HIV Insight: An Unusual Case of Invasive Kaposi's Sarcoma with Primary Effusion Lymphoma in an HIV Positive Patient: Case Report and Literature Review

We report a case of AIDS-related Kaposi's sarcoma (KS) with Primary Effusion Lymphoma (PEL) in a 28-year-old, African American male. Kaposi's sarcoma is an AIDS defining disease and typically will disseminate early in the course of the disease affecting the skin, mucous membranes, gastrointestinal tract, lymph nodes, and lungs. This case reports an unusual presentation of the disease along with primary effusion lymphoma. Although the most common organ systems affected by KS are the respiratory and the gastrointestinal systems, the lungs of this patient did not show any evidence of KS. Additionally, the patient demonstrates the rarely seen liver and unique pancreatic involvement by KS along with unusual synchronous bilateral pleural and peritoneal cavity involvement by PEL, adding to the distinct pattern of invasive AIDS-related Kaposi's sarcoma.

Below: CT scans of the chest and abdomen show large bilateral pleural effusions (a) and severe ascites (b). There is a 4.2 cm mass in the head of the pancreas (c).

Below: Cytologic evaluation of the pleural fluid shows large atypical lymphoid cells (arrows) ((a) H&E, ×100) expressing HHV8, CD30, and CD138 ((b), (c), and (d), resp.). The atypical cells show high proliferation index highlighted by Ki-67 immunostain (e) and positive staining for Epstein-Barr Virus (EBV) by in situ hybridization (f).

Below: The cut surface of liver shows a well-demarcated perivascular infiltration marked by reddish-brown tumorous tissue (arrows) (a). The head of the pancreas shows a reddish-brown infiltrating lesion (arrows) (d). Representative microscopic sections show spindle cells proliferation involving hepatic lobules ((b) H&E, ×20) and pancreatic acini ((e) H&E, ×10) with positive staining for HHV-8 antibody consistent with Kaposi's sarcoma ((c), (f)).