CLINICAL HISTORY:

Signs and symptoms:  A 71-year-old male presented for follow up in a busy dermatology practice. He was being treated for about 6 weeks for suspected psoriasis with minimal improvement. He had mild pruritis and the rash seemed to be spreading.

Previous Treatment:  topical steroids (mid-high potency), topical calcipotriene, topical antifungals (by prior physician)

Other information:  He had no other contributing skin lesions. He is of Jewish Ashkenazi descent.

PHYSICAL EXAM:

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Superficial and deep dermal proliferation of small, angulated vessels lined by inconspicuous endothelial cells, suggestive of lymphatics. These ‘jagged’ vessels separate collagen bundles and are accompanied by a sparse infiltrate of lymphocytes and plasma cells.

DIFFERENTIAL DIAGNOSIS:

1.   Angiosarcoma
2.   Microvascular Hemangioma
3.   Hobnail Hemangioma
4.   Kaposiform Hemangioendothelioma
5.   Spindle Cell Hemangioma

SCROLL DOWN FOR ANSWER AND DISCUSSION.

CORRECT DIAGNOSIS:

Classic Kaposi’s Sarcoma

DISCUSSION:

In 1872, Moritz Kaposi described five men with an unusual multi-focal sarcoma of the skin in Hungary which he termed ‘idiopathic multiple pigmented sarcoma of the skin’. Classic KS has been historically considered a chronic, protracted disease primarily affecting elderly men, generally Jewish or Mediterranean/Eastern European descent. Despite occasional reports concerning its occurrence in transplant patients and its endemic form in Africa, KS received little attention until it became epidemic among male homosexuals and was recognized as a sign of AIDS. HHV-8 was recognized as the probable inductive agent of all clinical variants of KS.

The course is slowly progressive, with rare lymph node or visceral involvement. There may be great enlargement of the lower extremities as a result of lymphedema. There may be periods of remission, particularly in the early stages of the disease. Sometimes lesions will even involute leaving the patient with atrophic and hyperpigmented scarring.

TREATMENT:

All types of KS are radiosensitive. Local excision, cryotherapy, locally injected chemotherapy or IFN, and laser ablation have been used for troublesome, localized lesions.

REFERENCES:

1.Safai B.. Pathophysiology and epidemiology of epidemic Kaposi’s sarcoma. Semin Oncol 1987;14:7-12
2. Bolognia JL, Jorizzo JL, Rapini RP, et al. Dermatology. Spain, Mosby 2003, p1830-1833
3. James WD, Berger TG, Elston D. Andrews’ diseases of the skin clinical dermatology tenth edition. Saunders 2006. p. 600-601.

Additional Comment:

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