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Presented by Dr. Pedram Argani and prepared by Dr. Kevan Salimian
This is an inguinal lymph node in a 23 year old male.
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Question 1 of 1
1. Question
This is an inguinal lymph node in a 23 year old male. Choose the correct diagnosis.
Correct
Answer: Kaposi sarcoma
Histologic Description: This lesion here is a bland spindle cell proliferation that primarily involves the capsule and extends both into the lymph node and perinodal soft tissue. One can appreciate in some foci an anastomosing vascular pattern. The lesional cells are not severely pleomorphic, they focally form fascicles, and there are admixed plasma cells present. There are focally extravasated red blood cells. The lesion demonstrates diffuse nuclear immunoreactivity for HHV8 by immunohistochemistry. These are the typical features of Kaposi sarcoma.
Differential Diagnosis: Angiosarcoma would demonstrate greater nuclear pleomorphism, and is HHV8 negative. Vascular transformation of the lymph node sinuses in a bland proliferation of vessels that involves the sinus, and is typically seen in obstructed lymph nodes or those which drain angiogenic neoplasms such as renal cell carcinoma. Malignant mesothelioma may focally have a pattern that mimics vascular neoplasms, but would be diffusely immunoreactive for cytokeratin and lack vascular markers.
Incorrect
Answer: Kaposi sarcoma
Histologic Description: This lesion here is a bland spindle cell proliferation that primarily involves the capsule and extends both into the lymph node and perinodal soft tissue. One can appreciate in some foci an anastomosing vascular pattern. The lesional cells are not severely pleomorphic, they focally form fascicles, and there are admixed plasma cells present. There are focally extravasated red blood cells. The lesion demonstrates diffuse nuclear immunoreactivity for HHV8 by immunohistochemistry. These are the typical features of Kaposi sarcoma.
Differential Diagnosis: Angiosarcoma would demonstrate greater nuclear pleomorphism, and is HHV8 negative. Vascular transformation of the lymph node sinuses in a bland proliferation of vessels that involves the sinus, and is typically seen in obstructed lymph nodes or those which drain angiogenic neoplasms such as renal cell carcinoma. Malignant mesothelioma may focally have a pattern that mimics vascular neoplasms, but would be diffusely immunoreactive for cytokeratin and lack vascular markers.
