title: Kaposi's sarcoma of the pancreas mimicking pancreatic cancer in an HIV-infected patient. Clinical diagnosis by detection of HHV 8 in bile and complete remission following antiviral and cytostatic therapy with paclitaxel.
abstract: BACKGROUND
  Diagnosis of pancreatic cancer is usually made by endoscopic retrograde cholangiopancreatography (ERCP) and corresponding findings in computed tomography (CT) or magnetic resonance imaging. Kaposi's sarcoma, a frequent tumor in individuals with a late-stage HIV infection, can be located in the gastrointestinal tract and cause identical symptoms to carcinoma of the same site. A close correlation of this tumor to human herpes virus 8 (HHV 8) has been known for several years and there are reports of successful antiproliferative therapy.
  
  
  METHODS
  Aspirated pancreatic juice and bile was investigated for the presence of HHV 8 by polymerase chain reaction. The clinical course of the patient under antiviral therapy and treatment with paclitaxel was studied.
  
  
  RESULTS
  A 47-yr-old HIV-infected man with a history of Kaposi's sarcoma of skin and lungs caused by obstructive jaundice in the years before was admitted. ERCP showed a typical double-duct sign and CT revealed a tumorous infiltration of the pancreatic head, highly suspicious for pancreatic adenocarcinoma. A mutation of the ki-ras gene could be ruled out and molecular analysis of bile identified HHV 8 by PCR. Intensive antiviral therapy, including foscarnet and treatment with paclitaxel led to a complete remission within 8 m.o.
  
  
  CONCLUSIONS
  Kaposi's sarcoma of the pancreas possibly mimics pancreatic cancer in HIV-infected subjects. Diagnosis may be made by identification of HHV 8 in pancreatic juice or bile, and successful clinical outcome is possible by intensive antiviral and cytostatic treatment with paclitaxel.
authors.affiliation: Department of Internal Medicine II, University Hospital of the Saarland, Homburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Menges
authors.forename: H W
authors.initials: HW
authors.lastname: Pees
mesh_terms: D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D001646:Bile / Q000821:virology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003937:Diagnosis, Differential; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D019288:Herpesvirus 8, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D011860:Radiography, Abdominal; D012074:Remission Induction; D012514:Sarcoma, Kaposi / Q000175:diagnosis* / Q000188:drug therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D000998:Antiviral Agents; D017239:Paclitaxel