Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 21, 2013; 19(23): 3608-3614
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3608
Diagnostic value of endothelial markers and HHV-8 staining in gastrointestinal Kaposi sarcoma and its difference in endoscopic tumor staging
Naoyoshi Nagata, Toru Igari, Takuro Shimbo, Katsunori Sekine, Junichi Akiyama, Yohei Hamada, Hirohisa Yazaki, Norio Ohmagari, Katsuji Teruya, Shinichi Oka, Naomi Uemura
Naoyoshi Nagata, Katsunori Sekine, Junichi Akiyama, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Toru Igari, Department of Clinical pathology, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Takuro Shimbo, Department of Clinical Research and Informatics, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Yohei Hamada, Hirohisa Yazaki, Katsuji Teruya, Shinichi Oka, Division of AIDS Clinical Center (ACC), National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Norio Ohmagari, Department of Infectious disease, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
Naomi Uemura, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Kohnodai Hospital, Chiba 272-8516, Japan
Author contributions: Nagata N participated in the design of the study, data acquisition and interpretation, performed endoscopy, and wrote the manuscript; Shimbo T participated in the design of the study and contributed to statistical analyses; Igari T evaluated pathological diagnosis and infection; Sekine K, Hamada Y, and Yazaki H, helped with data acquisition; Ohmagari N, Akiyama J, Teruya K, Oka S and Uemura N advised on the design of the study and contributed to the writing of the manuscript; all authors read and approved the submitted version of the manuscript.
Supported by A Grant from the National Center for Global Health and Medicine (21-101)
Correspondence to: Naoyoshi Nagata, MD, Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, 162-8655, Tokyo, Japan. nnagata_ncgm@yahoo.co.jp
Telephone: +81-3-32027181 Fax: +81-3-32071038
Received: February 16, 2013
Revised: April 4, 2013
Accepted: April 9, 2013
Published online: June 21, 2013
Processing time: 121 Days and 3.7 Hours
Abstract

AIM: To clarify the diagnostic values of hematoxylin and eosin (HE), D2-40, CD31, CD34, and HHV-8 immunohistochemical (IHC) staining in gastrointestinal Kaposi’s sarcoma (GI-KS) in relation to endoscopic tumor staging.

METHODS: Biopsy samples (n = 133) from 41 human immunodeficiency virus-infected patients were reviewed. GI-KS was defined as histologically negative for other GI diseases and as a positive clinical response to KS therapy. The receiver operating characteristic area under the curve (ROC-AUC) was compared in relation to lesion size, GI location, and macroscopic appearances on endoscopy.

RESULTS: GI-KS was confirmed in 84 lesions (81.6%). Other endoscopic findings were polyps (n = 9), inflammation (n = 4), malignant lymphoma (n = 4), and condyloma (n = 2), which mimicked GI-KS on endoscopy. ROC-AUC of HE, D2-40, blood vessel markers, and HHV-8 showed results of 0.83, 0.89, 0.80, and 0.82, respectively. For IHC staining, the ROC-AUC of D2-40 was significantly higher (P < 0.05) than that of HE staining only. In the analysis of endoscopic appearance, the ROC-AUC of HE and IHC showed a tendency toward an increase in tumor staging (e.g., small to large, patches, and polypoid to SMT appearance). D2-40 was significantly (P < 0.05) advantageous in the upper GI tract and for polypoid appearance compared with HE staining.

CONCLUSION: The diagnostic value of endothelial markers and HHV-8 staining was found to be high, and its accuracy tended to increase with endoscopic tumor staging. D2-40 will be useful for complementing HE staining in the diagnosis of GI-KS, especially in the upper GI tract and for polypoid appearance.

Keywords: Gastrointestinal Kaposi’s sarcoma; Hematoxylin and eosin; CD31; CD34; D2-40; Human herpesvirus-8

Core tip: Diagnosis of gastrointestinal Kaposi sarcoma (GI-KS) is important because treatment specifics depend on the extent of the disease. Endoscopic biopsy is a definitive diagnostic method for GI-KS, but its diagnostic accuracy has not been fully studied. In the current study, receiver operating characteristic area under the curve of hematoxylin and eosin (HE) staining, lymphatic and blood vessel endothelial cell markers, and HHV-8 was found to be high (> 0.80), and its accuracy tended to increase with endoscopic tumor staging. D2-40 will be useful for complementing HE staining in the diagnosis of GI-KS, especially in the upper GI tract and for polypoid appearance.