Kaposi's sarcoma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Farima Kahe M.D. [2] Haytham Allaham, M.D. [3] Amandeep Singh M.D.[4] Huda A. Karman, M.D.

Overview

Kaposi's sarcoma must be differentiated from other diseases that cause similar cutaneous, pulmonary, and gastrointestinal involvement, such as bacillary angiomatosis, AIDS-related lymphoma, and seborrheic keratosis.

Differentiating Kaposi's Sarcoma from other Diseases

• Kaposi's sarcoma must be differentiated from other diseases that cause similar cutaneous, pulmonary, and gastrointestinal involvement.

Diseases	Etiology	Congenital	Acquired	Demography	Clinical manifestations							Lab findings						Gold standard diagnosis	Associated findings
					Symptoms			Signs				CBC			LFT	ESR/CRP	Histopathology
					Appearance	Fever	Bleeding	BP	Hepatosplenomegaly	Lymphadenopathy	Other	WBC	Hb	Plt
Bacillary angiomatosis	HIV Chronic lymphocytic leukemia Cytotoxic chemotherapy Organ transplantation	–	+	Any age, usually between 20 -50 years	Solitary or multiple red, purple, flesh-colored, or colorless papules	±	±	Nl	–	–	Anorexia Weight loss Abdominal pain Nausea and vomiting Headache	Nl	Nl	Nl	Nl	Nl	Lobular vascular proliferations of vessels lined by plump endothelial cells	Clinical manifestation	Psychiatric disorders Personality changes Seizure
Arteriovenous malformation	Idiopathic	+	–	Any age	Nl	–	+	Nl	–	–	Headache Neurologic deficits Heart failure Macrocephaly	Nl	Nl	Nl	Nl	Nl	NA	Imaging	Hereditary hemorrhagic telangiectasia
Acroangiodermatitis	Idiopathic Hyperplasia of pre-existing vasculature HTN	–	–	Any age, more in males	Purplish-blue to brown papules and plaques	–	–	Nl	–	–	Paralysed legs	Nl	Nl	Nl	Nl	Nl	Hyperkeratosis Parakeratosis Acanthosis Mild spongiosis	Clinical manifesttations	Amputation Haemodialysis patients with arteriovenous shunts Hepatitis C Chronic venous insufficiency AV malformations
Angiosarcoma	Idiopathic	–	–	Adults, more in males	Enlarging bruise, a blue-black nodule, or an unhealed ulceration	–	–	Nl	–	–	–	Nl	↓	↓	Nl	Nl	Intercellular and intracellular lumina with or without red cells Intermediate filaments and pinocytotic vesicles in cytoplasm Weibel-Palade bodies	Biopsy	NA
Diseases	Etiology	Congenital	Acquired	Demography	Appearance	Fever	Bleeding	BP	Hepatosplenomegaly	Lymphadenopathy	Other	WBC	Hb	Plt	LFT	ESR/CRP	Histopathology	Gold standard diagnosis	Associated findings
Masson's hemangioma	Idiopathic	–	–	Rare	Normal	–	–	Nl	–	–	–	Nl	Nl	Nl	Nl	Nl	Papillary fronds lined by proliferating endothelium	Biopsy	Hemangioma Pyogenic granulomas Lymphangiomas
Seborrheic keratosis	Clonal expansion of a mutated epidermal keratinocyte	+	–	Any age	Usually asymptomatic Being stuck on the skin surface	–	–	Nl	–	–	–	Nl	Nl	Nl	Nl	Nl	Papillomatous epithelial proliferation containing horn cysts	Clinical manifestations	Dermatosis papulosa nigra Stucco keratosis Melanoacanthoma Polypoid lesions
Systemic lupus erythematosus (SLE)	Idiopathic	–	–	More common in female, typically in the 20 to 30 years	Erythema on the nasolabial folds Macular or diffusely erythematous in sun-exposed areas Discoid rash	±	–	↑	±	±	Weight loss Headache Arthralgia Myalgia Nausea Dyspepsia Pleuritic chest pain Dyspnea Hematuria	↑	↓	↓	Nl	Nl	Hyperkeratosis, epidermal atrophy, vacuolar interface dermatitis Thickening of the basement membrane Superficial, perivascular, and perifollicular mononuclear cell inflammatory infiltrate	Clinical manifestations	Raynaud phenomenon Neuropsychiatric symptoms Pleural effusion Peptic ulcer disease Pericarditis Myocarditis
Pyogenic granuloma	Trauma Hormonal influences Viruses Cytogenetic clonal deletion abnormalities	+	+	Any age, usually in 20-30 years	Painless red lesion Lobular capillary hemangioma	–	+	Nl	–	–	–	Nl	Nl	Nl	Nl	Nl	Neutrophilic infiltration Hemorrhage Necrosis of the overlying epidermis	Clinical manifestation	NA
Benign lymphangioendothelioma	Idiopathic	–	+	Any ages, median age is 50 years	single, slowly expanding patch, plaque, or nodule	–	–	Nl	–	–	–	Nl	Nl	Nl	Nl	Nl	Thin-walled endothelial-lined spaces that are interspersed between strands of collagen	Biopsy	NA
Cavernous hemangioma	Idiopathic	–	–	Usually in third to fifth decades of life.	Painless, slowly progressive protrusion or bulging of their globe	–	–	Nl	–	–	–	Nl	Nl	Nl	Nl	Nl	Engorged vascular channels, which are tightly knit and separated by fibrous septae	Clinical manidestation	Diplopia Decreased color vision Visual field deficits
Diseases	Etiology	Congenital	Acquired	Demography	Appearance	Fever	Bleeding	BP	Hepatosplenomegaly	Lymphadenopathy	Other	WBC	Hb	Plt	LFT	ESR/CRP	Histopathology	Gold standard diagnosis	Associated findings