陰莖卡波西氏肉瘤在HIV陰性患者的罕見病例報告與文獻回顧

謝佳駤¹、曾文歆^1,2、朱彰堯³、葉麗青³、劉建良^1,4、黃冠華¹

台南永康奇美醫院 外科部 泌尿科¹；國立中山大學生物醫學研究所²；台南永康奇美醫院 病理部³，外科部 泌尿腫瘤科⁴

Penis Classic Kaposi Sarcoma in a HIV-negative patient - A Rare Case Report and Literature Review

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chang-Yao Chu³、Khin Than Win³、Chien-Liang Liu^1,4、Steven K. Huang¹

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

² Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³ Department of Pathology, Chi Mei Medical Center, Tainan, Taiwan;

⁴ Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Purpose: Kaposi sarcoma (KS) is an angioproliferative neoplasm. Areas around the skin, mucosa, and viscera could be involved, including the genitalia. Traditionally, classic KS lesions have a general distribution, which is a well-recognized manifestation of acquired immune deficiency syndrome (AIDS). However, KS limited to the glans penis is extremely rare in HIV-seronegative patients. Herein, we present a 66-year-old HIV-seronegative man who presented with two 5-mm purplish papules on the glans penis, which were reported as KS after an excisional biopsy of the lesion.

Case presentation: A 66-year-old married man with a history of hypertension presented with two painless purplish hard nodules on the glans penis. He denied prior use of any immunosuppressive agent or outside-marriage hetero- or homo-sexual activity. There were no palpable lymph nodes in the inguinal area. During the physical examination, no other lesions were observed on the skin or extremities. Laboratory tests demonstrated normal blood cell counts and urine analysis and culture. Serologic testing for HIV, hepatitis B virus, hepatitis C virus and rapid plasma reagin were all negative.

Abdominal sonography revealed only fatty liver without other abnormal findings. Surgical excision was arranged and the histopathology report revealed atypical spindle cell proliferation.

Immunohistochemistry for the melanoma was non-reactive for S-100, HMB-45, and Melan-A, but was immunoreactive for HHV-8 and CD34, which was consistent with KS. Further computed tomography from the chest to the pelvic region detected no visceral lesion or lymphadenopathy. Because the wound recovered well and no additional lesion was discovered, further conservative treatment was chosen.

Conclusions: Primary Kaposi sarcoma of the penis is extremely rare in HIV-seronegative patients. In a study by Fatahzadeh et al on 2012, there were only 19 cases with penile KS in HIV-negative patients. Since no any additional lesions were noted, conservative treatment for our patient was chosen. Treatment needs to be carefully customized, based on every patient’s clinical performance and immune status.