kaposi’s sarcoma, m 85, right leg biopsy

8/9/2019 Kaposis sarcoma, M 85, right leg biopsy.

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Kaposis sarcomaKaposis sarcoma

Deba P Sarma, MDDeba P Sarma, MD

OmahaOmaha


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F 85, both legsF 85, both legs

Purple infiltrated papules and macules in both legs below the knee


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Proliferative vascular neoplasm involving entire dermis


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Abnormal spindle cell proliferation with vascular slits and vascularAbnormal spindle cell proliferation with vascular slits and vascular

structures with red cell extravasationstructures with red cell extravasation


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CD 34: Positive


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HHV 8: Positive stippled dots in the nuclei


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Kaposis sarcomaKaposis sarcoma

Kaposi's sarcoma (KS) was first described in 1872 by aKaposi's sarcoma (KS) was first described in 1872 by aHungarian dermatologist, Dr. Moritz Kaposi.Hungarian dermatologist, Dr. Moritz Kaposi.

There are four recognized forms of KS ::

Classic KS is an indolent, purplish skin neoplasm of theClassic KS is an indolent, purplish skin neoplasm of the

lower extremities seen in elderly white males oflower extremities seen in elderly white males ofAshkenazic or Mediterranean descent in their sixth toAshkenazic or Mediterranean descent in their sixth toeighth decades.eighth decades.

Endemic KS, representing 10% of the adultEndemic KS, representing 10% of the adultmalignancies in Africa.malignancies in Africa.

KS in transplant patients on immunosuppressiveKS in transplant patients on immunosuppressivetherapy.therapy.

Epidemic KS in AIDS patients, and, after nonEpidemic KS in AIDS patients, and, after non--Hodgkin'sHodgkin'slymphoma, is the most common malignancy in AIDS.lymphoma, is the most common malignancy in AIDS.

The origin of the spindle cell, the hallmark cell ofThe origin of the spindle cell, the hallmark cell ofKaposi sarcoma, is unknown. Most research favors aKaposi sarcoma, is unknown. Most research favors alymphatic endothelial cell or an endotheliallymphatic endothelial cell or an endothelial--cellcellprecursor.precursor.


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Cutaneous Kaposi sarcoma usually begins as discrete red orCutaneous Kaposi sarcoma usually begins as discrete red orpurple patches in the lower limbs.purple patches in the lower limbs.

HHVHHV--8 causes all 4 types of KS; immunosuppression is the8 causes all 4 types of KS; immunosuppression is themost significant cofactor.most significant cofactor.

Microscopically, skin biopsy shows abnormal spindle cellMicroscopically, skin biopsy shows abnormal spindle cellproliferation with vascular slits and vascular structures withproliferation with vascular slits and vascular structures with

prominent endothelial cells in the dermis. Extravasatedprominent endothelial cells in the dermis. Extravasatederythrocytes and hemosiderinerythrocytes and hemosiderin--laden macrophages are seen.laden macrophages are seen.Some spindle cells may show nuclear pleomorphism andSome spindle cells may show nuclear pleomorphism andmitosis. Early Kaposi sarcoma may resemble granulationmitosis. Early Kaposi sarcoma may resemble granulationtissue with a diffuse chronic inflammatory infiltrate.tissue with a diffuse chronic inflammatory infiltrate.

Immunohistochemical stain for HHVImmunohistochemical stain for HHV--8 showing stippled8 showing stippleddots in the nuclei of the spindle cells is diagnostic. Thedots in the nuclei of the spindle cells is diagnostic. Thespindle cells of KS also are positive with CD34 and Factorspindle cells of KS also are positive with CD34 and FactorVIII immunostains.VIII immunostains.

kaposi’s sarcoma, m 85, right leg biopsy

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