Identification of An Etiologic Agent by Ultrastructural Evaluation of an Ulcerated Intraoral Nodule

Diagnosis:
AIDS-Kaposi's Sarcoma with Herpes-Like Virus

Discussion -- Clinicopathology
During the past 15 years, over 500,000 individuals have been diagnosed with AIDS with almost 60% of these individuals dying of complications associated with this viral illness. It has been estimated that as many as 1% of the US population is currently infected with HIV and have yet to develop an AIDS-defining disease. Although dramatic advances in diagnosis, monitoring and treatment have occurred during that time period, opportunistic infections and certain malignancies continue to affect HIV-seropositive individuals.

Kaposi’s sarcoma was recognized early in the AIDS epidemic as a disease defining entity. This vascular neoplasm may present as cutaneous, oral and/or visceral lesions either independently or synchronously. In fact, oral lesions may be the initial manifestation of Kaposi’s sarcoma in 22% of cases, and occurs concomitantly along with skin and/or visceral involvement in an additional 45% of cases. Initially, Kaposi’s sarcoma was reported in almost 40% of individuals with HIV infection. The current incidence is 15 to 20% in the homosexual/bisexual risk group, with an 8 to 12% incidence in the heterosexual risk group. Whether this represents a true decline or reduced reporting of KS is not known. Most frequently males are affected. KS accounts for over 80% of all malignancies diagnosed in AIDS and there is an increased risk for development of second malignancies in patients with KS. The development of KS also heralds progression of HIV infection with a 14 month median survival and in the presence of an opportunistic infection only a 6 to 9 month median survival.

Oral KS lesions occur as red to purple colored nodules and macules with mucosal ulceration in some cases. The lesions result in pain, dysphagia, difficulty with mastication, bleeding and may be cosmetically displeasing.

As shown in previous studies, intralesional injection of vinblastine provides a method for local control and provides a significant reduction in lesion size with complete resolution in almost 75% of cases. Recurrences occur with 25% of lesions with a mean disease-free period of 13 weeks.