LETTER
Hippokratia 2013, 17(1):96
Kampantais S1, Gourvas V2, Ioannidis S1
1First Department of Urology, Aristotle University Medical School, 2Department of Pathology, Gennimatas General Hospital, Thessaloniki, Greece
Key words: Kaposi sarcoma, HIV negative, HHV-8 positive, penis
Corresponding author: Spyridon Kampantais MD, 41 Ethnikis Aminis Str, 54643, Thessaloniki, Greece, tel: +302310963105, fax: +302310992543, e-mail: kabspir@hotmail.com
Dear Editor,
Kaposi’s sarcoma (KS), first described in 1872 by Moritz Kaposi, is a tumor of vascular origin1. Initial presentation on the penis is uncommon and is more often observed in AIDS patients, who usually develop an aggressive form of the disease2. Since the first report in 1902, few cases of primary penile Kaposi’s sarcoma in HIV negative patients have been reported in the literature3. We present a case of a male patient, who was HIV negative and human herpes virus 8 (HHV-8) positive and presented with two Kaposi’s sarcoma lesions on the inner layer of the prepuce.
An otherwise healthy 50-year-old man with no history of homosexual activity or sexual transmitted diseases presented to our department with two contiguous bluish penile nodules. The nodules were approximately 0,5cm in size and located on the inner layer of the prepuce. They were not painful and were reported to gradually enlarge over a two-month-period, since first noticed. As first clinical diagnosis, these lesions were considered to be genital warts. Under local anesthesia, an excision of the lesions was performed. Histological examination showed classical Kaposi’s sarcoma.
Blood test for HIV was negative. The presence of HHV-8 was analyzed at the paraffin-embedded excised tissue specimen and the final nested PCR product was tested positive. Physical examination revealed no evidence of inguinal lymph node involvement or other mucocutaneous lesions. Chest X-ray, abdominal and pelvic computed tomography did not demonstrate any additional visceral lesions. The patient is under follow up for six months with no evidence of disease recurrence.
KS limited to the external genitalia is extremely rare in HIV seronegative individuals. Gönen et al reported only 15 well-documented cases of primary penile KS in HIV negative patients in the English literature2.The differential diagnosis for penile lesion includes: pyogenic granuloma, condyloma acuminate, glomus tumor and molluscum contagiosum2. There is no established treatment for primary classic penile KS. Local surgery is recommended, particular for small or solitary lesions. In general, local recurrences are rare if the primary tumor is completely excised3.
Despite the fact that primary KS of the penis is extremely rare, it should be always considered by venereologists and urologists in the differential diagnosis of nonspecific lesions in this area, even in HIV negative patients.
Conflict of interest
None declared.
References
1. Chang Y, Cesarman E, Pessin MS, Lee F, Culpepper J, Knowles DM, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994; 266: 1865-1869.
2. Gönen M, Cenker A, Kiyici H, Kalkan M. Penile Kaposi’s sarcomas in a circumcised and HIV-seronegative patient. Int J Urol. 2006; 13: 318-320.
3. Micali G, Nasca MR, De Pasquale R, Innocenzi D. Primary classic Kaposi’s sarcoma of the penis: report of a case and review. J Eur Acad Dermatol Venereol. 2003; 17: 320-323.