AIDS-Related Gastrointestinal Neoplasms

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The entire gastrointestinal tract is a target organ for development of malignancy in patients with acquired immune deficiency syndrome (AIDS). The two most commonly encountered malignant tumors in the AIDS population are Kaposi sarcoma and non-Hodgkin's lymphoma (NHL).

In 1872, Kaposi sarcoma was first recognized and described by Moricz Kaposi, and noted to occur in elderly men of Eastern European extraction as a multicentric spindle cell tumor primarily confined to the skin. A second risk group was recognized in the 1950s occurring in West Africa. This latter group showed a distinct, significantly more aggressive form of Kaposi sarcoma with a predilection for involvement of extracutaneous sites including the bone, lymph nodes, and viscera. Four subgroups were recognized: (1) nodular, (2) florid, (3) infiltrative, and (4) lymphadenopathic. While impaired delayed hypersensitivity was recognized in this group, there was no clear-cut evidence of immunosuppression.1 In the early 1980s, Kaposi sarcoma was first recognized in profoundly immunocompromised men. This form of Kaposi sarcoma shares biologic similarities to subgroup 4 above and was subsequently made one of the criteria for a diagnosis of AIDS by the Centers for Disease Control and Prevention (CDC).

The gastrointestinal (GI) tract is a common target organ for opportunistic infections and malignancies in the human immunodeficiency virus (HIV-infected population. Both Kaposi sarcoma and B-cell non-Hodgkin's lymphoma are recognized as AIDS-defining malignancies involving the GI tract. Kaposi sarcoma has been shown to involve the GI tract in up to 50% of patients with cutaneous disease. Approximately 17% to 27% of those who develop non-Hodgkin's lymphoma will have GI tract involvement, and 12% to 22% will have liver involvement.2,3

This lesson will provide a review of the clinical, radiologic, and general features of gastrointestinal malignancies in the AIDS population.

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