kaposi 's sarcoma ( ks ) is a spindle - cell malignant low - grade vascular tumor associated with human herpesvirus 8 ( hhv-8 ) .
it was first published by the dermatologist moritz kaposi in the journal archiv fr dermatologie und syphilis , in 1872 . in the current literature ,
four main types of ks are described : ( 1 ) epidemic or aids - related ks , ( 2 ) ks in immunocompromised patients , ( 3 ) classic ks , and ( 4 ) endemic or african ks .
chronic lymphocytic leukemia ( cll ) is presented with an increasing number of functionally incompetent mature lymphocytes which are of monoclonal origin , mainly in the peripheral blood , bone marrow , and all throughout the reticuloendothelial system .
herein we report an interesting case of ks which was diagnosed during the course of cll as a secondary malignancy .
a 64-year - old female case presented with complaints of bluish and indurate lesions all over both lower extremities ( fig .
after initial evaluation , biopsy was done from the lesions and ks was diagnosed ( fig .
the patient has had a history of cll since the year of 1999 but she has not needed any active drug treatment since 1999 .
she did not have any complication such as bacterial infection or hemolytic anemia throughout the disease course .
there was no risk factor in her personal history that disposed the patient to aids .
quantitative immunoglobulin m and a levels were decreased , whereas immunoglobulin g level was normal .
although all tests were negative for systemic involvement of ks , ks lesions have an allover pattern in both extremities , so we planned to administer systemic chemotherapy which consisted of anthracycline , vincristine , and bleomycine .
after three cycles of systemic chemotherapy , the lesions had completely disappeared and there was no toxicity of chemotherapeutics .
although in the literature , there is a strong relationship between immunosuppression after solid organ transplantation and ks , there is no strong data that shows a relation between cll and ks .
patients with cll are prone to the viral , bacterial , and opportunistic infection even without taking any chemotherapeutics .
although immunosuppression in cll can dispose the patient to the infection , can it cause tending to the formation of secondary malignancy ?
reported that ks is 5 times more common in the cll population than the normal population . in this surveillance
analyzed 16,367 patients with cll , so we can not just say that the increased incidence of ks in cll patients is an incidental finding .
median latency time between diagnosis of cll and preceding ks was 75 months in this unique study .
it is true for all types of ks including aids - related ks , ks in immunocompromised patients , classic ks and endemic or african ks .
control of hhv-8 infection is mediated by an antiviral t - cell response to hhv-8 proteins .
latent hhv-8 infection of endothelial cells can cause subsequent conversion of endothelial cells into the spindle cells .
then the proliferative phase started , and vegf secretion increased from the infected endothelial cells .
this activation plays a pivotal role in the development of the final tumor . is this a mechanism that causes ks in cll patient ?
we know that there is an imbalance in circulating t - cell subpopulations in cll .
so theoretically , latent hhv-8 infection can be reactivated in cll patients and can trigger ks lesions . in conclusion , cll can dispose to the development of ks but the exact mechanism is not explained as much as ks preceding solid organ transplantation .
so physicians should be very careful about the probability of ks in newly and progressively developing skin lesions in cll .
 cutaneous manifestations can occur in the wide range of internal malignancy . 
 they can occur by metastases or local spread , direct infiltration , or a site of primary malignancy itself . 
 sometimes these manifestations are related with an underlying malignancy but they do not contain malignant cells as paraneoplastic dermatological syndromes . 
 chronic lymphocytic leukemia ( cll ) is the most common leukemia all over the world . 
 cutaneous lesions occur in up to 25% of patients . 
 most commonly seen cutaneous lesions in cll are those of infectious or hemorrhagic origin . 
 skin cancer risk was also increased eightfold in cll when compared with normal population , so cutaneous lesions in cll can be the first manifestation of secondary skin malignancy . 
 herein , we report an interesting case of kaposi 's sarcoma which was diagnosed during the course of cll . 
Introduction
Case Report
Discussion