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Genitourinary Cancer Case Study Primary Penile Kaposi Sarcoma in an HIV-negative 21-year-old Male Sophie Momen, 1 Cathy Corbishley, 2 Ruth Pettengell, 3 Ben Ayres 4 and Jens Samol 5 1. Senior House Officer in Medical Oncology, St George’s Hospital, London; 2. Consultant Histopathologist, Department of Histopathology, St George’s Hospital, London; 3. Consultant Medical Oncologist, Department of Medical Oncology, St George’s Hospital, London; 4. Consultant Urologist, Department of Urology, St George’s Hospital, London; 5. Senior Consultant Medical Oncology, Department of Medical Oncology, Johns Hopkins Singapore, Singapore Abstract We present a 21-year-old HIV-negative Somalian male who was diagnosed with an immunohistochemically proven human herpes virus 8 (HHV8)-positive primary penile Karposi’s Sarcoma (KS). He was treated with local surgery and remained in complete clinical remission for 18 months. This is the first case of a heterosexual teenage and young adult (TYA) patient diagnosed with a primary penile KS without a history of sexual intercourse. This case provides clinical evidence that KS may be transmitted through routes other than sexual transmission. Keywords Penile Karposi’s Sarcoma, HIV, HHV-8, local surgery, TYA cancers Disclosure: Sophie Momen, Cathy Corbishley, Ruth Pettengell, Ben Ayres and Jens Samol have no conflicts of interest to declare. No funding was received in the publication of this article. Compliance with Ethics Guidelines: All procedures were followed in accordance with the responsible committee on human experimentation and with the Helsinki Declaration of 1975 and subsequent revisions, and informed consent was received from the patient involved in this case study. Received: 21 October 2014 Accepted: 2 December 2014 Citation: European Oncology & Haematology, 2014;10(2):86–8 Correspondence: Jens Samol, Department of Medical Oncology, Johns Hopkins Singapore, 11 Jalan Tan Tock Seng, Singapore 308433. E: We present a 21-year-old Somalian male, who grew up in the UK, who presented initially to the urology department at a London university hospital with a 4-month history of two penile lesions. These lesions were located in the glans penis and had gradually enlarged, with concomitant bleeding and purulent discharge. In addition, the patient mentioned a 1-year history of intermittent night sweats. His past medical history included a circumcision at birth and hay fever. He denied any previous sexual activity. The family history was negative in terms of other malignancies. On examination there was a 1  cm diameter polypoid nodule on the right hand side of his urethral meatus and a 5  mm subcutaneous nodule on the left hand side of his glans penis. These lesions were non-tender and there was no palpable lymphadenopathy. Blood tests including full blood count, electrolytes, bone profile, myeloma screen, human immunodeficiency virus (HIV) antigen, serum human herpes virus 8 (HHV8) DNA and syphilis screen were negative. Hepatitis B and C virus were not detected. Immunoglobulin (Ig)A was raised polyclonally with marginally low IgM levels (0.3). Urinary Bence Jones proteins were normal. CD4/8 testing was not performed as the patient was HIV negative, had normal lymphocyte count at presentation and following local laboratory policy. He underwent local excision of the two lesions. Histopathology revealed spindle cell lesions (see Figures  1a and 1b) with tumour cells expressing CD34 and HHV8 (Figure 1c) on immunohistochemical (IHC) staining. They were Desmin negative. These findings were consistent with a diagnosis of Kaposi’s sarcoma (KS). The diagnosis was made at the National Lead Department for Penile Pathology in the UK. As the lesions extended to the deep margins, further wide local excision was performed confirming clear margins. At routine follow-up at 11 86 Figure 1a: Low-power Picture of Nodule (Hematoxylin and Eosin) months, polyclonally raised IgA with low IgM (0.2) remained the only abnormalities on blood tests. The patient has remained in complete clinical remission for the last 18 months. KS is a neoplastic vascular lesion first described in 1872 by Moritz Kaposi. Lesions can be subdivided into four distinct forms: classic, endemic, iatrogenic and AIDS-associated. 1,2 The classic form commonly presents in elderly men of Mediterranean decent and Ashkenazi Jews. 3 HHV8 is endemic in sub-Saharan Africa but Somalia is not part of the sub- Saharan KS belt. 4 KS often presents as cutaneous nodules, commonly on © Touc h ME d ic al ME d ia 2014