-type="doi">10.1016/j.biocel.2005.01.018</pub-id><pub-id pub-id-type="pmid">16188485</pub-id></mixed-citation></ref><ref id="B7"><mixed-citation publication-type="journal"><name><surname>Sullivan</surname><given-names>RJ</given-names></name><name><surname>Pantanowitz</surname><given-names>L</given-names></name><name><surname>Casper</surname><given-names>C</given-names></name><name><surname>Stebbing</surname><given-names>J</given-names></name><name><surname>Dezube</surname><given-names>BJ</given-names></name><article-title>Epidemiology, pathophysiology and treatment of Kaposi sarcoma-associated herpesvirus disease: Kaposi sarcoma, primary effusion lymphoma, and multicentric Castleman disease</article-title><source>Clin Infect Dis</source><year>2008</year><volume>47</volume><fpage>1209</fpage><lpage>1215</lpage><pub-id pub-id-type="doi">10.1086/592298</pub-id><pub-id pub-id-type="pmid">18808357</pub-id></mixed-citation></ref><ref id="B8"><mixed-citation publication-type="journal"><name><surname>Brambilla</surname><given-names>L</given-names></name><name><surname>Boneschi</surname><given-names>V</given-names></name><name><surname>Taglioni</surname><given-names>M</given-names></name><name><surname>Ferrucci</surname><given-names>S</given-names></name><article-title>Staging of classic Kaposi's sarcoma: a useful tool for therapeutic choices</article-title><source>Eur J Dermatol</source><year>2001</year><volume>13</volume><fpage>83</fpage><lpage>86</lpage></mixed-citation></ref><ref id="B9"><mixed-citation publication-type="journal"><name><surname>Kriegel</surname><given-names>RL</given-names></name><name><surname>Laubenstein</surname><given-names>LJ</given-names></name><name><surname>Muggia</surname><given-names>FM</given-names></name><name><surname>Kaposi's</surname><given-names>sarcoma</given-names></name><article-title>A new staging classification</article-title><source>Cancer Treat Rep</source><year>1983</year><volume>67</volume><fpage>531</fpage><lpage>534</lpage><pub-id pub-id-type="pmid">6861160</pub-id></mixed-citation></ref><ref id="B10"><mixed-citation publication-type="journal"><name><surname>Stebbing</surname><given-names>J</given-names></name><name><surname>Sanitt</surname><given-names>A</given-names></name><name><surname>Nelson</surname><given-names>M</given-names></name><name><surname>Pawles</surname><given-names>T</given-names></name><name><surname>Gazzard</surname><given-names>B</given-names></name><name><surname>Bower</surname><given-names>M</given-names></name><article-title>A prognostic index for AIDS-associated Kaposi's sarcoma in the era of higly active antiretroviral therapy</article-title><source>Lancet</source><year>2006</year><volume>367</volume><fpage>1495</fpage><lpage>1502</lpage><pub-id pub-id-type="doi">10.1016/S0140-6736(06)68649-2</pub-id><pub-id pub-id-type="pmid">16679162</pub-id></mixed-citation></ref><ref id="B11"><mixed-citation publication-type="journal"><name><surname>Boneschi</surname><given-names>V</given-names></name><name><surname>Brambilla</surname><given-names>L</given-names></name><name><surname>Berti</surname><given-names>E</given-names></name><name><surname>Ferrucci</surname><given-names>S</given-names></name><name><surname>Corbellino</surname><given-names>M</given-names></name><name><surname>Parravicini</surname><given-names>C</given-names></name><name><surname>Fossati</surname><given-names>S</given-names></name><article-title>Human Herpesvirus- 8 DNA in the skin and blood of patients with Mediterranean kaposi's Sarcoma: clinical correlations</article-title><source>Dermatology</source><year>2001</year><volume>203</volume><fpage>19</fpage><lpage>23</lpage><pub-id pub-id-type="doi">10.1159/000051697</pub-id><pub-id pub-id-type="pmid">11549794</pub-id></mixed-citation></ref><ref id="B12"><mixed-citation publication-type="journal"><name><surname>Brambilla</surname><given-names>L</given-names></name><name><surname>Labianca</surname><given-names>R</given-names></name><name><surname>Ferrucci</surname><given-names>SM</given-names></name><name><surname>Taglioni</surname><given-names>M</given-names></name><name><surname>Boneschi</surname><given-names>V</given-names></name><article-title>Treatment of classical Kaposi's sarcoma with gemcitabine</article-title><source>Dermatology</source><year>2001</year><volume>202</volume><fpage>119</fpage><lpage>122</lpage><pub-id pub-id-type="doi">10.1159/000051610</pub-id><pub-id pub-id-type="pmid">11306832</pub-id></mixed-citation></ref><ref id="B13"><mixed-citation publication-type="journal"><name><surname>Brambilla</surname><given-names>L</given-names></name><name><surname>Boneschi</surname><given-names>V</given-names></name><name><surname>Fossati</surname><given-names>S</given-names></name><name><surname>Melotti</surname><given-names>E</given-names></name><name><surname>Clerici</surname><given-names>M</given-names></name><article-title>Oral etoposide for Kaposi's Mediterranean sarcoma</article-title><source>Dermatologica</source><year>1988</year><volume>177</volume><fpage>365</fpage><lpage>369</lpage><pub-id pub-id-type="doi">10.1159/000248608</pub-id><pub-id pub-id-type="pmid">2466707</pub-id></mixed-citation></ref><ref id="B14"><mixed-citation publication-type="journal"><name><surname>Lauriola</surname><given-names>C</given-names></name><name><surname>Bergonzini</surname><given-names>R</given-names></name><article-title>The value of thermography and lymphography in the diagnosis and follow-up of Kaposi's disease</article-title><source>Rays</source><year>1985</year><volume>10</volume><fpage>85</fpage><lpage>90</lpage><pub-id pub-id-type="pmid">3843657</pub-id></mixed-citation></ref><ref id="B15"><mixed-citation publication-type="journal"><name><surname>Mahoney</surname><given-names>SE</given-names></name><name><surname>Paddock</surname><given-names>SW</given-names></name><name><surname>Smith</surname><given-names>LC</given-names></name><name><surname>Lewis</surname><given-names>DE</given-names></name><name><surname>Duvic</surname><given-names>M</given-names></name><article-title>Three-dimensional laser- scanning confocal microscopy of in situ hybridization in the skin</article-title><source>Am J Dermatopathol</source><year>1994</year><volume>16</volume><fpage>44</fpage><lpage>51</lpage><pub-id pub-id-type="doi">10.1097/00000372-199402000-00009</pub-id><pub-id pub-id-type="pmid">8160929</pub-id></mixed-citation></ref><ref id="B16"><mixed-citation publication-type="journal"><name><surname>Schmid-Wendtner</surname><given-names>MH</given-names></name><name><surname>Dill-Müller</surname><given-names>D</given-names></name><article-title>Ultrasound technology in dermatology</article-title><source>Semin Cutan Med Surg</source><year>2008</year><volume>27</volume><fpage>44</fpage><lpage>51</lpage><pub-id pub-id-type="doi">10.1016/j.sder.2008.01.003</pub-id><pub-id pub-id-type="pmid">18486024</pub-id></mixed-citation></ref><ref id="B17"><mixed-citation publication-type="journal"><name><surname>Wong</surname><given-names>S</given-names></name><name><surname>Kaur</surname><given-names>A</given-names></name><name><surname>Back</surname><given-names>M</given-names></name><name><surname>Lee</surname><given-names>KM</given-names></name><name><surname>Baggarley</surname><given-names>S</given-names></name><name><surname>Lu</surname><given-names>JJ</given-names></name><article-title>An ultrasonographic evaluation of skin thickness in breast cancer patients after postmastectomy radiation therapy</article-title><source>Radiat Oncol</source><year>2011</year><volume>6</volume><fpage>9</fpage><pub-id pub-id-type="doi">10.1186/1748-717X-6-9</pub-id><pub-id pub-id-type="pmid">21261940</pub-id></mixed-citation></ref><ref id="B18"><mixed-citation publication-type="journal"><name><surname>Bogner</surname><given-names>JR</given-names></name><name><surname>Zietz</surname><given-names>C</given-names></name><name><surname>Held</surname><given-names>M</given-names></name><name><surname>Spatling</surname><given-names>S</given-names></name><name><surname>Sandor</surname><given-names>P</given-names></name><name><surname>Kronawitter</surname><given-names>U</given-names></name><name><surname>Goebel</surname><given-names>FD</given-names></name><article-title>Ultrasound as a tool to evaluate remission of cutaneous Kaposi's sarcoma</article-title><source>J Acquir Immune Defic Syndr</source><year>1993</year><volume>6</volume><issue>5</issue><fpage>530</fpage><lpage>531</lpage><pub-id pub-id-type="doi">10.1097/00126334-199305000-00015</pub-id><pub-id pub-id-type="pmid">8483117</pub-id></mixed-citation></ref><ref id="B19"><mixed-citation publication-type="journal"><name><surname>Wang</surname><given-names>Y</given-names></name><name><surname>Dan</surname><given-names>HJ</given-names></name><name><surname>Fan</surname><given-names>JH</given-names></name><name><surname>Wen</surname><given-names>S-B</given-names></name><article-title>Evaluation of the correlation between Colour Power Doppler Flow Imaging and Vascular Endothelial Growth Factor in breast cancer</article-title><source>J Int Med Res</source><year>2010</year><volume>38</volume><fpage>1077</fpage><lpage>1083</lpage><pub-id pub-id-type="pmid">20819445</pub-id></mixed-citation></ref><ref id="B20"><mixed-citation publication-type="journal"><name><surname>Bertolini</surname><given-names>F</given-names></name><name><surname>Mancuso</surname><given-names>P</given-names></name><name><surname>Shaked</surname><given-names>Y</given-names></name><name><surname>Kerbel</surname><given-names>RS</given-names></name><article-title>Molecular and cellular biomarkers for angiogenesis in clinical oncology</article-title><source>Drug Discovery Today</source><year>2007</year><volume>12</volume><fpage>806</fpage><lpage>812</lpage><pub-id pub-id-type="doi">10.1016/j.drudis.2007.08.011</pub-id><pub-id pub-id-type="pmid">17933680</pub-id></mixed-citation></ref><ref id="B21"><mixed-citation publication-type="journal"><name><surname>Kalof</surname><given-names>AN</given-names></name><name><surname>Cooper</surname><given-names>K</given-names></name><article-title>D2-40 Immunochemistry-so far</article-title><source>Adv Anat Pathol</source><year>2009</year><volume>16</volume><fpage>62</fpage><lpage>64</lpage><pub-id pub-id-type="doi">10.1097/PAP.0b013e3181915e94</pub-id><pub-id pub-id-type="pmid">19098468</pub-id></mixed-citation></ref><ref id="B22"><mixed-citation publication-type="journal"><name><surname>Rezza</surname><given-names>G</given-names></name><name><surname>Lennette</surname><given-names>ET</given-names></name><name><surname>Giuliani</surname><given-names>M</given-names></name><name><surname>Pezzotti</surname><given-names>P</given-names></name><name><surname>Caprilli</surname><given-names>F</given-names></name><name><surname>Monini</surname><given-names>P</given-names></name><name><surname>Buttò</surname><given-names>S</given-names></name><name><surname>Lodi</surname><given-names>G</given-names></name><name><surname>Di Carlo</surname><given-names>A</given-names></name><name><surname>Levi</surname><given-names>JA</given-names></name><name><surname>Ensoli</surname><given-names>B</given-names></name><article-title>Prevalence and determinants of anti-lytic and andi-latent antibodies to human herpes virus-8 among Italian individuals at risk of sexually and parenterally transmitted infections</article-title><source>Int J Cancer</source><year>1998</year><volume>77</volume><fpage>361</fpage><lpage>365</lpage><pub-id pub-id-type="doi">10.1002/(SICI)1097-0215(19980729)77:3<361::AID-IJC9>3.0.CO;2-M</pub-id><pub-id pub-id-type="pmid">9663596</pub-id></mixed-citation></ref><ref id="B23"><mixed-citation publication-type="book"><name><surname>Cammarota</surname><given-names>T</given-names></name><source>Ecografia in Dermatologia</source><year>1998</year><publisher-name>Poletto Editore, Milano</publisher-name></mixed-citation></ref><ref id="B24"><mixed-citation publication-type="journal"><name><surname>Barillari</surname><given-names>G</given-names></name><name><surname>Ensoli</surname><given-names>B</given-names></name><article-title>Angiogenic effects of extracellular human immodeficiency virus type1 Tat protein and its role in the pathogenesis of AIDS-associated Kaposi's Sarcoma</article-title><source>Clin Microbiol Rev</source><year>2002</year><volume>15</volume><fpage>310</fpage><lpage>326</lpage><pub-id pub-id-type="doi">10.1128/CMR.15.2.310-326.2002</pub-id><pub-id pub-id-type="pmid">11932235</pub-id></mixed-citation></ref><ref id="B25"><mixed-citation publication-type="journal"><name><surname>Pyakurel</surname><given-names>P</given-names></name><name><surname>Pak</surname><given-names>F</given-names></name><name><surname>Mwakigonja</surname><given-names>AR</given-names></name><name><surname>Kaaya</surname><given-names>E</given-names></name><name><surname>Biberfeld</surname><given-names>P</given-names></name><article-title>KSHV/HHV-8 and HIV infection in Kaposi's sarcoma development</article-title><source>Infect Agent Cancer</source><year>2007</year><volume>2</volume><fpage>2</fpage><lpage>4</lpage><pub-id pub-id-type="doi">10.1186/1750-9378-2-4</pub-id><pub-id pub-id-type="pmid">17201930</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/LymphedemaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 004056 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 004056 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= LymphedemaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:3095540
|texte= AIDS-Kaposi Sarcoma and Classic Kaposi Sarcoma: are different ultrasound patterns related to different variants?
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:21489270" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a LymphedemaV1
| This area was generated with Dilib version V0.6.31. |  |