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Claudia Fiorot, Jacqueline Coblentz, Gerardo Discepola, Sabrina Cohen, Rubens Belfort, Miguel N Burnier; Kaposi’s sarcoma of the conjunctiva and orbit . Invest. Ophthalmol. Vis. Sci. 2017;58(8):3357.
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To report two cases with rare manifestations of Kaposi’s sarcoma.
Description of two case reports.
Case report 1: A 93-year-old caucasian male presented with a nodule in his left eye. His past clinical history reported a gastrointestinal stromal tumor treated with imatinib mesylate (Gleevec®). All laboratory tests were negative, including tests for HIV. There was no history of acquired or iatrogenic immunosuppression. Best corrected visual acuity was 20/25 in both eyes. Ophthalmic examination was normal except for biomicroscopy in the left eye, which revealed conjunctival hyperemia with a nodule in the left inferior fornix. The patient underwent computed tomography of both orbits, which confirmed the conjunctival nodule and also showed lateral invasion to the orbit. Total excision of the nodule was performed and the specimen was sent for histopathological analysis. At low magnification, a fragment of conjunctiva with a subepithelial tumor was seen. The tumor was composed of dilated blood vessels with numerous spindle cells interspersed between them. There were also extensive areas of hemorrhage. At high magnification, the intervascular tissue was composed of atypical spindle cells with spindle and hyperchromatic nuclei. Several extravasated red blood cells were observed. Immunohistochemistry against Human Herpes Virus 8 was positive, with nuclear expression, which confirmed the diagnosis of Kaposi’s sarcoma. Case report 2: A 50-year-old woman presented with hyperemia and itching in both eyes. She was previously treated for leprosy. Visual acuity was 20/20 in both eyes, intraocular pressure was 18mmHg in the right eye and 16mmHg in the left eye, and fundoscopy was normal. Biomicroscopy revealed intense hyperemia with inferior conjunctival nodules in both eyes, which was larger in the right eye. She also had lesions on her tongue and palate. Serology was performed and was positive for HIV (CD4+ 60 cells/μL). She started systemic treatment and surgical excision of the nodules was performed. Histopathological and immunohistochemistry analysis confirmed the diagnosis of Kaposi’s sarcoma.
Although Kaposi’s sarcoma is more common in HIV-positive males, these case reports are a reminder that elderly HIV-negative men can be affected, as well as HIV-positive women. Despite the conjunctiva being the most affected ocular structure, it is always important to rule out orbital invasion.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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