Kaposis Sarcoma of the Left Groin

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Kaposis Sarcoma of the Left Groin

• Svetlana Biggs
• Cytotechnology
• SUNY Upstate Medical University

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Kaposis Sarcoma

• A sarcoma cancer that develops in connective
  tissues ( cartilage, bone, fat, muscle, blood
  vessels) or fibrous tissues (tendons or
  ligaments).
• Named for Dr. Moritz Kaposi who first described
  it in 1872
• Developed in association with human
  immunodeficiency virus (HIV) infection and the
  acquired immunodeficiency syndrome (AIDS).
• Develop in the tissues below the skin surface or
  in the mucous membranes of the mouth, nose or
  anus.

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Kaposis Sarcoma

• Kaposis Sarcoma-associated herpesvirus is the
  eighth human herpesvirus (HHV-8).
• Kaposis Sarcoma is the most common neoplasm seen
  in the AIDS population.
• Prior to the AIDS epidemic, Kaposis Sarcoma was
  typically found in elderly Italian and Jewish
  men, organ transplant patients or young, adult
  African males.
• The incidence of Kaposis Sarcoma has decreased
  significantly in the AIDS population since 1996.

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Symptoms

• Multiple purplish skin lesions on arms or legs
• Nausea
• Watery diarrhea
• Vomiting with abdominal pain
• Weight loss

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Clinical Information

• 34 year old white male
• Diagnosed with HIV and lymphadenopathy
• Crepitus plaques on head, face, neck and
  extremities
• Tobacco use disorder
• History of depressive disorder and migraines
• Significant family history of cancer and coronary
  artery disease
• Allergic to contrast dye and almonds

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Clinical Information

• Lymph node biopsy pathology was consistent with
  Kaposis Sarcoma and no evidence of lymphoma.
• Scheduled for colonoscopy and EGD to rule out
  intestinal Kaposis Sarcoma.
• No further patient information available.

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Clinical Information

• Evaluated as an outpatient of the GI clinic and
  there was some concern for Kaposi via GI tract.
• Scheduled to have a colonoscopy and EGD.
• Patients health continues to decline with
  enlargement of lymph nodes in the groin, neck and
  axillary.
• FNA of single inguinal lymph node showed
  spinal-cell neoplasm.

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Type of Specimen

• Four slides fixed for pap stain
• Six slides, air-dried for DQ stain
• 10.5 ml RPMI with red and white tissue with
  aggregate dimensions of 0.2 x 0.1 x .0.1 cm for
  cell block

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Cytologic Findings

• Sparse cellularity
• Small loose groups of spindle cells with very
  slender cytoplasm
• Small to moderate amount cytoplasm with elongated
  cytoplasmic tails
• Elongated nuclei with evenly distributed, finely
  granular chromatin
• Small or inconspicuous nucleoli
• Background of hyaline globules representing
  degenerated erythrocytes and scattered
  inflammatory lymphocytes

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Cytologic Diagnosis

• Crushed spindle cells and occasional lymphoid
  cells
• The cell block shows a minute fragment of spindle
  cells with nuclear atypia
• Immunohistochemical stains show that spindle
  cells are positive for CD34 and CD31
• The findings are suggestive for Kaposis Sarcoma

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Spindle Cell400 x pap stain
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Spindle Cell100x pap stain
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Spindle Cell 100X DQ
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Spindle Cell400x DQ
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Spindle Cell100x CD34
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Spindle Cell100x CD31
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Histology Diagnosis

• Total effacement of lymph node architecture by a
  nodular proliferation of spindle cells with
  nuclear atypia and slit-like spaces containing
  red blood cells (erythrocytes).
• The proliferation extends into perinodal soft
  tissue.
• Acid-fast bacilli (AFB) positive organisms
  consistent with atypical mycobacterial infection.
• No well-formed granulomas.
• Immunohistochemical stains for CD31 and CD34 are
  positive

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Spindle Cells400x HE
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Spindle Cells400x HE
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Spindle Cells100x HE
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Treatment

• KS does become life threatening when it is in the
  lungs, liver or GI tract.
• Radiation therapy.
• The skin lesions of KS usually are not life
  threatening or disabling.
• The patient likelihood of survival depends on the
  type of Kaposis Sarcoma.

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Discussion

• The incidence of KS cases as a result of HIV
  infection has decreased 85 - 90 due to
  advancements in treatment.
• The most common site for KS is tissues below the
  skin surface, mucous membrane of the mouth, nose
  and anus.
• The abnormal tissue areas appear as raised
  blotches or lumps that may be purple, brown or
  red.
• The disease causes painful swelling, especially
  in the legs, groin area or skin around the eyes.

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