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Presented by Peter Illei, M.D. and prepared by Shiyama Mudali, M.D.
Case 4: 30 y.o. HIV+ African American male with an enlarged inguinal lymph node
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1. Question
Week 453: Case 4
30 y.o. HIV+ African American male with an enlarged inguinal lymph nodeimages/1alex/100410case4image1.jpg
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images/1alex/100410case4image5.jpgCorrect
Answer: Kaposi sarcoma
Histology: Sections of this inguinal lymph node show partial effacement of the architecture by a proliferation of relatively uniform spindle cells that oval-elongated nuclei. There are slit-like spaces between the tumor cells with extravasated red blood cells. Intracytoplasmic hyaline globules are mitoses can also be seen. An immunostain for Human herpes virus type 8 (HHV8) is positive in the spindle cells.
Discussion: Kaposi sarcoma (KS) was described by Moritz Kaposi, a Hungarian dermatologist working at the University of Vienna in 1872. The original cases were in patients who lived along the Mediterranean seaboard or Eastern European descent. Despite its name, KS is not considered a true sarcoma (a tumor arising from mesenchymal tissue) since it is a neoplasm of lymphatic endothelium that forms vascular channels that fill with red blood cells giving in a bruise-like appearance in cutaneous forms. The association with HHV8 was discovered in 1994. KS mainly affects patients who are immunosuppressed (i.e.: AIDS and transplant patients). At the start of AIDS epidemic KS was considered a hallmark lesion and was a common finding, today with the wide use of antiretoviral combination therapy it is rarely seen.
Incorrect
Answer: Kaposi sarcoma
Histology: Sections of this inguinal lymph node show partial effacement of the architecture by a proliferation of relatively uniform spindle cells that oval-elongated nuclei. There are slit-like spaces between the tumor cells with extravasated red blood cells. Intracytoplasmic hyaline globules are mitoses can also be seen. An immunostain for Human herpes virus type 8 (HHV8) is positive in the spindle cells.
Discussion: Kaposi sarcoma (KS) was described by Moritz Kaposi, a Hungarian dermatologist working at the University of Vienna in 1872. The original cases were in patients who lived along the Mediterranean seaboard or Eastern European descent. Despite its name, KS is not considered a true sarcoma (a tumor arising from mesenchymal tissue) since it is a neoplasm of lymphatic endothelium that forms vascular channels that fill with red blood cells giving in a bruise-like appearance in cutaneous forms. The association with HHV8 was discovered in 1994. KS mainly affects patients who are immunosuppressed (i.e.: AIDS and transplant patients). At the start of AIDS epidemic KS was considered a hallmark lesion and was a common finding, today with the wide use of antiretoviral combination therapy it is rarely seen.
