DER-1. Unusual manifestation of Kaposi's sarcoma.

A 59-year-old HIV-infected African American male presented with multiple, gradually increasing painless, non-itchy lumps over front and back of right thigh for past 8 months. He denied any constitutional symptoms and was not taking any treatment at this time. General physical examination was unremarkable except for presence of pallor. The right leg was diffusely swollen, erythematous and non-tender. There were multiple firm, nodular lesions of different sizes, shapes and colors across his right thigh. Bilateral inguinal lymphadenopathy was noticed. Laboratory data was significant for an anemia of chronic disease. CD4 count was 247. Chest x-ray was normal. CT scan of abdomen and pelvis was normal except for inguinal lymphadenopathy. Biopsy of one of the lesions revealed spindle cell vascular tumor with lymphangiectasia of overlying dermis. The final diagnosis was Kaposi's sarcoma. Kaposi's sarcoma (KS) is a low-grade vascular tumor associated with human herpes virus 8 (HHV-8). Four epidemiological forms of KS are: classic, African, organ transplant-associated and epidemic or AIDS-related. Skin involvement is characteristic of KS, however, involvement of oral mucosa, gastrointestinal tract and respiratory tract can occur. Skin lesions are usually found on lower extremity, face and genitalia. Lesions are usually symmetrical, non-tender, non-pruritic and tend to occur along skin tension lines. Early lesions can easily be mistaken as purpura, hematomas, angiomas, dermatofibromas, or nevi. Classical lesions of KS are papules, however, rarely plaque-like lesions can occur. Nodular, exophytic and fungating lesions like our patient have been described during later stages of disease. These lesions usually have variable color depending on their vascularity. Histologically, lesions show two major abnormalities: whorls of spindle-shaped cells with leukocytic infiltration and neovascularization with aberrant proliferation of small vessels. The classical lesions of KS should be differentiated from bacillary angiomatosis. Once the diagnosis of KS is established, staging is to done for prognosis.

M. Gautam, A. Shah, S. Kundu, and M. Ghobrial. Mercy Catholic Medical Center, Drexel University College of Medicine, Darby, PA.