Kaposi’s Sarcoma: Clinical Types, Oral Features, and Histopathology

Kaposi’s Sarcoma: Clinical Types, Oral Features, and Histopathology

Question. Write a short note on Kaposi’s sarcoma.

Answer. It is also known as multiple idiopathic hemorrhagic sarcoma of Kaposi.

• Kaposi’s sarcoma is the multicentric proliferation of vascular or spindle cell components.
• Kaposi’s sarcoma is currently associated with HIV/AIDS.

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Kaposi’s Sarcoma Clinical Features

• Clinically, Kaposi’s sarcoma is of four types, i.e.
• Classic (Chronic)
• Endemic (Lymphadenopathic; African)
• Immunosuppression associated (Transplant)
• AIDS related.

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Kaposi’s sarcoma Classic type

• Development of cutaneous multifocal blue-red nodules on the lower extremities.
• Lesion slowly increases in size and number, with some of the lesions extinguishing and new ones forming on adjacent or distinct skin.
• Orally, soft, bluish nodules occur on the palatal mucosa or gingiva.

Lymphadenopathic

• Present in young African children.
• There is generalized or localized enlargement of lymph node chain which includes cervical lymph nodes.
• Disease follow fulminant course with visceral involvement and minimum skin or mucous membrane involvement.

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Immunosuppression Associated

• It is usually seen in renal transplant patients.
• It occurs 1 to 2 years after transplantation
• Progression of disease is directly proportional to loss of cellular immunity of host.

AiDs Related

• Homosexual AIDS patients have maximum chances of developing Kaposi’s sarcoma.
• Lesions occur on cutaneous lesions i.e. along lines of cleavage and tip of nose.
• Oral lesions can occur anywhere in oral cavity, but predilection is for palatal mucosa and gingiva.
• Early oral mucosal lesions are flt and slight blue, red or purple plaques, either focal or diffse and may be completely asymptomatic.
• Later on these lesions may be more deeply discolored and there is development of surface papules and nodules which may become exophytic and ulcerated. These lesions can also bleed.
• Cervical lymphadenopathy and salivary gland enlargement is seen.

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Lymphadenopathic Histopathology

Early Lesion Or Patch Stage

• There is proliferation of small veins and capillaries around one or more preexisting dilated vessels.
• Slit like vessels are seen near periphery of preexisting blood vessel, skin adnexa and in between collagen fiers.
• Slit like vessels are lined by plump, mild atypical endothelial cells.
• There is presence of mononuclear inflmmatory cell infitrate consisting of mast cells, scattred erythrocytes and hemosiderin deposit.

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Advanced Lesion Or Plaque Stage

• There is a presence of increased numbers of capillaries and dilated vascular channels which are interspersed with proliferating sheets of sarcomatous cells with a large number of extravasated erythrocytes.
• Slit like vessels without visible endothelial lining are interspersed with spindle cells.
• Lesional cells show enlarged, hyperchromatic nuclei with mild­to­moderate pleomorphism.

Nodular Stage
In all features are more prominent than plaque stage.