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Presented by Jonathan Epstein, M.D. and prepared by Sarah Karram, M.D.
Case 3: A 45 year old man presented with a lesion on the penis.
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1. Question
Week 599: Case 3
A 45 year old man presented with a lesion on the penis.images/Karram/epstein_kaposi1.jpg
images/Karram/epstein_kaposi2.jpg
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images/Karram/epstein_kaposi4.jpg
images/Karram/epstein_kaposi5.jpgCorrect
Answer: Kaposis sarcoma
Histology: There is a dermal nodule of cellular spindle cells. The cells are arranged in short fascicles composed of cells with ovoid nuclei that are relatively uniform with scattered mitotic figures. In between the spindle cells are red blood cells that in areas form short rows.
Discussion: The histology in this case is classic for Kaposis sarcoma (KS). In this case due to the unusual site we verified the diagnosis with immunohistochemistry for HHV8 and CD31 and CD34. The tumor was negative for desmin. KS on the penis is typically associated with HIV infected patients. However, a minority are of Mediterranean descent with negative HIV status. In HIV patients, there are often multiple KS lesions, whereas in Mediterranean KS on the penis, the lesion is typically solitary. In both HIV and Mediterranean associated KS, the lesions are HHV8 positive.
Incorrect
Answer: Kaposis sarcoma
Histology: There is a dermal nodule of cellular spindle cells. The cells are arranged in short fascicles composed of cells with ovoid nuclei that are relatively uniform with scattered mitotic figures. In between the spindle cells are red blood cells that in areas form short rows.
Discussion: The histology in this case is classic for Kaposis sarcoma (KS). In this case due to the unusual site we verified the diagnosis with immunohistochemistry for HHV8 and CD31 and CD34. The tumor was negative for desmin. KS on the penis is typically associated with HIV infected patients. However, a minority are of Mediterranean descent with negative HIV status. In HIV patients, there are often multiple KS lesions, whereas in Mediterranean KS on the penis, the lesion is typically solitary. In both HIV and Mediterranean associated KS, the lesions are HHV8 positive.
