A rare case of bilateral conjunctival Kaposi's sarcoma in a
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Kaposi's sarcoma (KS) is a rare multi-centric vascular neoplasm, first described by Moritz Kaposi in 1872. It can appear in four different forms: classic, endemic, HIV-related and post-transplant form. We present an uncommon case of seronegative HIV infection patient with skin KS involving conjunctiva of both eyes.

An 83-years old white man referred to our department with a 3 months history of rapid growing conjunctival nodal lesions in both eyes, causing ectropion. Slit-lamp examination showed firm, pedicled purple-red nodular lesions (respectively 3 in right eye and 2 in left eye) on the infero-medial conjunctival fornix, causing bleeding and itching. Patient did not mention any pain or visual changes. Best corrected visual acuity was 20/30 for each eye and subsequent fundoscopic exam was normal for the age. No previous transplant history or intravenous drug abuse. The patient had pacemaker due to a previous myocardial infarction. The hematologic and biochemical tests were out of normal ranges. In particular, granulocytopenia and hypereosinophilia were observed. Serologic tests (Western Blot and ELISA tests) for HIV-1/2 were negative, while HCV-RNA was positive.

Further skin examination showed multiple, over 2 cm length, painless asymmetrical, not scaly, maculo-papular, hyperpigmented focally nodular cutaneous lesions involving face, trunk (anteriorly and posteriorly) and both legs. Subsequent oral cavity examination, chest X-ray, gastroscopy and colonoscopy did not reveal any abnormalities, while Computed Tomography (CT) scan showed a hyperdense soft tissue mass in the medial cantus region. After the acquisition of the informed consent, three conjunctival nodular lesions of right eye were surgically removed under local anesthesia. Histological examination showed a cellular nodular tumor composed of slit and sieve-like spaces containing red blood cells. Immunohistochemical examination revealed positive staining for CD31 on vessel walls. Both features were considered typical of nodular stage of KS. In addition, immunohistochemistry for HHV-8 was negative. Margins were tumor free.

Subsequently, the patient was administered with systemic chemotherapy (doxorubicin) to treat both skin and left eye lesions. No signs of recurrence were observed at 20 months’ follow-up. Both surgery and chemotherapy could be considered valid treatment options for conjunctival KS.

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