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Keywords:

  • circumcised;
  • HIV-negative;
  • Kaposi's sarcoma;
  • penis

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Abstract  Kaposi's sarcoma (KS) limited to penis is rare and usually observed in AIDS patients. However, in circumcised and HIV-seronegative patients, KS confined to the penis is extremely rare. We present the case of an HIV-seronegative and circumcised 55-year-old man, who presented with two reddish papules, one 5 mm in diameter on the coronal sulcus near the frenulum, and the other 2 mm in diameter on the glans penis, which were reported as a Kaposi's sarcoma after excision of the lesion.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

Kaposi's sarcoma (KS) is a vascular tumor of multifocal origin occurring primarily on the extremities. It was first described in 1872 by Dr Moriz Kaposi, a Hungarian dermatologist.1 In the pre-AIDS era KS was a rare sarcoma, and mainly seen in Mediterranean men. In the early 1980s after the onset of AIDS epidemic, the incidence of KS increased dramatically throughout the world.2,3

Kaposi's sarcoma limited to penis is rare and usually observed in AIDS patients. However, in circumcised and HIV-seronegative patients, KS confined to the penis is extremely rare. In the present paper we describe a penile KS in a HIV-seronegative and circumcised patient.

Case report

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

A 55-year-old circumcised Turkish man, with no history of homosexual activity, presented to the urology room with benign prostatic hyperplasia (BPH)-related symptoms and with a 6 month history of asymptomatic lesions on the penis. Physical examination revealed two reddish papules, one 5 mm in diameter on the coronal sulcus near the frenulum and the other 2 mm in diameter on the glans (Fig. 1). Past medical history revealed self excision of the bigger lesion with a blade. Infravesical obstruction due to BPH was diagnosed in the patient and he was otherwise healthy. Routine laboratory tests were normal. Transurethral resection of the prostate (TUR-P) was planned for the treatment of BPH, and before surgery, a dermatology consultation was done. According to the dermatology specialist, the lesions seemed like pyogenic granuloma, and for differential diagnosis a histologic examination should be made. The treatment plan was then revised to TUR-P and local excision of the lesions. During surgery, excision of the lesions with a 2-mm margin was performed. Histopathological examination revealed KS. On macroscopic examination, papular, red colored, dermal lesions with an ulcerated surface were seen. On microscopic examination, these proved to be vascular lesions with spindle cell proliferation and increased mitotic activity. Vascular clefts contain blood elements. Atypical spindle cells are organized as interlacing bundles with extravascular erythrocytes scattered around. These tumoral cells infrequently have intracytoplasmic, eosinophilic, periodic acid shift (PAS)-positive, hyaline globules. There are mixed inflammatory reactions and hemosiderin-laden macrophages between tumoral cells. Findings were evaluated as the nodular phase of classic Kaposi's sarcoma (Figs 2,3). After histopathological diagnosis chest, abdominal pelvic computed tomography (CT) scans and HIV tests were done. The patient was seronegative for HIV-I and HIV-II (by enzyme-linked immunosorbent assay). CT scans were also normal. A 1-year follow up did not show any disease progression or local recurrence.

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Figure 1. Two reddish papular lesions on the penis.

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Figure 2. Neoplastic spindle cell proliferation with vascular spaces. HE, ×200.

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Figure 3. Periodic acid shift (PAS)-positive hyalene globules (at the tip of the arrow). ×400, PAS.

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Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References

In the last 20 years, only 15 well-documented cases of primary penile KS in HIV-negative patients have been reported in the English literature.4–17 Among patients with primary classic penile KS, the most frequently involved site is the glans, and other frequently involved sites are foreskin, and coronal sulcus. The involvement of the shaft is rare and usually associated with lesions on the glans or coronal sulcus.12,13 Penile swelling and lymphatic edema due to massive involvement were also seen in some cases.10,13 The size of lesions can vary from a few millimeters to a few centimeters. Lesions are usually present as single reddish-purple nodules.4,7,8,11 Multiple papules, plaques and wart-like pedunculated lesions were also reported.5,6,10,12,14 In general, local recurrences are rare if the primary tumor is completely removed.12 Onset of new lesions is observed after a period of 6 months to 2 years. A patient who developed new lesions 2 months after the onset of primary tumor has also been described,16 and to date there is only one case reported to be disease-free at 5-year follow up.18

The histological pattern of penile KS is similar to that of KS located at other anatomic skin sites. The pathogenesis of KS is not well known. Recent studies have focus on causative infectious agents, and HHV-8 has been found to be associated with KS.19 HHV-8 tests were not available at our laboratory, so we could not use this test on our patient.

Treatment of primary penile KS includes local surgical excision, radiotherapy,6,10 laser therapy,12 and chemotherapy.20 No standard treatment guidelines are available. For small solitary lesions, surgical excision is recommended but for larger lesions radiation therapy is needed. Systemic chemotherapy is usually recommended for more advanced cases with visceral involvement or generalized lesions.

In conclusion, although rare, isolated Kaposi's sarcoma of the penis must be considered among the differential diagnoses of non-specific lesions of the penis.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Case report
  5. Discussion
  6. References