Updated: 12/18/2019

Kaposi Sarcoma

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Snapshot
  • A 60-year-old man presents to his primary care physician reporting unintentional weight loss, night sweats, and fevers. He complains of a “strange” rash on his face that bothers him cosmetically. The rash does not hurt or itch. On exam, there are multiple well-demarcated red or purple macules and papules. He has a history of risky behaviors, including IV drug use and unprotected intercourse with multiple partners. His CD4 count comes back at 100/mm3.
Introduction
  • Malignancy of lymphatic endothelial cells
  • Commonly affects
    • skin
    • lungs
    • lymph nodes
    • GI (especially in AIDS patients)
  • Pathogenesis
    • human herpes virus 8
    • genetic predisposition in some
  • Epidemiological subsets
    • AIDS
      • most common AIDS-associated malignancy
      • commonly seen in AIDS acquired through sexual contact
      • rarely seen in AIDS acquired through injection drug use
    • immunosuppression
      • post-transplant
    • classic sporadic
      • usually in older men
      • in people of Mediterranean origin
    • endemic
      • Eastern Africa
      • Southern Africa
      • 50% of childhood soft tissue tumors due to Kaposi’s sarcoma
Presentation
  • Symptoms 
    • B symptoms (fevers, night sweats, weight loss)
    • painless skin lesions
    • may have pain associated with internal lesions
  • Physical exam
    • red or purple lesions of varying morphologies
      • macules/patches
      • papules/plaques
      • nodules
    • common on face, oral mucosa, legs, and torso
    • lymph nodes may be enlarged
Evaluation
  • Diagnosis by clinical exam
  • Diagnosis confirmed with skin biopsy
    • neoplastic spindle-shaped cells that form clefts and vascular channels
  • Do CD4 count if AIDS is suspected
Differential Diagnosis
  • Melanoma
  • Bacillary angiomatosis
  • Pyogenic granuloma
Treatment
  • Anti-retroviral therapy
    • majority will resolve
  • Injection of vincristine or interferon
  • If the above fail
    • chemotherapy
      • doxorubicin/daunorubicin 
      • paclitaxel
      • etoposide
    • radiation
  • Discontinue any immunosuppressants
Prognosis, Prevention, and Complications
  • Prognosis
    • slow progression
  • Prevention
    • highly active anti-retroviral therapy for those with HIV infections
    • annual skin exam in those at risk
  • Complications
    • metastatic progression

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