Kaposi Sarcoma

Published on 20/07/2015 by admin

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Last modified 20/07/2015

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 Multifocal hypodense nodules or masses on CECT with delayed enhancement

• Gastrointestinal

image 50% of patients with cutaneous Kaposi sarcoma (KS) will have GI tract involvement
image Upper GI tract (especially stomach and duodenum) most common, but can affect any part of GI tract
image Submucosal nodules or polypoid masses (< 3 cm) most common, although larger infiltrative masses possible
image Regional enhancing lymphadenopathy common
image Lesions may cause intussusception or obstruction
image Submucosal nodules on barium studies with ulceration may appear as “target” or bull’s-eye lesions
• Lymphadenopathy

image Most commonly involves retroperitoneal lymph nodes
image Commonly hypervascular/avidly enhancing

TOP DIFFERENTIAL DIAGNOSES

• Lymphoma
• Hepatic opportunistic infections
• Intestinal opportunistic infections
• Other causes of hypervascular lymphadenopathy

image Hypervascular lymph node metastases
image Castleman disease
• Other causes of multiple hepatic/splenic nodules 

image Metastatic disease from other malignancies
image Sarcoid
image Hepatic microabscesses or fungal infection

PATHOLOGY

• Associated with human herpesvirus type 8 (HHV8) infection and variable cofactors
• 4 clinical subtypes of KS

image Classic (sporadic) KS: Affects elderly men of Eastern European or Mediterranean origin with visceral involvement uncommon

– Indolent cutaneous involvement of lower extremities
image Endemic (African) KS: Not associated with HIV, and accounts for up to 1/2 of all cancers in parts of Africa
image Iatrogenic (organ transplant-related) KS: Typically develops 1-2 years after transplant, with visceral involvement more likely with heart and liver transplants
image Epidemic (AIDS-related) KS: ↓ prevalence with antiretroviral therapies
image
(Left) Axial CECT in a patient with AIDS and disseminated Kaposi sarcoma (KS) shows widespread thoracic lymphadenopathy. Many of the lymph nodes demonstrate hypervascularity image, characteristic of KS.

image
(Right) Axial CECT in the same patient shows widespread abdominal lymphadenopathy image with hyperenhancing lymph nodes that help to distinguish KS from lymphoma or other causes of lymphadenopathy.
image
(Left) Axial CECT through the pelvis in an AIDS patient shows widespread avidly enhancing adenopathy image. On excisional biopsy, there was histologic evidence of Castleman disease and KS, both of which can present with avidly enhancing lymph nodes.

image
(Right) Axial CECT in a patient with HIV and KS shows widespread lymphadenopathy, including nodes in the groin image that show hyperenhancement. This patient complained of marked edema of the lower extremities, a common symptom of KS-induced inguinal lymphadenopathy.

TERMINOLOGY

Abbreviations

• Kaposi sarcoma (KS)

Definitions

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