Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.
ATLAS OF THE GROSS AND MICROSCOPIC FEATURES OF SIMULATORS OF KAPOSI'S SARCOMA
Kaposi's Sarcoma: A Text and Atlas. Gottlieb GJ, Ackerman AB, eds. Philadelphia, Lea and Febiger, p. 73-110, 1988.. Unique Identifier : AIDSLINE ICDB/88647196 Gottlieb GJ; Ackerman AB; Dept. of Anatomic Pathology, William Beaumont Hosp., Royal Oak,; MI
Abstract:
Characteristics of conditions that mimic or are mimicked by Kaposi's sarcoma (KS) are described. Color plates show the appearance on the skin of the following: ecchymosis, stasis changes, malignant melanoma, granuloma annulare, insect bites, secondary syphilis, lichen planus, hypertrophic lichen planus, dermatofibroma, hemangioma, glomus tumor, pyogenic granuloma, squamous cell carcinoma, and acroangiodermatitis. For each example, a case of KS that has a similar appearance is illustrated. Along with the increased number of cases of KS associated with acquired immune deficiency syndrome (AIDS), the number of simulators of this neoplasm has increased. Special attention is paid to two simulators of KS in young homosexuals with AIDS. In one example, scattered, slightly scaly, raised pink papules of secondary syphilis may closely simulate lesions of KS. In another example, acroangiodermatitis, which is either a cutaneous manifestation of a deeper vascular malformation or a focal exaggeration of stasis changes in patients with vascular insufficiency, may closely simulate KS when found on the lower extremities and feet of young men. The most consistent difficulties in diagnosis are encountered in attempting to differentiate KS from some hemangiomas. In general, hemangiomas tend to be composed of rounder, better formed vessels with thicker walls and to be lined by plumper endothelial cells. In adequate biopsy specimens, the lobular pattern of pyogenic granuloma, with its prominent fibrous septa, and the organizing intravascular thrombus of a Masson's lesion are easily diagnosed and readily differentiated from KS. There may be similarities in foci between angiosarcoma and KS, especially when areas composed of spindle cells from both neoplasms are compared. The late plaque and nodular lesions of KS must be differentiated from other inflammatory and neoplastic proliferations of spindle cells, such as scars, dermatofibromas, spindle-cell squamous-cell carcinoma, spindle-cell malignant melanoma, and leiomyosarcoma. Especially in older persons, KS lesions on the lower extremities may coexist with changes caused by severe stasis. With a high index of suspicion, adequate biopsy specimens, and strict application of histologic criteria, the correct diagnosis of KS and its look-alikes should be possible in most, if not all, cases.
Keywords: Acquired Immunodeficiency Syndrome/*PATHOLOGY Biopsy Diagnosis, Differential Human Sarcoma, Kaposi's/*PATHOLOGY Skin/PATHOLOGY Skin Diseases/PATHOLOGY Skin Neoplasms/*PATHOLOGY MONOGRAPH
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Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.
