In June and July of 1981 reports from California and New York City described the unusual occurrence of life-threatening opportunistic infections, particularly P carinii pneumonia and Kaposis sarcoma in young, previously healthy homosexual men. Since that time, approximately 25 percent of patients with the acquired immunodeficiency syndrome (AIDS) have presented with Kaposi’s sarcoma, most often demonstrating cutaneous or lymph node involvement. In the pre-AIDS era, pulmonary involvement with this tumor was thought to be rare. This study is a retrospective analysis of the clinical presentation, including roent-genographic and pathologic findings of pulmonary Kaposi’s sarcoma in AIDS patients. There are so many hospitals, clinics, medical workers and preparations. The is full of interesting information.
Materials and Methods
Between November, 1980 and 1984, 318 patients with Kaposis sarcoma presented to New York University Medical Center who met the Centers for Disease Control criteria for diagnosis of the acquired immunodeficiency syndrome. Ninety of these patients with Kaposi’s sarcoma (including one patient with only pulmonary involvement) were evaluated by fiberoptic bronchoscopy and/or open lung biopsy due to fever, cough and/or abnormal chest roentgenogram. Fiberoptic bronchoscopic examination including transbronchial biopsy and alveolar lavage was the initial procedure in 89 of the 90 patients. Transbronchial biopsy samples (usually three to five) were obtained from a roentgenographically-affected lobe. Transbronchial biopsy specimens were cultured for cytomegalovirus. Alveolar lavage fluid was analyzed cytologically and the centrifuged pellet was stained with silver methenamine and Ziehl-Neelson stains. In addition, the lavage fluid was cultured for aerobic bacterial, mycobacterial and fungal organisms and was stained for Legionella utilizing the direct fluorescent antibody technique. Endobronchial anatomy was inspected for sarcomatous lesions (observed in six patients); endobronchial biopsy was performed in four of these patients. Thoracotomy with open lung biopsy was the alternative initial diagnostic procedure in one patient with coagulopathy and severe gas exchange abnormalities. Open lung biopsy followed an initial non-diagnostic bronchoscopic biopsy in 14 patients. One patient underwent mediastinoscopy following negative transbronchial and open lung biopsies. Autopsies were performed in 29 of the 90 patients with Kaposis sarcoma.
Thus, in the 19 patients with pulmonary Kaposis sarcoma, the following diagnostic procedures were performed: fiberoptic bronchoscopy (17) with endobronchial biopsy (four) and transbronchial biopsy (17); open lung biopsy (nine); mediastinoscopy (one); and autopsy (nine).