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Histological variants of cutaneous Kaposi sarcoma.

Grayson W, Pantanowitz L - Diagn Pathol (2008)

Bottom Line: This review provides a comprehensive overview of the broad clinicopathologic spectrum of cutaneous Kaposi sarcoma (KS) lesions.Variants discussed include: usual KS lesions associated with disease progression (i.e. patch, plaque and nodular stage); morphologic subtypes alluded to in the older literature such as anaplastic and telangiectatic KS, as well as several lymphedematous variants; and numerous recently described variants including hyperkeratotic, keloidal, micronodular, pyogenic granuloma-like, ecchymotic, and intravascular KS.Involuting lesions as a result of treatment related regression are also presented.

View Article: PubMed Central - HTML - PubMed

Affiliation: Histopathology Department, Ampath National Laboratory Support Services, Johannesburg, South Africa. wayne.grayson@live.com

ABSTRACT
This review provides a comprehensive overview of the broad clinicopathologic spectrum of cutaneous Kaposi sarcoma (KS) lesions. Variants discussed include: usual KS lesions associated with disease progression (i.e. patch, plaque and nodular stage); morphologic subtypes alluded to in the older literature such as anaplastic and telangiectatic KS, as well as several lymphedematous variants; and numerous recently described variants including hyperkeratotic, keloidal, micronodular, pyogenic granuloma-like, ecchymotic, and intravascular KS. Involuting lesions as a result of treatment related regression are also presented.

No MeSH data available.


Related in: MedlinePlus

Lymphangioma-like Kaposi sarcoma. A. Low-power photomicrograph depicting the upper dermal expansion by a proliferation that is distinctly reminiscent of a lymphatic neoplasm or malformation. Note the reactive epidermal hyperplasia and hyperkeratosis (H&E stain). B. Closer view of the "lymphangiomatous" proliferation, with each gaping channel lined by a monolayer of plump Kaposi sarcoma cells, and frothy, pale eosinophilic intraluminal fluid resembling lymph (H&E stain). C. Positive staining of lining cells with the lymphatic endothelial marker D2-40. D. Nuclei of the same cellular population show immunoreactivity for LNA-1.
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Figure 8: Lymphangioma-like Kaposi sarcoma. A. Low-power photomicrograph depicting the upper dermal expansion by a proliferation that is distinctly reminiscent of a lymphatic neoplasm or malformation. Note the reactive epidermal hyperplasia and hyperkeratosis (H&E stain). B. Closer view of the "lymphangiomatous" proliferation, with each gaping channel lined by a monolayer of plump Kaposi sarcoma cells, and frothy, pale eosinophilic intraluminal fluid resembling lymph (H&E stain). C. Positive staining of lining cells with the lymphatic endothelial marker D2-40. D. Nuclei of the same cellular population show immunoreactivity for LNA-1.

Mentions: LLKS appears to exist (or co-exist) in two forms microscopically. The first comprises a patch or plaque stage lesion in which irregular, ectatic, interanastomosing vascular channels dissect dermal collagen bundles, resulting in a striking histological resemblance to a lymphatic tumor, such as a benign lymphangioendothelioma/acquired progressive lymphangioma (Figure 6) [31,32,42]. In these cases the promontory sign tends to be particularly conspicuous (Figure 7). Erythrocytes are usually absent from these channels. Slender papillae may project into vessels. In the second form, much larger, well formed endothelial lined spaces occupy the papillary dermis and the upper reticular dermis (Figure 8). These channels may closely abut on the overlying epidermis, in a pattern somewhat analogous to lymphangioma circumscriptum. It is the latter pattern which may give rise to the clinical appearance of "bullous" cutaneous lesions. Features of usual plaque stage KS are often encountered subjacent to these large channels; this useful diagnostic clue may be absent from biopsies that are too superficial, especially shave biopsies. The endothelial cells lining the ectatic, lymphangioma-like channels in both forms are immunoreactive for HHV-8 LNA-1, as well as the lymphatic endothelial marker D2-40 (Figure 8).


Histological variants of cutaneous Kaposi sarcoma.

Grayson W, Pantanowitz L - Diagn Pathol (2008)

Lymphangioma-like Kaposi sarcoma. A. Low-power photomicrograph depicting the upper dermal expansion by a proliferation that is distinctly reminiscent of a lymphatic neoplasm or malformation. Note the reactive epidermal hyperplasia and hyperkeratosis (H&E stain). B. Closer view of the "lymphangiomatous" proliferation, with each gaping channel lined by a monolayer of plump Kaposi sarcoma cells, and frothy, pale eosinophilic intraluminal fluid resembling lymph (H&E stain). C. Positive staining of lining cells with the lymphatic endothelial marker D2-40. D. Nuclei of the same cellular population show immunoreactivity for LNA-1.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2526984&req=5

Figure 8: Lymphangioma-like Kaposi sarcoma. A. Low-power photomicrograph depicting the upper dermal expansion by a proliferation that is distinctly reminiscent of a lymphatic neoplasm or malformation. Note the reactive epidermal hyperplasia and hyperkeratosis (H&E stain). B. Closer view of the "lymphangiomatous" proliferation, with each gaping channel lined by a monolayer of plump Kaposi sarcoma cells, and frothy, pale eosinophilic intraluminal fluid resembling lymph (H&E stain). C. Positive staining of lining cells with the lymphatic endothelial marker D2-40. D. Nuclei of the same cellular population show immunoreactivity for LNA-1.
Mentions: LLKS appears to exist (or co-exist) in two forms microscopically. The first comprises a patch or plaque stage lesion in which irregular, ectatic, interanastomosing vascular channels dissect dermal collagen bundles, resulting in a striking histological resemblance to a lymphatic tumor, such as a benign lymphangioendothelioma/acquired progressive lymphangioma (Figure 6) [31,32,42]. In these cases the promontory sign tends to be particularly conspicuous (Figure 7). Erythrocytes are usually absent from these channels. Slender papillae may project into vessels. In the second form, much larger, well formed endothelial lined spaces occupy the papillary dermis and the upper reticular dermis (Figure 8). These channels may closely abut on the overlying epidermis, in a pattern somewhat analogous to lymphangioma circumscriptum. It is the latter pattern which may give rise to the clinical appearance of "bullous" cutaneous lesions. Features of usual plaque stage KS are often encountered subjacent to these large channels; this useful diagnostic clue may be absent from biopsies that are too superficial, especially shave biopsies. The endothelial cells lining the ectatic, lymphangioma-like channels in both forms are immunoreactive for HHV-8 LNA-1, as well as the lymphatic endothelial marker D2-40 (Figure 8).

Bottom Line: This review provides a comprehensive overview of the broad clinicopathologic spectrum of cutaneous Kaposi sarcoma (KS) lesions.Variants discussed include: usual KS lesions associated with disease progression (i.e. patch, plaque and nodular stage); morphologic subtypes alluded to in the older literature such as anaplastic and telangiectatic KS, as well as several lymphedematous variants; and numerous recently described variants including hyperkeratotic, keloidal, micronodular, pyogenic granuloma-like, ecchymotic, and intravascular KS.Involuting lesions as a result of treatment related regression are also presented.

View Article: PubMed Central - HTML - PubMed

Affiliation: Histopathology Department, Ampath National Laboratory Support Services, Johannesburg, South Africa. wayne.grayson@live.com

ABSTRACT
This review provides a comprehensive overview of the broad clinicopathologic spectrum of cutaneous Kaposi sarcoma (KS) lesions. Variants discussed include: usual KS lesions associated with disease progression (i.e. patch, plaque and nodular stage); morphologic subtypes alluded to in the older literature such as anaplastic and telangiectatic KS, as well as several lymphedematous variants; and numerous recently described variants including hyperkeratotic, keloidal, micronodular, pyogenic granuloma-like, ecchymotic, and intravascular KS. Involuting lesions as a result of treatment related regression are also presented.

No MeSH data available.


Related in: MedlinePlus