(58) Non-AIDS-Related Kaposi Sarcoma of the Tongue: A Case Study and Literature Review

Abstract: Kaposi sarcoma (KS), associated with Human Herpesvirus-8 (HHV-8), is a multifactorial disease primarily linked with human immunodeficiency virus (HIV) infection. HHV-8, a DNA virus, typically presents in advanced HIV leading to vascular malignancy, B-cell lymphoproliferative disorders, including primary effusion lymphoma and multicentric Castleman disease. HHV-8 can establish latency in vascular endothelium for extended periods, with viral replication occurring under certain conditions, triggering the infectious phase.¹

AIDS-related Kaposi sarcoma commonly arises in the oral mucosa and has been known to have metastatic potential. KS is classified into several subtypes, including classic, endemic, and iatrogenic.¹ Classic KS typically affects Mediterranean, Eastern European, and Jewish populations, seen as slowly growing papules or nodules presenting on the extremities with an endemic variant primarily affecting the African male population requiring systemic pharmacotherapy.¹ A smaller subset of iatrogenic KS has also been documented in literature.

Oropharyngeal KS in HIV-negative patients is rare, requiring differentiation from AIDS-associated KS. This review aims to discuss the occurrence of oral lesions in non-AIDS-associated KS and explore various treatment options. This study also presents a rare case of a seronegative geriatric male patient with KS of the tongue and cutaneous lesions.

A literature review for non-AIDS KS that mentioned oral lesions was conducted across 21 articles published from 1995-2025; the review indicated that non-AIDS associated KS has been reported in Mediterranean groups and groups at risk for immunosuppression, hence warranting further discussion. A review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) utilizing PubMed, and Google Scholar. Among the 21 articles screened, 17 articles met the criteria for this review. The included research focused on non-AIDS related KS through the identification of oral mucosal lesions and cutaneous lesions. Studies were excluded if they exclusively mentioned HIV-associated KS.

KS should be considered in the differential diagnosis for oral vascular lesions, even in immunocompetent individuals. Treatment strategies for head and neck KS lesions vary based on lesion location, size, symptom severity, and metastatic progression.<sup>2/sup> For non-HIV-associated KS in the oral cavity, treatment options include surgical excision, cryotherapy, radiation, vinblastine injections, or systemic chemotherapy (single-agent or combination). Given the potential comorbidities associated with chemotherapeutic agents, surgical excision or radiation may be preferred in the absence of symptoms such as odynophagia, dysphagia, or hemorrhage.2 A multidisciplinary approach is necessary for managing oropharyngeal KS, particularly in cases with extensive disease or metastasis. Treatment should be individualized, after factoring into consideration the patient’s functional status and quality of life.

1. Cesarman E, Damania B, Krown SE, Martin J, Bower M, Whitby D. Kaposi sarcoma. Nat Rev Dis Primers. 2019 Jan 31;5(1):9. doi: 10.1038/s41572-019-0060-9. PMID: 30705286; PMCID: PMC6685213.
2. Server EA, Durna YM, Yigit O, Bozkurt ER. Supraglottic Kaposi's Sarcoma in HIV-Negative Patients: Case Report and Literature Review. Case Rep Otolaryngol. 2016;2016:1818304. doi: 10.1155/2016/1818304. Epub 2016 Jun 8. PMID: 27375914; PMCID: PMC4916285.
Oral Kaposi SarcomaKaposi Sarcoma of the Tongue-Histopathology</sup>