Primary Kaposi sarcoma of the glans: A rare case in an HIV‐negative patient

Abstract First presentation of the Kaposi sarcoma (KS) on the penis is not prevalent, and it was reported in 2%‐3% of the cases that mostly occurred in the HIV‐positive patients. Here, we report a case of primary KS on the glans penis in an HIV‐negative patient.

that is mainly observed in HIV and immune-compromised patients.
First presentation of the KS on the penis is not prevalent, and it was reported in 2%-3% of the cases that mostly occurred in patients with AIDS. 4 Therefore, the report of the primary non-HIV-related KS in the penis is rare in the literature. Here, we report a patient with a classic form of KS who had a primary penile lesion.

| CASE PRESENTATION
A 50-year-old man was admitted to our dermatology clinic at our teaching hospital. He presented with erythematous nodular penile lesions of 4 months' duration. There was no history of fever, weight loss, or any other symptoms. He also denied | 1135 any history of systemic disease. Our patient was married with no history of extramarital relationship.
In his physical examination, there were some reddish, nontender nodules of 5-10mm on the ventral and dorsal sides of glans penis ( Figure 1). No other skin lesion was observed on his skin. There were no palpable lymph nodes in the inguinal region.
Then skin biopsy was taken from the lesion, and the histopathology examination revealed atypical spindle cell proliferation, forming slit-like vessels grouped in bundles and RBC extravasation ( Figure 2). Furthermore, the immunohistochemical study was performed and the pathology confirmed the diagnosis of KS based on a positive HHV-8 immunostaining ( Figure 3). All of his laboratory tests including HIV viral serology were negative. His chest X-ray was normal. No enlarged lymph nodes were found in his abdominopelvic ultrasonography. In addition, the patient was evaluated for the presence of any other systemic involvement and the result was negative. Our patient underwent cryotherapy for 3 courses with complete disappearance of penile lesions, and no local recurrence occurred after one year (Figure 4).

| DISCUSSION
As a malignant tumor, KS originates from lymphatic endothelial cells. Classic, endemic, epidemic, iatrogenic, and nonepidemic forms are the 5 types of KS. 5 Although genital lesions were observed in 20% of KS cases, only 3% of them had the primary localized lesion on the glans penis. 6 The most prevalent form of KS is the nodular form which is found in 83% of the cases. 7 The rare classic type that mostly occurs in the Mediterranean and Eastern Europe population may be also observed in the lower extremities of elderly non-HIV patients between the 6th and 7th decades of age. 8 The infrequent presentation of this classic type is primary penile lesions similar to our patient, which is considered mostly to associate with HHV-8 as an indispensable factor. Table 1 summarizes some relevant cases of genital KS and other associated features according to their publication date.
The patients with KS are commonly asymptomatic but the most commonly observed complaints are pain (48.8%), edema (21.2%), bleeding (14.9), and itching (3.9%). 7 Due to the higher possibility of non-Hodgkin's lymphoma and malignant melanoma development in these patients, management of the lesion is very challenging. Simple excision, radiotherapy, laser, photodynamic therapy, and cryotherapy are among the recommended treatments. In addition, chemotherapy is