Objective: Kaposi's Sarcoma (KS) is the most common low-grade mesenchymal angioproliferative disease seen in patients infected with the human immunodeficiency virus (HIV). Lymph node involvement is rare in classical KS, but it is common in endemic and epidemic (AIDS-related) KS. Kaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus type 8(HHV8), was first described in HIV-associated KS. Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)is a rare lymphoma with an incidence of 0.1 to 0.2/100,000/y. Significant histological feature is the presence of CD20 (+) CD15 (−) CD30 (−) variants in a nodular infiltration lymphocyte pattern of Reed-Sternberg cells. The coexistence of Hodgkin's disease (HD) and KS is a rare condition.
Case report: A 41-year-old male patient presented to the hematology outpatient clinic with painless swelling in the left armpit. There were no B symptoms at the patient's presentation. He had a history of RAI due to hyperthyroidism in 2004 and using 100mcg of Levothyroxine. He also had a history of 7packs/year of cigarette (exsmoker) and alcohol use as a social drinker. On physical examination, a well-demarcated, flip, painless lymphadenomegaly (LAM) was detected in the left axillary region, and hepatosplenomegaly (HSM) was not spresent. The laboratory results were as follows: wbc: 8300UL; 15.1g/dL, lymphoyte: 1450mm3, plt: 197,000UL, albumin: 4.5g/L, calcium: 10.9mg/dL, ldh: 156U/L, uric acid: 6.5mg/dL. The serological tests were negative, other biochemical parameters were normal. The peripheral smear of the patient was evaluated as normal morphology. An cxcisional lymph node biopsy was taken from the left axilla. The pathology result was interpreted as nodular lymphocyte predominant Hodgkin's lymphoma (NLP) classical type and Kaposi's sarcoma with diffuse HHV-8 positivity. Bone marrow biopsy revealed no Kaposi's or Hodgkin's lymphoma infiltration. PET-CT imaging was performed for lymphoma staging. Lymphoproliferative disease involvement was observed at the left axilla level 2, 3 in bilateral, cervial, left infraclavicular, retropectoral area and along the medial line of the spleen. It was evaluated as stage II S. No additional lesion was detected in the patient evaluated by dermatology for Kaposi's sarcoma. Gastroscopy and colonoscopy were performed for gastrointestinal tract involvement and evaluated with biopsy. Helicobacter Pylori was observed in gastroscopy and eradication treatment was given. No pathological finding was seen in colonoscopy. By evaluating as early-stage NLP Hodgkin's Lymphoma, the patient was initiated on radiotherapy.
Methodology: Except for the need for an impaired immune system for the development of KS, it is thought that the relationship of KS with HD may be related to common pathogenic mechanisms instead of a direct causal relationship.
Results: Recently, HD and KS development has been associated with EBV and HHV-8, respectively. Although there are cases of KS and classical HD coexistence in the same lymph node, the coexistence of KS and NLPHL subtype in the same lymph node is quite rare.
Conclusion: Although KS is most commonly associated with immunodeficiency due to HIV infection or other causes of immunosuppression, it was not associated with any immunodeficiency status in our case. Due to the fact that KS and NLPHL were present in the same lymph node as two separate primers and were not immunosuppressed, we presented our case below. It was also unusual for KS to have primary lymph node involvement without cutaneous involvement.
