<prompt> All are true regarding kaposi sarcoma except one ?Predominent in maleMulticentric originChemotherapy is treatment of choiceOccurs in AIDS pt only  <response>: Ans is d ie Occurs in AIDS pt. only There are at least 4 distinct epidemiological forms of Kaposis sarcoma, only one form is associated with AIDS. The 4 distinct forms are ? 1 The classic form - that occurs in older men of predominantly Mediterranian or Eastern European, Jewish backgrounds. 2 Equatorial African form - that occurs in all ages. 3 The form associated with organ transplantation 4 The form associated with HIV-I infection. Kaposis Sarcoma K.S. Kaposis Sarcoma is a multicentric neoplasm consisting of multiple vascular nodules appearing in the skin, mucous memb and lymph nodes, lung, GIT etc. Lesions often appear in sun-exposed areas, paicularly the tip of the nose, and have a propensity to occur in areas of trauma Koebner phenomenon Course ranges from indolent with only minor skin or lymph node involvement to fulminant with extensive cutaneous and visceral involvement. AIDS related kaposis sarcoma occurs predominantly in homosexual men 96 K.S. does not result from a neoplastic transformation of cells in the classic sense and so is not truly a sarcoma. It is a manifestation of excessive proliferation of spindle cells that are believed to be of vascular origin. it is more a consequence of disordered cytokine regulation of cell growth than a true cancer. Generally speaking the tumor respects tissue planes and is rarely invasive. Disseminated K.S. is believed to be dt occurence of multiple neoplasm all over the body rather than to metastasis. Though K.S. is an oppuunistic ds in HIV-infected individuals but unlike oppounistic infection, its occurance is not strictly related to the level of depression of CD4T cells counts. It may be seen at any stage of HIV inf even in the presence of normal CD4T cell count. Human Herpes virus-8 HHV-8 is universally present in all forms of KS in all the 4 types In constrast to most maligancies, in which lymph node involvement implies metastatic spread and a poor prognosis, lymph node involvement may be seen very early in KS. and is of no clinical significance. Management of KS associated with HIV In the majority of cases, effective ARV therapy is quite helpful in achieving control. Spontaneous regressions have been repoed in the setting of HAA. For patients in whom tumor persists or in whom control of HIV replication is not possible options exist. Treatment is indicated under two main circumstances. 1 For a single lesion or a limited number of lesions causing significant discomfo or cosmetic problems localized radiation, intralesional vinblastine, or cryotherapy 2 For large number of lesions or visceral invlovement Systemic therapies, either IFN- or chemotherapy is considered Interferon- IFN provides an added advantage of having ARV activity; thus, it may be the appropriate first choice for single-agent systemic therapy for early patients with disseminated disease. Chemotherapy- Three of the chemotherapeutic agent that have been approved by the FDA for KS are: - liposomal daunorubicin, - liposomal doxorubicin, and - paclitaxel Liposomal daunorubicin is approved as first-line therapy for patients with advanced KS. The single most impoant determinant of response appears to be the CD4 T cell count. 