Intravascular papillary endothelial hyperplasia or Masson's hemangioma is a rare vascular tumor. The reactive proliferation of endothelial cells in this disease mimics other benign or malignant vascular proliferation such as angiosarcoma or Kaposi's sarcoma. It is important to make an accurate distinction to avoid confusion with these malignant tumors. This would facilitate a proper diagnosis, which is essential so that the patient is not subjected to unnecessarily aggressive or inappropriate treatment.
Diagnosis ; Endothelial Cells ; Hemangioma ; Hemangiosarcoma ; Humans ; Hyperplasia ; Sarcoma, Kaposi

AIDS-Related Opportunistic Infections ; diagnosis ; Humans ; Oral Medicine ; Sarcoma, Kaposi ; diagnosis

BACKGROUND: The differential diagnosis of Kaposi sarcoma includes many disease that range from benign disease to malignant tumors. However, little information is available about the immunohistochemical characteristics of Kaposi sarcoma. METHODS: The expressions of 13 various proteins (HHV-8 LNA-1, Ki-67, bcl-2, p53, CD31, CD34, factor VIII, D2-40, vimentin, SMA, S-100, EMA, and c-kit) were evaluated immunohistochemically in 49 vascular tumors including 16 Kaposi sarcomas, 8 angiosarcomas, 2 hemangioendotheliomas, and 23 benign vascular tumors with using the tissue array method. RESULTS: All 16 cases of Kaposi sarcoma showed nuclear staining for HHV-8 LNA-1, whereas all the cases of angiosarcoma and benign vascular lesions were negative for HHV-8 LNA-1 (p<0.001). All Kaposi sarcoma were positive for D2-40, which is a marker of lymphatic differentiation, but 25% of the benign vascular lesions and 30.4% of the angiosarcoma were positive for D2-40 (p<0.001). The mean proliferation index as assessed by Ki-67 immunostaining revealed no difference between the benign and malignant vascular lesions (p>0.05). No Kaposi sarcoma showed a bcl-2 expression, but 62.5% of the angiosarcomas and 21.7% of the benign vascular tumors had bcl-2 expressions (p=0.005). CONCLUSIONS: Immunohistochemical detection of HHV-8 LNA-1 and D2-40 are useful tools to differentiate Kaposi sarcoma from other vascular tumors.
Diagnosis, Differential ; Factor VIII ; Hemangioendothelioma ; Hemangiosarcoma ; Herpesvirus 8, Human ; Immunohistochemistry ; Sarcoma, Kaposi* ; Vimentin

Spindle cell hemangioendothelioma was first described in 1986 to characterize a particular angiomatous lesion which shows different clinical features, however, it has recently been designated as spindle cell hemangioma (SCH) due to its benign nature. Microscopically, this peculiar vascular tumor consists of cavernous blood vessels intermixed with solid areas predominantly composed of spindle cells, resembling Kaposi sarcoma. A 39-year-old woman presented with a bean-sized, tender, bluish nodule on the pulp of her right thumb. The 1 year old lesion had increased slowly in size over this time. Histologic examination of the lesion showed that it was composed of large irregularly-dilated, thin-walled cavernous blood spaces containing organizing thrombi, numerous red blood cells, and a spindle cell mass which was partially connected with the vessel wall and invaded the stroma. A diagnosis of SCH was made based on histologic and immunohistochemical findings. After the lesion was totally excised, there has been neither recurrence nor occurence of new lesions to date.
Adult ; Blood Vessels ; Diagnosis ; Erythrocytes ; Female ; Hemangioendothelioma ; Hemangioma* ; Humans ; Recurrence ; Sarcoma, Kaposi ; Thumb

BACKGROUND: Pulmonary Kaposi's sarcoma (PKS) directly affects the life expectancy of those infected and yet the clinical and radiographic features of Kaposi's sarcoma (KS) with pulmonary involvement are nonspecific, which makes diagnosis difficult. In Uganda, pulmonary tuberculosis, which has clinical features that closely resemble those of PKS, also occurs commonly and thus confusion is bound to arise. Bronchoscopy is a recognized diagnostic investigatory modality for PKS. The aim of present study was to identify unique or useful points for the differential diagnosis of PKS and other opportunistic infections. METHODS: The clinical, radiologic, and bronchoscopic findings in thirty-five Ugandan patients (age 20-50, median 32) with PKS were analyzed. RESULTS: Cough and weight loss were most common and occurred in 97.1%, whereas fever occurred in 62.9%, and breathlessness in 57.1%. Thirty-four patients (97.1%) showed mucocutaneous KS, and palatal KS was most frequent and was observed in 74.3%. In addition, 25 patients (71.4%) showed the characteristic endobronchial plaques of KS. The most frequently observed radiographic abnormality was bilateral reticulonodular density. Histological examinations of bronchoscopic biopsies revealed KS in 7 (36.6%) cases. Five PFS patients (25%) also had co-existent tuberculosis. CONCLUSIONS: The majority of patients with PKS showed no specific findings on physical examination, apart from mucocutaneous KS. Our findings indicate that palatal KS may be a strong predictor of PKS. In Uganda, pulmonary tuberculosis may be the most common concomitant pulmonary infection in PKS patients.
Uganda ; Tuberculosis, Pulmonary/diagnosis ; Sarcoma, Kaposi/*diagnosis ; Middle Aged ; Male ; Lung Neoplasms/*diagnosis ; Humans ; Female ; Diagnosis, Differential ; *Bronchoscopy ; Adult

BACKGROUND: Kaposi's sarcoma (KS) is a multicentric proliferative vascular tumor which involves cutaneous and visceral tissues. Recent study has clearly identified human herpes virus 8 (HHV8) in all Kaposi's sarcoma patients, indicating that HHV8 is closely involved in the pathogenesis of Kaposi's sarcoma. OBJECTIVE: The purpose of this study was to document clinical and histopathological features of KS and to emphasize the necessity of detection of HHV8 in the differential diagnosis of KS from other vascular lesions. METHODS: The medical records and histopathological slides of patients with KS diagnosed at Ajou University Hospital from January 1995 to December 2004 were reviewed. We performed immunohistochemical stain and polymerase chain reaction (PCR)-based analysis to detect HHV8 in KS and other vascular lesions. RESULTS: Among 12 patients, classic KS was found in 9 patients, AIDS-associated KS in 1 patient, and iatrogenic immunosuppressive KS in 2 patients. Patients with KS presented with various clinical features, showing purple- colored macules to nodules or tumors. Although lower extremities are most frequently involved sites, involvement of other sites such as arm and neck was noticed. Mucosal and systemic involvement was detected in AIDS- associated case. Immunohistochemical stains for HHV8 were positive in all KS, but they were negative in other vascular lesions. PCRs for HHV8 were positive in 8 of 11 (72.7%) KS, but they were negative in other vascular lesions. Classic KS responded well to surgical and radiation therapies and showed indolent course. Immunosuppressive KS regressed partially after dose reduction of immunosuppressive drug therapy, but the lesions persisted. CONCLUSION: Immunohistochemical stain and/or PCR for HHV8 are useful means to differentiate KS from other vascular tumors.
Arm ; Coloring Agents ; Diagnosis, Differential ; Drug Therapy ; Humans* ; Lower Extremity ; Medical Records ; Neck ; Polymerase Chain Reaction ; Sarcoma, Kaposi*

PURPOSE: To evaluate the radiographic and CT findings of pulmonary complications other than pulmonary edema arising from renal transplantation. MATERIALS AND METHODS: Among 393 patients who had undergone renal transplantation at our hospital during a previous ten-year period, 23 with pulmonary complications other than pulmonary edema were included in this study. The complications involved were infection caused by CMV (n=6), bacteria (n=4), fungus (n=4), tuberculosis (n=2), varicella (n=1) or chlamydia (n=1), and malignancy involving lung cancer (n=4) or Kaposi's sarcoma (n=1). Two chest radiologists reviewed all images. RESULTS: The complications manifesting mainly as pulmonary nodules were lung cancer(4/4), tuberculosis (1/2), and Kaposi's sarcoma(1/1). Pulmonary consolidation was a main feature in bacterial infection(4/4), fungal infection(3/4), tuberculosis(1/2), chlamydial infection(1/1), and varicellar pneumonia(1/1). Ground-glass attenuation was a main CT feature in CMV pneumonia(4/6), and increased interstitial marking was a predominant radiographic feature in CMV pneumonia(2/6). CONCLUSION: The main radiologic features described above can be helpful for differential diagnosis of the pulmonary complications of renal transplantation.
Bacteria ; Chickenpox ; Chlamydia ; Diagnosis, Differential ; Fungi ; Humans ; Kidney Transplantation* ; Lung ; Lung Neoplasms ; Pulmonary Edema ; Sarcoma, Kaposi ; Thorax ; Tuberculosis

OBJECTIVETo explore the clinicopathologic features of kaposiform hemangioendothelioma (KHE).

METHODSThe clinicopathologic data were studied in three cases of KHE and review the literatures.

RESULTSTwo cases were female and one was male. All cases occurred in infancy. Two tumor located in axillary chest wall and one in lumbar region. All of the three patients had Kasabach-Merritt syndrome. Histologically, the tumor was composed of spindle-shaped cells. in all cases nodular growth pattern was seen. Immunohistochemically, Neoplastic spindled cells expressed CD34 and CD31. Associated lymphangiomatosis was present in two cases. Two tumors were resected completely, one was resected partly. the follow-up period ranged from 6 months to 3 years, and all were alive.

CONCLUSIONSKaposiform hemangioendothelioma is a rare locally aggressive vascular tumor that mainly occurred in early infancy. It is frequently complicated by Kasabach-Merritt syndrome, and it has features common to both capillary hemangioma and Kaposi sarcoma. The prognosis of KHE is determined by the size, location and the hemorrhage degree of vascular tumor. Better outcome might be achieved in patients with KHE of the skin and in the soft tissues under the skin. It appears that the main treated measure should be wide local excision.

Diagnosis, Differential ; Female ; Hemangioendothelioma ; complications ; pathology ; Humans ; Infant ; Male ; Purpura, Thrombocytopenic ; etiology ; Sarcoma, Kaposi ; complications ; pathology ; Skin Neoplasms ; complications ; pathology

Kaposi's sarcoma is a rare and slowly progressive disease that primarily affects the skin but has an associated visceral involvement. It can occur in the HIV-positive patients or patients treated with immunosuppressants. However, it is extremely rare in the patients receiving the treatment for inflammatory bowel disease. We used corticosteroid for the treatment of ulcerative colitis in 60-year-old woman. Then, Kaposis's sarcoma occured in the skin and colon of the patient. Since she was HIV-negative, we believed that it was developed from the condition of corticosteroid-induced immunosuppression. We present a case of skin and colonic Kaposi's sarcoma in a HIV-negative woman following treatment with corticosteroid for ulcerative colitis.
Aged ; Colitis, Ulcerative/*complications/drug therapy ; Colonic Neoplasms/*complications/diagnosis ; English Abstract ; Female ; Humans ; Sarcoma, Kaposi/*complications/diagnosis ; Skin Neoplasms/*complications/diagnosis

The incidence of Kaposi's sarcoma increases in renal transplant patients who had immunosuppressive therapy. In Korea, 4 cases of Kaposi's sarcoma in renal transplant patients have been reported. All of these cases had skin lesions. We experienced pulmonary Kaposi's sarcoma in 25- year-old man proven by open lung biopsy. He had re ceived cyclosporine and prednisolone as immunosuppres sive agent for 8 months since renal transplantation. He admitted to the hospital because of fever and pulmonary nodules on chest X-ray, and he had no skin lesion. Sputum examinations were negative for microorganisms and malignancy. He had bloody and frothy secretions on bronchoscopic study, and BAL fluid examinations were negative for microorganisms and malignancy. Open lung biopsy was carried out which showed Kaposi's sarcoma nodules. Immunosuppressive agents were discontinued after diagnosis but pulmonay nodules progressed. He died of respiratory failure 10 days after diagnosis. Pulmonary Kaposi's sarcoma has to be considered in the differential diagnosis in immunosuppresed patients who present with fever and pulmonary nodules.
Biopsy ; Cyclosporine ; Diagnosis ; Diagnosis, Differential ; Fever ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Transplantation ; Korea ; Lung ; Lung Neoplasms ; Prednisolone ; Respiratory Insufficiency ; Sarcoma, Kaposi* ; Skin Manifestations* ; Skin* ; Sputum ; Thorax