Zusammenfassung
Seit 1987 wurden an der Klinik und Poliklinik für HNO-Kranke der Universität München 233 HIV-infizierte Patienten behandelt. 46 dieser Patienten wiesen ein Kaposi-Sarkom in der Kopf-Hals-Region auf. Hiervon waren 91% homosexuell. Am häufigsten waren die Mundschleimhaut (67%), der Oropharynx (65%) und die Haut (39,1%) betroffen. Seltenere Lokalisationen waren Larynx (10,9%), Hypopharynx (8,7%), Lymphknoten (6,5%) und Nasopharynx (4,3%). 15 Patienten hatten als erstes Zeichen einer HIV-Infektion ein Kaposi-Sarkom im Kopf-Hals-Bereich. Die klinische Diagnose sollte histologisch untermauert werden, da differentialdiagnostisch teilweise seltene, aber gut therapierbare Erkrankungen (z. B. bazilläre, epitheloidzellige Angiomatose) in Betracht kommen. Histomorphologisch weisen flache Befunde ein mehr angiomatoides Baumuster auf, während bei den fortgeschrittenen knotigen Kaposi-Sarkomen ein sarkomatöses Zellbild vorherrscht. Bei symptomatischen Kaposi-Sarkomen der Schleimhaut stellt die palliative CO2- und Nd:YAG-Laserbehandlung die Therapie der Wahl dar.
Summary
Since 1987 233 HIV-infected patients have been treated at the Department of Otorhinolaryngology, Head and Neck Surgery of the Ludwig-Maximilians-University of Munich. 70% of these patients had advanced immunodeficiency disease (ARC and AIDS). 46 presented a Kaposi's sarcoma (KS) in the head and neck region. 91% were homosexual men. KS was most often located in the mouth (67%), Oropharynx (65%) and skin (39,1%), while the larynx (10,9%), hypopharynx (8,7%), lymph nodes (6,5%) and nasopharynx (4,3%) were rarely involved. In 15 patients, a KS of the head and neck region was the initial symptom for the HIV-infection. Although the clinical features of this disease are typical, histological examination is required because differential diagnosis can show other rare diseases, such as bacillary angiomatosis, which are easily cured. The morphology of early plain or elevated KS exhibits more irregular vascular components while the nodular KS is dominated by sarcomatous cell lines. Immunohistochemical studies with antibodies to viral components revealed no reactivity to HIV-, HPV-, HSV-, EBV- and CMV-antigenes. The best local treatment proved to be CO2- or ND: YAG-laser therapy. Cutaneous lesions were treated with camouflage or by fractionated radiotherapy. Advanced disease showed best response to systemic chemotherapy. Despite the advanced stage of immunodeficiency syndrome, an adequate local or systemic therapy can obviously improve the quality of life in HIV-infected patients.
Schlüsselwörter
Kopf und Hals - HNO - HIV-Infektion - AIDS - Kaposi-Sarkom - Lokalisation - Therapie - Histologie - Immunhistochemie
Key words
Head and Neck - Otorhinolaryngology - HIV-infection - AIDS - Kaposi's sarcoma - Localisation - Therapy - Histology - Immunocytochemistry
