Imaging Manifestations of Kaposi Sarcoma

Hepatic Kaposi sarcoma: A case report and review of the literature

Kaposi sarcoma (KS) is an aggressive cancer caused by human herpesvirus-8, primarily seen in immunocompromised patients. As opposed to the well-described cutaneous manifestations and pulmonary complications of KS, hepatic KS is rarely reported before death as most patients with hepatic KS do not manifest symptoms or evidence of liver injury. In patients with acquired immune deficiency syndrome, hepatic involvement of KS is present in 12%-24% of the population on incidental imaging and in approximately 35% of patients with cutaneous KS if an autopsy was completed after their death. Patients with clinically significant hepatic injury due to hepatic KS usually have an aggressive course of disease with hepatic failure often progressing to multi-organ failure and death. Here we report an unusual presentation of acute liver injury due to hepatic KS and briefly review the published literature on hepatic KS.

Beyond gastric adenocarcinoma: Multimodality assessment of common and uncommon gastric neoplasms

Despite advances in molecular biology, imaging, and treatment, gastric neoplasms remain a significant cause of morbidity and mortality; gastric adenocarcinoma is the fifth most common malignancy and third most common cause of death worldwide (Brenner et al., Methods Mol Biol 472:467-477, 2009; Howson et al. Epidemiol Rev 8:1-27, 1986; Roder, Gastric Cancer 5(Suppl 1):5-11, 2002; Ferlay et al., GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. International Agency for Research on Cancer, 2013). Because of both the frequency at which malignant gastric tumors occur as well as the worldwide impact, gastric neoplasms remain important lesions to identify and characterize on all imaging modalities. Despite the varied histologies and behaviors of these neoplasms, many have similar imaging features. Nonetheless, the treatment, management, and prognosis of gastric neoplasms vary by pathology, so it is essential for the radiologist to make every effort to differentiate between these lesions and raise the less common entities as differential diagnostic considerations when appropriate.

"Periportal neoplasms"--a CT perspective: review article

The periportal space is a potential space surrounding the portal vein and its intrahepatic branches. A variety of neoplasms can involve the periportal region, whether primary or secondary, owing to contiguous spread from surrounding hepatic parenchyma or from adjacent organs. CT plays an important role in not only diagnosing these lesions but also determining the extent of the disease. Most of the malignancies leading to the periportal spread manifest as periportal hypodensity either distinctly or in contiguity with the primary tumour. Even in known malignancies, periportal hypodensity commonly results from non-neoplastic causes like periportal oedema; hence, a knowledge of the imaging findings to ascertain its presence as well as to conclude the definite neoplastic spread is prudent. Periportal spread of neoplasm may suggest locally aggressive or disseminated disease (in extrahepatic malignancies), which may change management accordingly.

Asymptomatic Pulmonary Allograft Kaposi Sarcoma: A Case Report

Solid-organ transplant recipients are at high risk of developing malignancies. A greater risk of Kaposi sarcoma has been reported in lung recipients in our country, particularly in those from Southern Italy, probably due to the high prevalence of Human herpes virus 8 infection. Kaposi sarcoma affecting only the lung allograft is extremely rare. We describe a case of a lung recipient who developed Kaposi sarcoma only in the graft, 22 months after transplant. The patient, a 65-year-old man from Southern Italy, underwent bilateral lung transplant for idiopathic pulmonary fibrosis in January 2009. He developed mild/moderate acute cellular rejection (≥A2) in 4 of 6 scheduled transbronchial biopsies thus was treated with increased immunosuppressive therapy, shifting from cyclosporine to tacrolimus and mycophenolate mofetil. In July 2010, a high-resolution computed tomography scan showed small bilateral lung nodules, despite a generally good condition. After 2 months, his condition worsened with a severe weight loss. A positron emission tomography scan showed mild metabolic activity in the lesions with no other localizations. In October 2010, a lung biopsy was performed, with results showing typical histologic and immunohistochemical features of Kaposi sarcoma. Molecular tissue evaluations and serologic analyses were positive for Human herpes virus 8. The patient's immunosuppressive therapy was suspended, and he started liposomal doxorubicin treatment; however, after the first cycle, he developed severe respiratory dysfunction. The patient died 27 months after lung transplant for neoplasm. Our report highlights the importance of considering Kaposi sarcoma in the differential diagnosis for lung nodules in lung transplant recipients, even in the absence of any initial specific symptom or cutaneous lesion.

[Kaposi sarcoma in bronchopulmonary localization revealing HIV infection]

La maladie de Kaposi (MK) associée au VIH, forme dite épidémique, a été décrite la 1ère fois en 1981 par Hymmes. C'est l'affection maligne la plus fréquente au cours du SIDA. La MK est à l'origine de 10% des atteintes pleuropulmonaires au cours de l'infection par le VIH et 40% des pneumopathies en cas de MK cutanéomuqueuse. Les localisations pulmonaires occupent la deuxième place des atteintes viscérales après la forme digestive. Le diagnostic repose sur des arguments épidémiologiques, cliniques, radiologiques, biologiques, endoscopiques et histologiques. Nous rapportons un cas de MK broncho-pulmonaire compliquant une infection VIH chez un patient présentant une maladie de Kaposi cutanée de découverte fortuite au cours de l'atteinte pulmonaire. Le diagnostic a été retenu après avoir éliminé les maladies opportunistes à tropisme pulmonaire. Le Kaposi pulmonaire constitue l'atteinte la plus grave de la MK-sida et la survie après le diagnostic est courte malgré les thérapeutiques agressives.

Case Report: Pulmonary Kaposi Sarcoma in a non-HIV patient

Kaposi Sarcoma (KS) is an angioproliferative tumor associated with human herpes virus 8 (HHV-8).  Often known as one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases, pulmonary involvement in KS has only been discussed in a handful of case reports, rarely in a non-HIV patient. Herein we report the case of a 77 year-old- male who presented with a 6-week history of progressive dyspnea on exertion accompanied by productive cough of yellow sputum and intermittent hemoptysis. His past medical history was significant for Non-Hodgkin's Follicular B-Cell Lymphoma (NHL). Patient also had biopsy-confirmed cutaneous KS. His physical exam was notable for a 2cm firm, non-tender, mobile right submandibular lymph node.  Lungs were clear to auscultation. He had multiple violet non-tender skin lesions localized to the lower extremities. CT scan of the chest showed numerous nodular opacities and small pleural effusions in both lungs. A thoracenthesis was performed, showing sero-sanguineous exudative effusions. Histopathology failed to demonstrate malignant cells or lymphoma. A subsequent bronchoscopy revealed diffusely hyperemic, swollen mucosa of the lower airways with mucopurulent secretions. Bronchoalveolar lavage PCR for HHV-8 showed 5800 DNA copies/mL.  It was believed that his pulmonary symptoms were likely due to disseminated KS.  This case illustrates the potential for significant lung injury from KS. It also demonstrates the use of PCR for HHV-8 to diagnose KS in a bronchoalveolar lavage sample in a case when bronchoscopic biopsy was not safe. Furthermore, this case is unique in that the patient did not match the typical KS subgroups as HIV infection and other immune disorders were ruled out. Recognition of this syndrome is critical to the institution of appropriate therapy. As such, this case should be of interest to a broad readership across internal medicine including the specialties of Pulmonology and Critical Care.

Resolution of diffuse skin and systemic Kaposi's sarcoma in a renal transplant recipient after introduction of everolimus: a case report

We present a case report of a patient with diffuse skin and systemic Kaposi's sarcoma (KS), 1 year after renal transplantation. A concomitant Pyrenochaeta romeroi granuloma of the right hallux was diagnosed and illustrated an important immunodysfunction in our patient. Four months after reduction in immunosuppression and switch to everolimus, a total regression of the KS was observed. Reduction in the immunosuppression and treatment with terbinafine cleared the P. romeroi infection, while lowering immunosuppression and changing the type of immunosuppressive therapy were important steps in the successful management of the KS. In recent years, evidence of the antitumor effects of everolimus is increasing: total regression of KS in combination with renal function preservation in renal graft recipients is possible with mammalian target of rapamycin (mTOR) inhibitor-based regimens. In addition, with increasing numbers of human immunodeficiency virus-positive transplant recipients, mTOR inhibitors may play a more crucial role in the management of KS.

Computed Tomography Virtual Bronchoscopy: Normal Variants, Pitfalls, and Spectrum of Common and Rare Pathology

A broad spectrum of pathologies that involve the laryngotracheobronchial airway and imaging plays a crucial role in evaluating these abnormalities. Computed tomography with virtual bronchoscopy has been found to be very helpful in defining the location, extent, and nature of these lesions, and is increasingly being used even in patients with contraindications for fiberoptic bronchoscopy and laryngoscopy. Ionizing radiation, associated with virtual bronchoscopy, can be minimized by using low-dose multidetector computed tomography and hybrid iterative reconstruction techniques. Furthermore, retrospectively generated virtual bronchoscopy from a routinely acquired computed tomography data set eliminates additional cost and radiation. In the future, virtual bronchoscopy assisted with advanced navigational techniques will broaden the diagnostic and therapeutic landscape. This article presents the characteristic features of common and rare laryngotracheobronchial pathologies seen with virtual bronchoscopy.

What is hiding in the hindgut sac? Looking beyond rectal carcinoma

Objectives

Although rectal cancer is by far and large the most common pathology involving the rectum that needs imaging, there are many other important but less common pathological conditions affecting anorectal region. The objective of this pictorial review is to discuss the cross-sectional imaging features of less common anorectal and perirectal diseases.

Results

Although a specific histological diagnosis cannot usually be made due to considerable overlap in the imaging appearances of anorectal diseases, this review illustrates the cross-sectional imaging findings with emphasis on magnetic resonance imaging (MRI) that can help in narrowing down the differentials to a reasonable extent.

Teaching points

• Variety of pathology exists in the anorectum apart from common rectal carcinoma

• Anorectal diseases present as non-specific wall thickening indistinguishable from rectal carcinoma

• Computed tomography (CT) and MRI can help in narrowing down the differentials, although often biopsy is warranted.

Outside the inside: a review of soft-tissue abnormalities seen on thoracoabdominal computed tomography

In this review, we illustrate the computed tomographic features of thoracoabdominal soft-tissue abnormalities, which may be easily overlooked and often can provide important information regarding systemic processes. Examples include necrotizing fasciitis, heterotopic ossification, fat necrosis, benign and malignant neoplasms, endometriosis, and collagen vascular disease as well as systemic and congenital pathology.

Imaging of uncommon esophageal malignancies

Malignant esophageal neoplasms other than squamous cell carcinoma and adenocarcinoma are uncommon and include endocrine tumors, lymphoid malignancies, melanoma, malignant stromal tumors, and secondary tumors (metastases). Imaging, though not diagnostic in many cases, helps in selecting the appropriate treatment strategy by determining the anatomic extent of the tumor and locoregional and distant spread. In this article, we provide a comprehensive review of the imaging features of these uncommon esophageal malignancies.

Primary intraosseous Kaposi's sarcoma of the maxilla in AIDS: a case report

In China, Kaposi's sarcoma (KS) is very rare. However, KS does occur as one of the complications in patients with acquired immunodeficiency syndrome (AIDS). Usually AIDS-related KS involves the lymph nodes, the skin and gastrointestinal tract. Intraosseous KS have been reported but it is very rare. We report a case of primary intraosseous KS of the maxilla in an AIDS patient, proven by pathology findings and showed multiple metastasis by positron emission tomography and computed tomography (PET/CT). To our knowledge, this is the first report of primary intraosseous KS of the maxilla in an AIDS patient in China.

Epstein-Barr virus (EBV)-related smooth muscle tumors of central nervous system--a report of two cases and review of literature

Epstein-Barr virus-related smooth muscle cell tumors (EBV-SMTs) are rare albeit increasingly recognized tumors in immunocompromised patients. We report on the imaging features of EBV-SMTs occurring in the central nervous system (CNS) in two patients. Central areas of T2 prolongation, surrounding vasogenic edema, mass effect on adjacent neuroparenchyma, dural tails, and underlying bone erosions were the notable imaging findings. Besides the usual differentials of extraaxial tumors like meningioma, hemangiopericytoma, and lymphoma, CNS EBV-SMTs should be considered in immunocompromised patients.

Hepatic Kaposi's sarcoma in a patient affected by AIDS: Correlation between histology and imaging

Kaposi's sarcoma (KS) is an aggressive, multifocal oncologic disease, which frequently involves skin and internal organs, predominantly affecting homosexual men with AIDS. Hepatic KS is rarely reported in living patients, while autopsies show liver involvement in 35% of patients with KS. Ultrasound (US) of the liver in AIDS patients shows hyperechoic nodules with periportal bands; CT shows a hypodense lesion before and after contrast administration, but in the late phase after iodinated contrast agent injection the nodules are enhanced. Those findings are considered indicative of hepatic KS [1-3].

[Pulmonary involvement due to HHV-8 virus during the course of HIV infection]

HHV-8 is a herpes virus discovered in 1994 in Kaposi sarcoma cells. Its involvement was later demonstrated in multicentric Castleman disease and in primary lymphoma effusion lymphoma. These diseases arise almost exclusively in immunocompromised patients, mostly in association with HIV infection. Apart from Kaposi's sarcoma, combined antiretroviral therapy does not seem to have reduced the incidence of these diseases, which remain rare. In these three diseases, pulmonary involvement is common and may be the presenting feature. Kaposi's sarcoma of the lung is usually asymptomatic but may require specific therapy. Pulmonary involvement is mostly associated with cutaneous disease. Patients with Castleman disease typically present with fever and lymphadenopathy, associated with interstitial lung disease without opportunistic infection. Patients with primary lymphoma effusion presents with fever and an exudative lymphocytic pleural effusion, without a pleural mass on the CT-scan. Rapid diagnosis of these conditions avoids unnecessary invasive examinations and leads to prompt specific treatment.

Soft tissue tumors of the head and neck: imaging-based review of the WHO classification

The World Health Organization (WHO) system for defining and classifying soft tissue tumors is usually applied to lesions that occur in the trunk and extremities, but it also provides an excellent framework for characterizing nonepithelial extraskeletal tumors of the head and neck. Although nonepithelial extraskeletal tumors are in the minority among head and neck lesions, they are by no means rare. The WHO classification system recognizes nine major types based on histologic differentiation: adipocytic, fibroblastic or myofibroblastic, fibrohistiocytic, smooth muscle, skeletal muscle, vascular, pericytic, and chondro-osseous tumors, as well as soft tissue tumors of uncertain differentiation. Tumors of each histologic type may be further subclassified on the basis of their biologic behavior as benign, intermediate (ie, having malignant potential), or malignant. Imaging plays an important role in the noninvasive diagnosis and characterization of nonepithelial soft tissue tumors of the head and neck, providing clues about tumor grade, composition, extent, and involvement of adjacent structures. Although the imaging characteristics of many such tumors are nonspecific, consideration of the clinical history in concert with the imaging findings may help limit the differential diagnosis or even allow reliable diagnosis of some of these tumors.

Kaposi's sarcoma: imaging overview

Kaposi's sarcoma (KS), a low-grade malignancy that is associated with human herpesvirus-8 (HHV-8), is a multifocal tumor that most commonly affects mucocutaneous sites. It might also involve lymph nodes and visceral organs, in particular of the respiratory and gastrointestinal tract, but it can affect every organ system. Four forms of the disease have been recognized: the classic, the endemic, the transplant-associated, and the epidemic form. The endemic form, or African KS, currently accounts for 10%-50% of all cancers in adults and up to 25% of cancers in children in certain parts of Africa. The epidemic form or acquired immune deficiency syndrome (AIDS)-associated KS is a frequent neoplasm in bisexual and homosexual men with AIDS in the United States. Even though in North America and Europe the incidence of KS in men with AIDS has decreased significantly after the introduction of highly active antiretroviral therapy (HAART), in some developing countries, the incidence of KS keeps growing. The pathophysiology, clinical manifestations, imaging findings, and more relevant differential diagnoses are reviewed.

Chest neoplasms with infectious etiologies

A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi’s sarcoma, Castleman’s disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.

AIDS-related primary Kaposi sarcoma of the nasopharynx

Primary nasopharyngeal Kaposi sarcoma is extremely rare, as only 1 case has been previously reported in the literature. We report a new case, which occurred in a 37-year-old man with a known history of acquired immune deficiency syndrome (AIDS). The patient presented with complaints of recurrent epistaxis and postnasal hemorrhage. Endoscopic examination detected a bluish, smooth, firm, nonpulsatile mass in the nasopharyngeal wall. Histopathologic findings on biopsy were consistent with Kaposi sarcoma. The tumor was successfully treated with radiotherapy. Kaposi sarcoma should be considered in the differential diagnosis of any AIDS patient who presents with recurrent unilateral nasal bleeding.

Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient

BACKGROUND

Diarrhoea is a common presentation throughout the course of HIV disease.

AIM

To review the literature relating to aetiology, investigation and management of diarrhoea in the HIV-infected adult.

METHODS

The PubMed database was searched using major subject headings 'AIDS' or 'HIV' and 'diarrhoea' or 'intestinal parasite'. The search was limited to adults and to studies with >10 patients.

RESULTS

Diarrhoea affects 40-80% of HIV-infected adults untreated with antiretroviral therapy (ART). First-line investigation is by stool microbiology. Reported yield varies with geography and methodology. Molecular and immunological methods and special stains have improved diagnostic yield. Endoscopy is diagnostic in 30-70% of cases of pathogen-negative diarrhoea and evidence supports flexible sigmoidoscopy as a first line screening procedure (80-95% sensitive for CMV colitis), followed by colonoscopy and terminal ileoscopy. Radiology is useful to assess severity, distribution, complications and to diagnose HIV-related malignancies. Side effects and compliance with ART are important considerations in assessment. There is a good evidence base for many specific therapies, but optimal treatment of cryptosporidiosis is unclear and only limited data support symptomatic treatments.

CONCLUSIONS

The immunological response to HIV infection and Antiretroviral therapy remains incompletely understood. Antiretroviral therapy regimens need to be optimised to suppress HIV while minimising side effects. Effective agents for management of cryptosporidiosis are lacking. There is an urgent need for enhanced regional diagnostic facilities in countries with a high prevalence of HIV. The ongoing roll-out of Antiretroviral therapy in low-resource settings will continue to change the aetiology and management of this problem, necessitating ongoing surveillance and study.

Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation

Although the vast majority of gastrointestinal (GI) masses are epithelial neoplasms, a variety of subepithelial masses are infrequently encountered during endoscopic or radiologic examination. A subepithelial mass, which was previously called a submucosal mass, is defined as a mass covered with normal-appearing mucosa, whether the underlying process is intramural or extramural in origin. At contrast material-enhanced computed tomography (CT), hypervascular subepithelial masses are usually detected more easily than isoattenuating or hypovascular masses. Entities that appear as intramural hypervascular subepithelial lesions include neuroendocrine tumors, GI stromal tumor, glomus tumor, hemangioma, angiosarcoma, Kaposi sarcoma, nerve sheath tumors, hypervascular metastases, heterotopic tissues, and vascular structures. Entities that appear as extramural hypervascular subepithelial lesions include Castleman disease, solitary fibrous tumor, inflammatory myofibroblastic tumor, and actinomycosis. Some rare gastric cancers resemble subepithelial tumors. In comparison with endoscopic ultrasonography, CT is of limited value in differentiating the layers of the GI wall and determining the origin of mass lesions. However, recent advances in multidetector CT with multiplanar reformation allow one to determine whether a GI mass is of epithelial, intramural subepithelial, or extramural subepithelial origin. Furthermore, the full extent of tumors can be delineated, and local invasion and distant metastases can be identified. Familiarity with the characteristic CT appearances of hypervascular subepithelial masses of the GI tract will help radiologists make a more confident diagnosis.

Imaging of the most frequent superficial soft-tissue sarcomas

Superficial soft-tissue sarcomas are malignant mesenchymal tumors located within the cutaneous and/or subcutaneous layers. Most superficial soft-tissue sarcomas are low-grade tumors; yet, the risk of local recurrence is high, and initial wide surgery is the main prognostic factor. Some of these superficial sarcomas may grow, following an infiltrative pattern, and their real extent may be underestimated clinically. Imaging techniques are useful to determine precisely the real margins of the tumor, especially in cases of clinically doubtful or recurrent or large superficial lesions. Imaging tools enable one to determine the relationship with the superficial fascia separating the subcutaneous layer from the underlying muscle. In our institution ultrasonographic examination is followed by magnetic resonance (MR) imaging when the size of the lesion exceeds 3-5 cm. Imaging assessment is performed prior to biopsy, enabling optimal surgical management. Imaging features of the main superficial sarcomas are detailed in the following article, according to their major locations: those arising in the epidermis and/or dermis, which are most often diagnosed by dermatologists, and the subcutaneous sarcomas.

[Imaging of nasopharyngeal diseases]

This article gives an overview about the main nasopharyngeal pathologies and incidental findings, which a radiologist could be confronted with in daily practice. These include nasopharyngeal cysts, lymphoid hyperplasia, juvenile angiofibroma, carcinomas and non-Hodgkin lymphoma. Typical radiological findings, possibilities for making a specific diagnosis, differential diagnosis and description of the spread of a neoplasm are the central points. Investigation techniques and clinical signs are briefly summarized.

Pulmonary involvement in Kaposi sarcoma: correlation between imaging and pathology

Kaposi sarcoma is a low-grade mesenchymal tumor involving blood and lymphatic vessels. There are four variants of this disease, each presenting a different clinical manifestation: classic or sporadic, African or endemic, organ transplant-related or iatrogenic, and AIDS-related or epidemic. Kaposi sarcoma is the most common tumor among patients with HIV infection, occurring predominantly in homosexual or bisexual men. The pulmonary involvement in Kaposi sarcoma occurs commonly in critically immunosupressed patients who commonly have had preceding mucocutaneous or digestive involvement.

The etiology of Kaposi sarcoma is not precisely established; genetic, hormonal, and immune factors, as well as infectious agents, have all been implicated. There is evidence from epidemiologic, serologic, and molecular studies that Kaposi sarcoma is associated with human herpes virus type 8 infection. The disease starts as a reactive polyclonal angioproliferative response towards this virus, in which polyclonal cells change to form oligoclonal cell populations that expand and undergo malignant transformation.

The diagnosis of pulmonary involvement in Kaposi sarcoma usually can be made by a combination of clinical, radiographic, and laboratory findings, together with the results of bronchoscopy and transbronchial biopsy. Chest high-resolution computed tomography scans commonly reveal peribronchovascular and interlobular septal thickening, bilateral and symmetric ill-defined nodules in a peribronchovascular distribution, fissural nodularity, mediastinal adenopathies, and pleural effusions. Correlation between the high-resolution computed tomography findings and the pathology revealed by histopathological analysis demonstrate that the areas of central peribronchovascular infiltration represent tumor growth involving the bronchovascular bundles, with nodules corresponding to proliferations of neoplastic cells into the pulmonary parenchyma. The interlobular septal thickening may represent edema or tumor infiltration, and areas of ground-glass attenuation correspond to edema and the filling of air spaces with blood. These findings are a result of the propensity of Kaposi sarcoma to grow in the peribronchial and perivascular axial interstitial spaces, often as continuous sheets of tumor tissue.

In conclusion, radiological findings can play a major role in the diagnosis of pulmonary Kaposi sarcoma since characteristic patterns may be observed. The presence of these patterns in patients with AIDS is highly suggestive of Kaposi sarcoma.

Pulmonary Kaposi sarcoma in a human immunodeficiency virus - infected woman: a case report

Approximately 90% to 95% of Kaposi sarcoma cases occur in human immunodeficiency virus – infected homosexual and bisexual men. Pulmonary Kaposi sarcoma is uncommon in women, and rarely considered as a potential cause of diffuse lung disease in women with acquired immunodeficiency syndrome. The disease is usually mistaken clinically for pulmonary infection. A 32-year-old woman was admitted with a 2-month history of dyspnea, evening fever, hemoptysis, weight loss, and generalized adenomegaly. Physical examination showed erythematous macules in the lower limbs. Skin and open lung biopsy demonstrated Kaposi sarcoma. Computerized tomography demonstrated peribronchovascular interstitial thickening. Although uncommon, pulmonary Kaposi sarcoma should be considered in the differential diagnosis of diffuse lung disease in women with AIDS.

AIDS-related Kaposi sarcoma of the lung presenting with a "crazy-paving" pattern on high-resolution CT: imaging and pathologic findings

Kaposi sarcoma (KS) is a fulminate and disseminated form of acquired immunodeficiency syndrome (AIDS)-defining neoplasm, usually presenting pulmonary involvement. We report a 40-year-old woman with AIDS and biopsy-proven KS showing unusual high-resolution computed tomography (HRCT) findings. HRCT showed areas of ground-glass attenuation with superimposed septal thickening ("crazy-paving" pattern). CT-pathologic correlation revealed that crazy-paving pattern in this case was due to accompanying pulmonary edema and hemorrhage in addition to tumor cell infiltration into the peribronchovascular interstitium, interlobular and alveolar septa. The authors suggest the inclusion of KS in the differential diagnosis of lung diseases in patients with AIDS presenting with crazy-paving pattern on the HRCT.

Primary Kaposi sarcoma of the subcutaneous tissue

Background

Involvement of the subcutis by Kaposi sarcoma (KS) occurs primarily when cutaneous KS lesions evolve into deep penetrating nodular tumors. Primary KS of the subcutaneous tissue is an exceptional manifestation of this low-grade vascular neoplasm.

Case presentation

We present a unique case of acquired immune deficiency syndrome (AIDS)-associated KS manifesting primarily in the subcutaneous tissue of the anterior thigh in a 43-year-old male, which occurred without overlying visible skin changes or concomitant KS disease elsewhere. Radiological imaging and tissue biopsy confirmed the diagnosis of KS.

Conclusion

This is the first documented case of primary subcutaneous KS occurring in the setting of AIDS. The differential diagnosis of an isolated subcutaneous lesion in an human immunodeficiency virus (HIV)-infected individual is broad, and requires both imaging and a histopathological diagnosis to guide appropriate therapy.

Kaposi sarcoma in unusual locations

Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.

MR imaging manifestations of skin tumors

In this study, we evaluated MR imaging findings of skin tumors and categorized them into four types: (1) discrete mass lesions of the dermis and epidermis, (2) mass lesions of the subcutis with or without abutment to the skin, (3) diffuse or localized skin thickening without a true mass, and (4) a skin mass with bone destruction. The categorization of MR images may be useful in the differential diagnosis of skin tumors.

Sarcoma de Kaposi relacionado à síndrome da imunodeficiência adquirida: características do comprometimento hepático na tomografia computadorizada e na ressonância magnética

Sarcoma de Kaposi é uma neoplasia associada a condições de imunossupressão que acomete os vasos linfáticos e sanguíneos. É a neoplasia intra-hepática mais comum na síndrome da imunodeficiência adquirida. A tomografia computadorizada e a ressonância magnética revelam múltiplos pequenos nódulos, proeminência e realce dos planos periportais, devido à presença de tecido neoplásico. Os autores descrevem um caso de paciente masculino, de 47 anos de idade, com síndrome da imunodeficiência adquirida e sarcoma de Kaposi disseminado.