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Updated: Dec 26 2021

Kaposi Sarcoma

  • 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)
  • epidemiology
    • 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
  • etiology
    • Pathogenesis
      • human herpes virus 8
      • genetic predisposition in some
  • 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
  • Differential Diagnosis
    • Melanoma
    • Bacillary angiomatosis
    • Pyogenic granuloma
  • diagnosis
    • 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
  • Treatment
    • Prevention
      • highly active anti-retroviral therapy for those with HIV infections
      • annual skin exam in those at risk
    • Anti-retroviral therapy
      • majority will resolve
    • Injection of vincristine or interferon
    • If the above fail
      • chemotherapy
        • doxorubicin/daunorubicin
        • paclitaxel
        • etoposide
      • radiation
    • Discontinue any immunosuppressants
  • Complications
    • Metastatic progression
  • Prognosis
    • Slow progression
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