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]

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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, such as:

• Kaposi's sarcoma cutaneous lesions must be differentiated from:

• Bacillary angiomatosis
• Arteriovenous malformation
• Acroangiodermatitis
• Masson's hemangioma
• Angiosarcoma
• Seborrheic keratosis
• Erythematous lupus
• Pigmented purpuric dermatosis
• Pyogenic granuloma
• Benign lymphangioendothelioma
• Cavernous hemangioma
• Sarcomatoid carcinoma
• Spindle cell hemangioendothelioma

• Kaposi's sarcoma pulmonary lesions must be differentiated from:

• AIDS-related lymphoma
• Atypical pneumonia
• Fungal or mycobacterial infection
• Lung cancer

• Kaposi's sarcoma gastrointestinal lesions must be differentiated from:

• Peptic ulcer disease
• Inflammatory bowel disease (IBD)
• Gastrointestinal tract cancer

Diseases	Etiology	Congenital	Acquied	Demography	Clinical manifestations							Lab findings						Gold standard diagnosis	Additional 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 in 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	N/A	Imaging	Hereditary hemorrhagic telangiectasia
Acroangiodermatitis	Idioathic	-	-	More frequent in male, any ages	Purplish-blue to brown papules and plaques	-	-	Nl	-	-	-	Nl	Nl	Nl	Nl	Nl	Hyperkeratosis, parakeratosis, acanthosis, and mild spongiosis	Clinical manifesttations	Amputees, Haemodialysis (HD) patients with arteriovenous (AV) shunts Paralysed legs Hepatitis C Chronic venous insufficiency AV malformations
Angiosarcoma	Idiopathic	-	-	More frequent in males, usually in adults	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 vesiclesin cytoplasm Weibel-Palade bodies	Biopsy	-
Masson's hemangioma	Idiopathic	-	-	N/A		-	-	Nl	-	-	-	Nl	Nl	Nl	Nl	Nl	Papillary fronds lined by proliferating endothelium	Clinical manifestations and histological findings	HemangiomaS Pyogenic granulomas Lymphagiomas
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 coomon in female, typically in the 20 to 30 years	Erythema on the nasolabial folds Macular or diffusely erythematous in sun-exposed areas (photosensitive rash) Discoid rash	+/-	-	↑	+/-	+/-	Weight loss Headache Arthralgia Myalgia Nausea and dyspepsia Pleuritic chest pain Dyspnea Hematuria	↑	↓	↓	-	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 diseas Pericarditis Myocarditis
Pigmented purpuric dermatosis
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
Benign lymphangioendothelioma
Cavernous hemangioma
Sarcomatoid carcinoma
Spindle cell hemangioendothelioma