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Bangladesh Journal of Medical Science Vol.09 No.2 Apr’10 

Case report 

A rare case of laryngeal Kaposi’s sarcoma 
 

J Mohd Tahir1, KN Gopalan2, MB Marina3, SHA Primuharsa Putra4
 
Abstract 

Kaposi’s sarcoma (KS) is the most common malignancy observed in patient with acquired 
immune deficiency syndrome (AIDS). It rarely causes upper airway obstruction. We 
report a 39-year-old gentleman, a former intravenous drug user with AIDS and Hepatitis C 
positive who developed progressive hoarseness with stidor. He underwent an emergency 
tracheostomy and direct laryngoscopy revealed a whitish globular laryngeal mass 
obscuring the glottic region. A biopsy of the mass was taken and the histopathological 
report showed evidence of spindle cell connective tissue, consistent with Kaposi’s 
sarcoma. It is important for clinicians or surgeons to maintain a high index of suspicion for 
the diagnosis of laryngeal KS in immunodeficiency patient even without cutaneous 
manifestation. 
 
Keywords:  Airway obstruction, Laryngeal, Kaposi’s sarcoma, HIV. 

Introduction   

Kaposi’s sarcoma (KS) is a rare 
subcutaneous lesion linked mainly with 
patients suffering from AIDS. In HIV 
infection, Kaposi Sarcoma is an AIDS-
defining disease. It is usually an indolent 
vascular tumour with some variance 
depending on the epidemiologic subtype, 
of which there are four:  Classical type, 
African-endemic KS, Iatrogenic KS and 
Epidemic AIDS-related KS.1,2,3 
 
The presentation of AIDS patient with KS 
as laryngeal emergency is rare and only a 
few cases being reported in the literature.1,4  
It was first described in 1872 by the 
Hungarian physician Moritz Kaposi. The 
characteristic feature of this lesion is 
multifocal violaceous nodules with the 
predilection for the skin of the lower 
extremities. KS may involve every tissue 
in the human body. Incidence of KS has 
been reported as high as 20% in 

homosexual men who have HIV, 3% in 
heterosexual intravenous drug users, 3% in 
women and children, 3% in transfusion 
recipients and 1% in hemophiliacs.5  
Mochloulis G et al  in his 10 years 
retrospective study showed the commonest 
site of laryngeal involvement was the 
supraglottis (65%).6
 
Case report 

A 39-year-old gentleman with AIDS and 
Hepatitis C presented with 4 month history 
of progressive hoarseness and stridor. He 
was a former intravenous drug user with a 
history of sexual promiscuity. Fibreoptic 
laryngoscopy revealed a large, whitish 
globular mass occupying about two-thirds 
of the laryngeal inlet, obscuring the glottic 
region (Fig 1). There were no cutaneous 
manifestations of the disease. The 
emergency tracheostomy was performed 
under local anesthesia as patient had 

1. J Mohd Tahir, MD, MSurg ORL-HNS, Department of Otorhinolaryngology-Head & Neck Surgery, 
Hospital Sultanah Aminah, Johor Bahru, Malaysia. 

2. KN Gopalan, MD, MSurg ORL-HNS, Ear, Nose & Throat-Head & Neck Consultant Clinic, Lam Wah 
Ee Hospital, Penang, Malaysia. 

3. MB Marina, MD, MSurg ORL-HNS, Department of Otorhinolaryngology-Head & Neck Surgery, 
Universiti Kebangsaan, Malaysia Medical Centre, Kuala Lumpur, Malaysia. 

4. *SHA Primuharsa Putra, MD, MSurg ORL-HNS, Ear, Nose & Throat-Head & Neck Consultant Clinic, 
KPJ Seremban Specialist Hospital, Seremban, Negeri Sembilan, Malaysia. 

*Corresponds to: Dr Primuharsa Putra Bin Sabir Husin Athar, Ear, Nose & Throat-Head & Neck Consultant 
Clinic, KPJ Seremban Specialist Hospital, Jalan Toman 1, Kemayan Square, 70200 Seremban, Negeri 
Sembilan, Malaysia. Tel: 07-767 7800. Direct/Fax: 06-765 3406. Email: putrani@yahoo.co.uk. 



Primuharsa Putra SHA et al. 

impending upper airway obstruction. 
Direct laryngoscopy revealed the above 
mass, as well as oesophageal candidiasis. 
A biopsy of the mass was taken and the 
histopathological report showed evidence 
of spindle cell connective tissue, consistent 
with Kaposi’s sarcoma (Fig 2). Subsequent 
staining and cultures for tuberculosis and 
fungal organisms were negative. He has 
not encountered any significant 
complications and was evaluated for 
radiation therapy. He was discharged home 
with the tracheostomy and plans for 
outpatient follow-up visits. 
 

 
Figure 1: Laryngeal view showing mass 
obstructing the airway 
 

 
Figure 2: Slide showing presence of spindle 
cell 
 
Discussion 

Kaposi’s sarcoma (KS) of the head and 
neck has been well described in the 
literature.  KS of the upper aerodigestive 
tract is not unusual; the palate and gingiva 
are the most frequently involved sites.7 
However, KS resulting in upper airway 

obstruction in AIDS patients is extremely 
rare. The epiglottis appears to be the most 
common laryngeal site. 6,8  As with any 
laryngeal disorder, the presenting 
symptoms can range from hoarseness and 
dysphagia to stridor or complete airway 
obstruction. Other symptoms commonly 
seen with laryngeal involvement are pain, 
bleeding and speech abnormalities. 
 
The diagnosis can usually be easily 
established by fiberoptic laryngeal 
examination. After establishing the 
diagnosis, therapy is usually aimed at 
symptomatic relief. 
 
Urgent intervention is indicated for lesions 
producing acute or impending airway 
obstruction. In this case, endotracheal tube 
intubation was impossible to be done 
because the mass was located at the 
supraglottic region and obstructing a direct 
view of the glottis. Tracheostomy should 
be immediately offered and should always 
be considered prior to any treatment 
protocol, since local therapy can often 
exacerbate airway compromise as 
mucositis and soft tissue edema develop. 
 
Mochloulis G et al had experienced of 
significant hemorrhage and developed 
acute airway obstruction after performing 
biopsy of the KS lesion of the larynx.6 
Therefore, he didn’t recommend biopsy of 
suspected laryngeal KS. In our case, we 
were able to do direct laryngoscopy and 
took biopsy from the lesion using cold 
instrument without any complication. 
Schiff et al in his report of 2 cases had 
performed a biopsy using a carbon dioxide 
laser without major complication.8 
Histologically, the distinctive features of 
KS are spindle-shaped cells with a random 
orientation, many extravasated 
erythrocytes, and thin vascular slits 
occurring in a reticular network of collagen 
fibers. 
 
Treatment of laryngeal KS was in general, 
conservative. It consists of systemic and 

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A rare case of laryngeal Kaposi’s sarcoma 

local therapies. Systemic therapy is usually 
reserved for patients with rapidly 
progressing and/or widespread disease 
while local therapy is usually used to 
palliate pain and to improve function.8 
Low dose radiotherapy to the larynx and 
systemic chemotherapy had been 
advocated.9 Apart from that, treatment of 
the HIV itself is important as KS often 
responds to the improvement in 
immunological status. In the late 1990s, the 
introduction of 2 new classes of 
antiretroviral drugs, the non-nucleoside 
analog reverse transcriptase inhibitors and 
protease inhibitors, resulted in improved 
antiretroviral efficacy in patients with 
AIDS.10   Combinations of three or more 
antiretroviral agents from at least two 
different classes became known as 

HAART (Highly Active Antiretroviral 
treatment). Lukawska et al reported that 
more than 50% of patients with cutaneous 
KS responded to HAART.9 The cutaneous 
response is not as immediate as the 
virological and immunological responses, 
taking 3-6 months to improve. He had 
evaluated that mucosal presentation of KS 
has an equivalent response rate to 
cutaneous KS. Palliative radiotherapy was 
planned to this patient as he presented with 
life-threatening clinical disease 
progression. During the pre-HAART era, 
radiotherapy had an important role in the 
management of low-volume cutaneous KS. 
However, this method is now less common 
as a first-line treatment, and is becoming a 
second-line or third-line treatment after 
chemotherapy.

 
______________ 

 
 
References 
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9. Lukawska J, Cottrill C, Bower M. The 
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