title: Classic Kaposi's sarcoma in Morocco: clinico-epidemiological study at the National Institute of Oncology.
abstract: BACKGROUND
  Classic Kaposi's sarcoma (CKS) is a rare disease likely associated with human herpes virus 8 (HHV-8) infection, and occurs predominantly in Jewish, Mediterranean and middle eastern men. There is a dearth of data in Moroccan patients with CKS regarding epidemiology, clinical characteristics and outcomes. This report examines a cohort of patients with CKS evaluated at the national institute of oncology over 11-year period.
  
  
  METHODS
  A retrospective analysis of patients referred to the national institute of oncology with classical Kaposi sarcoma, between January 1998 and February 2008, was performed. Reviewed information included demographics, clinical and pathological staging, death or last follow-up.
  
  
  RESULTS
  During the study period, 56 patients with a diagnosis of CKS have been referred to our hospital. There were 11 (19.7%) females and 45 (80.3%) males (male-to-female ratio: 4:1). Mean age at diagnosis was 61.7 ± 15 (range: 15-86 years). Nodules and/or plaques were the most frequent type of lesion. The most common location was the lower limbs, particularly the distal lower extremity (90%). In addition to skin involvement, visceral spread was evident in 9 cases. The most common visceral involvement sites were lymph nodes (44%), lung (22%), and gastrointestinal tract (22%). Associated lymphoedema was seen in 24 (42%) of the patients. There were 18 stage I patients (32.14%), 8: stage II (14.28%), 21 stage III (37.5%) and 9 stage IV (16.07%). A second primary malignancy was diagnosed in 6 cases (10.7%), none of the reticuloendothelial system. With a median follow-up of 45 months, 38 (67.8) patients are alive, of whom 25 (65.78%) patients with stable disease, five with progressive disease currently under systemic chemotherapy and 8 (21.05%) are alive and free of disease, over a mean interval of 5 years.
  
  
  CONCLUSIONS
  This is the largest reported series in our context. In Morocco, CKS exhibits some special characteristics including a disseminated skin disease at diagnosis especially in men, a more common visceral or lymph node involvement and a less frequent association with second malignancies.
authors.affiliation: Medical oncology department, National Institute of Oncology, Rabat, Morocco.
authors.forename: Hassan
authors.initials: H
authors.lastname: Errihani
authors.forename: Narjisse
authors.initials: N
authors.lastname: Berrada
authors.forename: Soundouss
authors.initials: S
authors.lastname: Raissouni
authors.forename: Fadoi
authors.initials: F
authors.lastname: Rais
authors.forename: Hind
authors.initials: H
authors.lastname: Mrabti
authors.forename: Ghizlane
authors.initials: G
authors.lastname: Rais
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000473:pathology; D017678:Sex Distribution; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology; D055815:Young Adult
references.citation: Epidemiol Rev. 1991;13:178-99
references.pmid: 1765111
references.citation: Br J Cancer. 2003 Nov 3;89(9):1657-60
references.pmid: 14583765
references.citation: Int J Dermatol. 1994 Nov;33(11):755-62
references.pmid: 7822076
references.citation: Cancer. 2002 Nov 1;95(9):1982-7
references.pmid: 12404293
references.citation: Int J Cancer. 1999 Jan 18;80(2):173-7
references.pmid: 9935195
references.citation: Cancer. 1989 Dec 1;64(11):2393-8
references.pmid: 2804932
references.citation: J Am Acad Dermatol. 1996 May;34(5 Pt 1):804-14
references.pmid: 8632078
references.citation: Blood. 2000 Oct 1;96(7):2562-7
references.pmid: 11001912
references.citation: Gastrointest Endosc. 1995 Oct;42(4):336-9
references.pmid: 8536903
references.citation: Cutis. 1996 Apr;57(4):220-2
references.pmid: 8727769
references.citation: Ann N Y Acad Sci. 1984;437:373-82
references.pmid: 6398650
references.citation: J Invest Dermatol. 2008 Jun;128(6):1578-80
references.pmid: 18185536
references.citation: Cancer Res. 2002 Apr 15;62(8):2406-13
references.pmid: 11956104
references.citation: Int J Cancer. 1980 Jul 15;26(1):23-9
references.pmid: 6263803
references.citation: Semin Oncol. 1984 Mar;11(1):53-9
references.pmid: 6538993
references.citation: Am J Med. 1981 Nov;71(5):779-83
references.pmid: 7304649
references.citation: Nat Med. 1995 Dec;1(12):1274-8
references.pmid: 7489408
references.citation: Rev Med Interne. 1995;16(7):484-6
references.pmid: 7569416
references.citation: Eur J Dermatol. 2003 Jan-Feb;13(1):83-6
references.pmid: 12609790
references.citation: Acta Pathol Microbiol Scand Suppl (1926). 1963;:Suppl 161:1+
references.pmid: 5877051
references.citation: Dermatology. 1995;191(2):104-8
references.pmid: 8520054
references.citation: Int J Cancer. 1998 Jul 29;77(3):319-21
references.pmid: 9663588
references.citation: Crit Rev Oncol Hematol. 2008 Dec;68(3):242-9
references.pmid: 18657433
references.citation: J Immunol. 1992 Dec 1;149(11):3727-34
references.pmid: 1431144
references.citation: Cancer. 1996 May 15;77(10):2132-6
references.pmid: 8640682
references.citation: Eur J Dermatol. 2001 Mar-Apr;11(2):157-8
references.pmid: 11275818
references.citation: Cancer. 1959 Mar-Apr;12(2):289-98
references.pmid: 13638949
references.citation: J Am Acad Dermatol. 2008 Aug;59(2):179-206; quiz 207-8
references.pmid: 18638627
references.citation: AIDS. 1998 Oct 22;12(15):2067-72
references.pmid: 9814876
references.citation: Mod Pathol. 2008 May;21(5):572-82
references.pmid: 18376387
references.citation: Am J Clin Oncol. 1998 Oct;21(5):498-500
references.pmid: 9781608
references.citation: Dermatologica. 1973;146(2):115-22
references.pmid: 4711877
references.citation: Lancet Infect Dis. 2002 May;2(5):281-92
references.pmid: 12062994
references.citation: Cancer Treat Rep. 1983 Jun;67(6):531-4
references.pmid: 6861160
references.citation: J Eur Acad Dermatol Venereol. 2008 Mar;22(3):297-302
references.pmid: 18269597
references.citation: J Surg Oncol. 2004 Sep 1;87(3):146-51
references.pmid: 15334644
references.citation: Cancer. 2000 Feb 1;88(3):500-17
references.pmid: 10649240
references.citation: Science. 1994 Dec 16;266(5192):1865-9
references.pmid: 7997879
references.citation: Cancer. 1960 Jul-Aug;13:684-94
references.pmid: 13818924
references.citation: Rev Med Interne. 2006 Mar;27(3):227-35
references.pmid: 16337065
references.citation: Tissue Antigens. 1995 Feb;45(2):117-9
references.pmid: 7792757
references.citation: Int J Dermatol. 1997 Oct;36(10):735-40
references.pmid: 9372346