Table 2.
Outcomes in patients with clinically symptomatic hepatic Kaposi sarcoma
| Age (yr) | Sex | HIV status | CD4 count (cells/mm3) | Liver chemistry profile | Pathology | Treatment | Hospital course + complications |
| 45[63] | M | (+) | 192 | T Bil 19.35 ALP 1309 AST 204 ALT 188 GGT 827 | HHV-8 PCR VL (+) 24000 copies/mL. Liver biopsy revealed features of KS with spindle cells, extravasation of red blood cells and haemosiderin deposition. IHC staining HHV8 (+) | Paclitaxel, Montelukast | Continued on chemotherapy. Subsequently developed respiratory and renal failure, anemia and thrombocytopenia from aggressive metastatic KS |
| 36[64] | M | (+) | 17 | PTT 70 (s) ALT 185 T Bil 23 | Necroscopy showed bile duct proliferation with diffuse fibrosis with lymphohistiocytic infiltration | Liposomal doxorubicin | Jaundice, renal failure, fulminant liver failure |
| 28[65] | M | (+) | NR | NR | Biopsy residues of spindle cells lining portal tracts. Immunoperoxidase staining factor VIII (+) | Palliative care | Liver function continued to decline and patient died from respiratory failure two weeks later |
| 38[66] | M | (+) | < 2001 | AST 147 ALT 180 ALP 573 | Gross specimen with fibrous thickening of portal tracts and dark red nodules in periportal areas and diffusely infiltrating liver parenchyma | Chemotherapy, NOS | Partial cutaneous response, died several weeks later |
| 40[4] | M | (+) | NR | Reportedly, “normal” | KS present on biopsy of lymph nodes. US with three 7-12 mm hyperechoic nodules. Periportal groups of dilated blood filled cavernous spaces lined by flat endothelial cells and interspersed of spindle cells. Extravasated erythrocytes and minimal hemosiderin deposits | Combination Chemotherapy, NOS | Complete remission of cutaneous lesions and reduction in size of two of the lesions with the third not visible. Readmitted six months later for severe relapse of cutaneous KS. Reinitiated chemotherapy with rapid deterioration and death within one month |
| 48[67] | M | (+) | 8 | TBili 20.0 ALP 947 AST 186 ALT 155 INR 1.9 | Liver biopsy was Cytokeratin-7 and HHV-8 staining positive | Ganciclovir and Rituximab | Presented with jaundice and acute liver injury with a cholestatic pattern, progressed to fulminant hepatic failure and ultimately death |
| 44[68] | M | (+) | CD4/CD8 ratio 0.08 | AST 153 ALT 124 ALP 1228 | Laproscopy demonstrated enlarged liver with multiple purple 2-3 mm nodules Biopsy demonstrated spindle cells, vascular slits, extravasated red cells and lymphocytic infiltration | Platinum based chemotherapy, NOS | Primary hepatic manifestations without cutaneous lesions. Persistent abdominal pain after treatment. Progressed to cutaneous lesions six weeks after treatment. Lost to follow-up |
1
Less than 200, not otherwise reported. M: Male; F: Female; TBili: Total Bilirubin (units, mg/dL); ALP: Alkaline phosphatase (units, IU/L); AST: Aspartate transaminase (IU/L); ALT: Alanine transaminase (IU/L); GGT: Gamma glutamyl transpeptidase (units, IU/L); HHV-8: Human herpes virus-8; PCR: Polymerase chain reaction; VL: Viral load; IHC: Immunohistochemistry; NR: Not reported; NOS: Not otherwise specified; US: Ultrasound; KS: Kaposi sarcoma.