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Presented by Peter Illei, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 6: The patient is a 24 y.o. black male with AIDS and a CD4 count of 4, off of HAART for a month due to long-term nonadherence.
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1. Question
Week 313: Case 6
The patient is a 24 y.o. black male with AIDS and a CD4 count of 4, off of HAART for a month due to long-term nonadherence. He was transferred to Johns Hopkins Hospital for abdominal pain, diarrhea, and hypotension. He had presented approximately 12 days prior to his transfer to Hopkins with complaints of general malaise and 10 stools per day diarrhea. Subsequently, he developed an acute abdomen for which an exploratory laparotomy was performed and a segment of the ileum and adherent colon was resected.images/Kaposi 1 6_11_07.jpg
images/Kaposi 2 6_11_07.jpg
images/Kaposi 3 6_11_07.jpg
images/Kaposi 4 6_11_07.jpgCorrect
Answer: Kaposi’s sarcoma
Histology: none provided
Discussion: Typical microscopic features of Kaposi’s sarcoma (KS) include the presence of spindle cells that form slit-like spaces filled with red blood cells. The spindle cells lack significant atypia and show low mitotic activity. The affected area also may contain admixed lymphocytes, hemosiderin laden macrophages and variously sized PAS positive hyaline bodies. The latter represent ingested and degraded red blood cells, a finding that is helpful for making the diagnosis, nevertheless is not specific for KS. Immunohistochemically the spindle cells are positive for vascular markers (CD31, CD34 and factor VIII) and are negative for c-kit, muscle markers and S-100.
KS, once the most common neoplasm in AIDS patients has been rapidly declining with widespread use of combination anti-retroviral therapy. In its sporadic form, KS mostly affects the skin and has an indolent course. In AIDS patients, KS is usually widespread and involves the skin, mucous membranes, the GI tract, lymph nodes and lungs and has a more aggressive course in patients who no or ineffective anti-retroviral therapy. Practically in all cases of KS (including sporadic, immunosuppression and AIDS related cases) the presence of human herpesvirus 8 (HHV8) can be demonstrated suggesting an etiologic connection between the virus and development of KS.
Incorrect
Answer: Kaposi’s sarcoma
Histology: none provided
Discussion: Typical microscopic features of Kaposi’s sarcoma (KS) include the presence of spindle cells that form slit-like spaces filled with red blood cells. The spindle cells lack significant atypia and show low mitotic activity. The affected area also may contain admixed lymphocytes, hemosiderin laden macrophages and variously sized PAS positive hyaline bodies. The latter represent ingested and degraded red blood cells, a finding that is helpful for making the diagnosis, nevertheless is not specific for KS. Immunohistochemically the spindle cells are positive for vascular markers (CD31, CD34 and factor VIII) and are negative for c-kit, muscle markers and S-100.
KS, once the most common neoplasm in AIDS patients has been rapidly declining with widespread use of combination anti-retroviral therapy. In its sporadic form, KS mostly affects the skin and has an indolent course. In AIDS patients, KS is usually widespread and involves the skin, mucous membranes, the GI tract, lymph nodes and lungs and has a more aggressive course in patients who no or ineffective anti-retroviral therapy. Practically in all cases of KS (including sporadic, immunosuppression and AIDS related cases) the presence of human herpesvirus 8 (HHV8) can be demonstrated suggesting an etiologic connection between the virus and development of KS.
