‘The American Joural of Dermatopathology Volume 3 Number 2 ‘Summer 1981 Geoffrey J. Gottlieb, M.D. ‘Anna Ragaz, M.D. A, Bernat Joseph V. Vogel, M.D. Alvin Friedman-Kien, M.D. Arkadi M. Rywlin, M.D. Edward A. Weiner, M.D. Ackerman, M.D. A preliminary communication on extensively disseminated Kaposi’s sarcoma in young homosexual men In the past 2 years we have encountered nine cases ‘of Kaposi's sarcoma in homosexual men who were. in their 30s and 40s. In general, they presented themselves with widespread cutaneous lesions of the disease at all stages of development, i.e., patches, plaques; and nodules (Figs. 1, 2, and 3). Lymph nodes were involved in at least five of the patients and were detected fairly early in the course of the disease (Fig. 4). Visceral involvement was found in three of the patients to date. Five of the nine men have already died of the disease within the 2 years of our observation. Kaposi’s sarcoma in North America and Western Europe tends to affect elderly Jewish and Italian men and the disease is usually long enduring. The occurrence of a rapidly progressive, extensively disseminated, and quickly fatal form of the disease in youngish homosexual men is unusual, to say the least. This sudden, very high incidence of the con- dition in male homosexuals suggests an epidemic and raises the possibility of an infectious cause, especially because homosexuals are now known to have high incidences of many infectious diseases, eg., venereal diseases and viral hepatitis. An infectious (viral) cause is nowadays being seriously considered for Kaposi's sarcoma. Evidence for this possibility derives from the demonstration of herpes-type virus particles in neoplastic cells cul- From the Departments of Dermatology (GJG, AR, AF-K, ABA) ‘and Pathology (EAW, ABA) of the New York University School of Medicine; The Memorial Sloan-Kettering Cancer Center, New York, New York (JVV); and the Mount Sinai Medical Center, Miami Beach, Florida (AMR), ‘Small, slightly irregularly shaped plaques of Kaposi’s sarcoma ‘on the trunk of a 40-year-old homosexual man, Note that the plaques are not deeply colored as is usually the case in Kaposi's ‘sarcoma in elderly men, utFIGURE? Plaques and nodules of Kaposi’s sarcoma in the postauricular region of a 33-year-old homosexual man, iS eae % FIGURES 3a and 38 Photomicrographs ofa biopsy specimen from one of the plaques pictured in Fig. | show irregularly shaped, variously sized endothelial lined spaces throughout the dermis, There are also increased numbers of spindle-shaped cells and patchy mononuclear cenit contig pam el, Thee mrs ears retype of thosin plague lesions of Kaposi’s sarcoma.FIGURES da and 4 ‘Kaposi's sarcoma in a lymph node of a 33-year-old homosexual man, The spindle-cell neoplasm on the right into interweaving fasciles and replaces the normal nodal architecture r magnification in Fig, 4. Single erythrocytes are seen inthe interstices tures ofthe neoplasm within this lymph node are virtually identical toKaposi's sarcoma in homosexual men FIGURE 4 (conned) tured from patients with Kaposi’s sarcoma, ele- vated titers of antibodies to cytomegalovirus, and unusually high prevalence of the disease in certain geographical areas, e.g., equatorial Africa.) Clinicians may not entertain the possibility of Kaposi's sarcoma in persons who are still young and if lesions of that condition are in the patch or plaque stages only. We publicize this preliminary report in ‘order to alert clinicians and pathologists to an un- usually fulminant form of Kaposi's sarcoma that ‘occurs in young homosexual men and to promote early diagnosis and quick inception of treatment of this form of the disease that is rapidly progressive to fatality and threatens to become rampant in ho- mosexuals. ‘A detailed report of these cases with particular reference to their clinical and pathologic features is being prepared. Serologic studies of titers of an- tibodies to viruses, tissue cultures for viruses, elec- tron microscopy for viruses, and epidemiologic surveys are also under way in affected individuals and the homosexual population at large. Oo References. 1. Dietzman, D.E., Hanisch, J.P., Ray, C.G,, Alexander, ER, land Holmes, K:K.: Hepatitis B surface antigen (HB,Ag) and 4 antibody 1o HB,Ag. Prevalence in homosexual and hetero- sexual men, JAMA 238: 2625-2626, 1977. 2, Fluker, JL A 10-year study of homosexually transmitted infection Br J Vener Dis 52: 155-160, 1976. 3, Giraldo, G., Beth, E. and Haguenau, F: Herpes-type virus particles in tissue culture of Kapos’s sarcoma from different ‘Beographie regions. ‘I Natl Cancer Inst 49: 1509-1526, 1972 4, Giraldo, G., Beth, E, Henle, W.yel al: Antibody patterns to herpesvirus in Kapos's sarcoma” II, Serologic association of American Kapos’s sarcoma with cytomegalovirus. Int J Cancer 22: 126-131, 1978. 5, Taylor, JF., Smith, P.G., Bull, D., and Pike, M,C. Kaposi's sarcoma in Uganda: Geographic and ethnic distribution, BrJ Cancer 26: 483-497 , 1972. Acknowledgment “The authors thank Mr. William Slue, Jr. for his assis- tance in clinical photography. Write for reprints to: A. Bernard Ackerman, M.D. Department of Dermatology, New York University School of Medicine, 530 First Avenue, New York, New York 10016. ‘The American Journal of Dermatopathology