Angiosarcoma-like Kaposi Sarcoma: A Distinctive Histomorphologic Variant Representing an Important Diagnostic Pitfall.
Journal
The American journal of surgical pathology
ISSN: 1532-0979
Titre abrégé: Am J Surg Pathol
Pays: United States
ID NLM: 7707904
Informations de publication
Date de publication:
01 12 2022
01 12 2022
Historique:
pubmed:
11
8
2022
medline:
16
11
2022
entrez:
10
8
2022
Statut:
ppublish
Résumé
Kaposi sarcoma (KS) is a rare low-grade angioproliferative neoplasm associated with human herpesvirus 8 (HHV-8) infection with multiple clinical subtypes and varying histopathologic patterns. Histologically, many different variants of KS have been reported, yet all can be difficult to recognize and must be differentiated from other vascular tumors. In this report, we studied fourteen cases of a newly described variant of KS reminiscent of a well-differentiated angiosarcoma (angiosarcoma-like KS). All cases showed a diffuse, ill-defined infiltrative dermal-based lesion composed of numerous anastomosing vascular channels of varying caliber lined by a single layer of endothelium with minimal pleomorphism. The vascular proliferation ramified through the dermis and dissected the collagen bundles along with infiltration into the subcutaneous fat and around skin appendages. All cases showed expression of vascular markers (CD31, CD34, and ERG) and were positive for HHV-8. None showed the classic histopathology associated with KS. Without clinical guidance these tumors can be difficult to recognize as KS, creating significant diagnostic challenges. Our study expands on a rare histologic variant of KS that ought to be considered in the differential diagnosis of any cutaneous well-differentiated angiosarcoma. Awareness of this variant of KS is of important for proper diagnosis and management of these patients; thus, careful attention to the histomorphology and clinical history can help lead the pathologist to the correct diagnosis.
Identifiants
pubmed: 35948518
doi: 10.1097/PAS.0000000000001946
pii: 00000478-202212000-00015
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1732-1738Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
Références
Buonaguro FM, Tornesello ML, Satriano RA, et al. Kaposi’s sarcoma: aetiopathogenesis, histology and clinical features. J Eur Acad Dermatol Venereol. 2003;17:138–54.
Chang Y, Cesarman E, Pessin MS, et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi’s sarcoma. Science. 1994;266:1865–1869.
Cossu S, Satta R, Cottoni F, et al. Lymphangioma-like variant of Kaposi’s sarcoma: clinicopathologic study of seven cases with review of the literature. Am J Dermatopathol. 1997;19:16–22.
Grayson W, Pantanowitz L. Histological variants of cutaneous Kaposi sarcoma. Diagn Pathol. 2008;3:31.
O’Donnell PJ, Pantanowitz L, Grayson W. Unique histologic variants of cutaneous Kaposi sarcoma. Am J Dermatopathol. 2010;32:244–250.
Onak Kandemir, N, et al. Cavernous hemangioma-like kaposi sarcoma: histomorphologic features and differential diagnosis. Case Rep Med. 2013;2013:959812.
Taylor JF, Templeton AC, Vogel CL, et al. Kaposi’s sarcoma in Uganda: a clinico-pathological study. Int J Cancer. 1971;8:122–135.
O’Connell KM. Kaposi’s sarcoma: histopathological study of 159 cases from Malawi. J Clin Pathol. 1977;30:687–695.
Pantanowitz L, Duke WH. Lymphoedematous variants of Kaposi’s sarcoma. J Eur Acad Dermatol Venereol. 2008;22:118–20.
Alvarez P, Salinas C, Bravo F, et al. Epithelioid Kaposi sarcoma: a new histological variant. Am J Dermatopathol. 2021;43 ). 209–212.
Schwartz RA, Spicer MS, Janninger CK, et al. Keloidal Kaposi’s sarcoma: report of three patients. Dermatology. 1994;189:271–274.
Kempf W, Cathomas G, Burg G, et al. Micronodular Kaposi’s sarcoma - a new variant of classic-sporadic Kaposi’s sarcoma. Dermatology. 2004;208:255–258.
Craddock KJ, Labonte S, Ghazarian D. Anaplastic Kaposi sarcoma resembling epithelioid angiosarcoma in an HIV-positive man. Eur J Dermatol. 2008;18:358–359.
Schwartz RA. Kaposi’s sarcoma: an update. J Surg Oncol. 2004;87:146–151.
Reznitsky C, Resnik SR, Calame A, et al. An unusual case of pyogenic granuloma-like Kaposi sarcoma. Dermatol Online J. 2021;27:13030.
McClain CM, Haws AL, Galfione SK, et al. Pyogenic granuloma-like Kaposi’s sarcoma. J Cutan Pathol. 2016;43:549–551.
Cabibi D, Cacciatore M, Viviano E, et al. ‘Pyogenic granuloma-like Kaposi’s sarcoma’ on the hands: immunohistochemistry and human herpesvirus-8 detection. J Eur Acad Dermatol Venereol. 2009;23 ). 587–589.
Cesarman E, Moore PS, Rao PH, et al. Kaposi’s sarcoma-associated herpesvirus-like DNA sequences in AIDS-related body-cavity-based lymphomas. N Engl J Med. 1995;332:1186–1191.
Soulier J, Grollet L, Oksenhendler E, et al. Kaposi’s sarcoma-associated herpesvirus-like DNA sequences in multicentric Castleman’s disease. Blood. 1995;86:1276–80.
Antman K, Chang Y. Kaposi’s sarcoma. N Engl J Med. 2000;342:1027–1038.
Papagatsia Z, Jones J, Morgan P, et al. Oral Kaposi sarcoma: a case of immune reconstitution inflammatory syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009, 108:70–75.
Lazova R, McNiff JM, Glusac EJ, et al. Promontory sign—present in patch and plaque stage of angiosarcoma!. Am J Dermatopathol. 2009;31:132–136.
Ramirez JA, Laskin WB, Guitart J. Lymphangioma-like Kaposi sarcoma. J Cutan Pathol. 2005;32:286–292.
Requena L, Kutzner H, Mentzel T, et al. Benign vascular proliferations in irradiated skin. Am J Surg Pathol. 2002;26:328–337.
Ackerman AB. Subtle clues to diagnosis by conventional microscopy. The patch stage of Kaposi’s sarcoma. Am J Dermatopathol. 1979;1:165–172.
Suster S, Rosai J. Intranodal hemorrhagic spindle-cell tumor with “amianthoid” fibers. Report of six cases of a distinctive mesenchymal neoplasm of the inguinal region that simulates Kaposi’s sarcoma. Am J Surg Pathol. 1989;13:347–357.
Radu O, Pantanowitz L. Kaposi sarcoma. Arch Pathol Lab Med. 2013;137:289–294.
Pantanowitz L, Dezube BJ, Pinkus GS, et al. Histological characterization of regression in acquired immunodeficiency syndrome-related Kaposi’s sarcoma. J Cutan Pathol. 2004;31:26–34.
Satta R, Cossu S, Massarelli G, et al. Anaplastic transformation of classic Kaposi’s sarcoma: clinicopathological study of five cases. Br J Dermatol. 2001;145:847–849.
Ronchese F, Kern AB. Lymphangioma-like tumors in Kaposi’s sarcoma. AMA Arch Derm. 1957;75:418–427.
Borroni G, Brazzelli V, Vignoli GP, et al. Bullous lesions in Kaposi’s sarcoma: case report. Am J Dermatopathol. 1997;19:379–383.
Snyder RA, Schwartz RA. Telangiectatic Kaposi’s sarcoma. Occurrence in a patient with thymoma and myasthenia gravis receiving long-term immunosuppressive therapy. Arch Dermatol. 1982;118:1020–1021.
Urquhart JL, Uzieblo A, Kohler S. Detection of HHV-8 in pyogenic granuloma-like Kaposi sarcoma. Am J Dermatopathol. 2006;28:317–321.
Schwartz RA, Spicer MS, Thomas I, et al. Ecchymotic Kaposi’s sarcoma. Cutis. 1995;56:104–106.
Bassioukas K, Zioga A, Hantschke M, et al. Hemorrhagic Kaposi sarcoma. Successful treatment with IFN-alpha. Eur J Dermatol. 2004;14:37–40.
Requena L, Sangueza OP. Cutaneous vascular proliferations. Part III. Malignant neoplasms, other cutaneous neoplasms with significant vascular component, and disorders erroneously considered as vascular neoplasms. J Am Acad Dermatol. 1998;38(pt 1):143–175; quiz 176–178..
Smith KJ, Skelton HG III, James WD, et al. Angiosarcoma arising in Kaposi’s sarcoma (pleomorphic Kaposi’s sarcoma) in a patient with human immunodeficiency virus disease. Armed Forces Retroviral Research Group. J Am Acad Dermatol. 1991;24(pt 1):790–792.
Holden CA. Histogenesis of Kaposi’s sarcoma and angiosarcoma of the face and the scalp. J Invest Dermatol. 1989;93(suppl):119S–124S.
Shehan JM, Ahmed I. Angiosarcoma arising in a lymphedematous abdominal pannus with histologic features reminiscent of Kaposi’s sarcoma: report of a case and review of the literature. Int J Dermatol. 2006;45:499–503.
Schwartz RA, Kardashian JF, McNutt NS, et al. Cutaneous angiosarcoma resembling anaplastic Kaposi’s sarcoma in a homosexual man. Cancer. 1983;51:721–726.
Cheuk W, Wong KOY, Wong CSC, et al. Immunostaining for human herpesvirus 8 latent nuclear antigen-1 helps distinguish Kaposi sarcoma from its mimickers. Am J Clin Pathol. 2004;121:335–342.
Fink-Puches R, Zöchling N, Wolf P, et al. No detection of human herpesvirus 8 in different types of cutaneous angiosarcoma. Arch Dermatol. 2002;138:131–132.
Remick SC, Patnaik M, Ziran NM, et al. Human herpesvirus-8-associated disseminated angiosarcoma in an HIV-seronegative woman: report of a case and limited case-control virologic study in vascular tumors.. Am J Med. 2000;108:660–664.
Robin YM, Guillou L, Michels JJ, et al. Human herpesvirus 8 immunostaining: a sensitive and specific method for diagnosing Kaposi sarcoma in paraffin-embedded sections. Am J Clin Pathol. 2004;121:330–334.
Blumenfeld W, Egbert BM, Sagebiel RW. Differential diagnosis of Kaposi’s sarcoma. Arch Pathol Lab Med. 1985;109:123–127.
Manuraj S, Steve M, Heinz K, et al. Negative HHV-8 immunoreactivity in HIV associated Kaposi’s sarcoma. J Cutan Pathol. 2016;43:626–628.
Martí N, Monteagudo C, Pinazo I. Negative herpesvirus-8 immunoreactivity does not exclude a diagnosis of Kaposi sarcoma. Br J Dermatol. 2011;164:209–11.
Davis DA, Scott DM. Lymphangioma-like Kaposi’s sarcoma: etiology and literature review. J Am Acad Dermatol. 2000;43(pt 1):123–127.
Pugalagiri P, Muller S, Cox DP, et al. Lymphangioma-like Kaposi sarcoma of the oral mucosa. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116:84–90.
Leibowitz MR, Dagliotti M, Smith E. Rapidly fatal lymphangioma-like Kaposi’s sarcoma. Histopathology. 1980;4:559–66..
Guillou L, Fletcher CD. Benign lymphangioendothelioma (acquired progressive lymphangioma): a lesion not to be confused with well-differentiated angiosarcoma and patch stage Kaposi’s sarcoma: clinicopathologic analysis of a series. Am J Surg Pathol. 2000;24:1047–1057.