Kaposi sarcoma

Pulmonary
Kaposi sarcoma in a human immunodeficiency virus – infected woman: a case report. HRCT scan obtained with lung window shows diffuse peribronchovascular thickening and small nodules bilaterally. There are also nodules in the fissures and interlobular septal thickening.
casesjournal.biomedcentral.com • CC-by-2.0
Brain
localization of Kaposi’s sarcoma in a patient treated by combination antiretroviral therapy. Magnetic Resonance Images (MRI) of the brain at control after 26 days of anti- Toxoplasma treatment. A. On Axial FLAIR T2-weighted images the lesions are hyperintense, with hypointense halo and surrounding edema. B. Diffusion-weighted imaging of the lesions showed restricted diffusion. C. On unenhanced Axial T1-weighted images the lesions signal is heterogeneous. D. On enhanced Axial T1-weighted images faint lesions enhancement are depicted.
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Kaposi
sarcoma in foot. Doppler ultrasound of the calf lesion. The lesion shows vascularity within.
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Kaposi
sarcoma in foot. Coronal FFE (GRE): Foot lesion appears hyperintense with a hypointense rim and central signal void area (corresponding to the T1W hyperintensity).
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Kaposi
sarcoma in foot. Coronal T1W: Foot lesion appears hypointense with a central hyperintensity on T1W.
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Thoracic
Kaposi Sarcoma. High-resolution chest CT shows the same findings of Fig.3. in the coronal plane.
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Pulmonary
Kaposi sarcoma in a human immunodeficiency virus – infected woman: a case report. HRCT scan obtained with lung window shows diffuse peribronchovascular thickening and small nodules bilaterally. There are also nodules in the fissures and interlobular septal thickening.
casesjournal.biomedcentral.com • CC-by-2.0
Pulmonary
Kaposi sarcoma in a human immunodeficiency virus – infected woman: a case report. HRCT scan obtained with lung window shows diffuse peribronchovascular thickening and small nodules bilaterally. There are also nodules in the fissures and interlobular septal thickening.
casesjournal.biomedcentral.com • CC-by-2.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A to C. Chest X-rays of three patients with pulmonary KS showing bilateral paracardiac infiltration. Confluent lesions are most evident in C.
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MRI imaging
of soft tissue tumours of the foot and ankle. Kaposi’s sarcoma. Coronal T1W (a) and post-contrast T1FS (b) images of the foot showing an exophytic lesion, low signal on T1W with avid enhancement and a nodular proliferation of the dermis
insightsimaging.springeropen.com • CC-by-4.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A and B. High-resolution CT scans of two patients with pulmonary KS showing peribronchovascular thickening and irregular narrowing of the bronchial lumen.
ojrd.biomedcentral.com • CC-by-2.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. High-resolution CT scan at the level of the main bronchi of a patient with pulmonary KS, showing diffuse ill-defined large nodules and paracardiac peribronchovascular thickening.
ojrd.biomedcentral.com • CC-by-2.0
Chronic cough
conundrum: a case report of a new diagnosis of HIV and pulmonary Kaposi’s sarcoma. Upright AP Chest x-ray with bilateral, diffuse, airspace opacities was read as consistent with multilobar pneumonia possibly due to TB, MAI, aspergillosis or recurrent aspiration. The patient was ultimately determined to have pulmonary Kaposi’s sarcoma
bmcpulmmed.biomedcentral.com • CC-by-4.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A to D. High-resolution CT scans (A and B) of two patients with pulmonary KS that demonstrate marked peribronchovascular and interlobular septal thickening and the presence of small parenchimal nodules. Photomicrographs of histologic specimen show tumor cells infiltrating the periarteriolar connective tissue (C), and a neoplastic parenchymal nodule with indistinct borders (D) (HE, ×40).
ojrd.biomedcentral.com • CC-by-2.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. High-resolution CT scan of a patient with pulmonary KS at the level of the main bronchi shows ground-glass attenuation areas in the posterior regions of both lungs, which correspond to pulmonary hemorrhage. Peribronchovascular thickening is observed in the right lung, as well as bilateral pleural effusion.
ojrd.biomedcentral.com • CC-by-2.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A and B. High-resolution CT scan (A) shows areas of ground-glass attenuation and interlobular septal thickening in the upper lobes. A crazy-paving pattern is observed in the right upper lobe. Photomicrograph of histologic section (B) demonstrates infiltration of the interlobular septa due to edema and neoplastic cells and also edema filling the alveolar airspace (HE, ×40).
ojrd.biomedcentral.com • CC-by-2.0
Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. CT scan (mediastinal window) at the level of the carina of a patient with pulmonary KS shows bilateral pleural effusion.
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Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A and B. High-resolution CT scan at the level of the main bronchi (A) of a patient with pulmonary KS demonstrates irregularity of the pleural surfaces and nodularity of the oblique fissures bilaterally. Photomicrograph of histologic section (B) demonstrates a neoplastic nodule adjacent to the pleural surface (HE, ×40).
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Thoracic
Kaposi Sarcoma. Chest radiograph shows right paracardiac consolidation of the middle lobe (silhouette sign), first thought to be consistent with lobar pneumonia.
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Thoracic
Kaposi Sarcoma. High-resolution chest CT, axial lung window, demonstrates a right peribronchovascular consolidation with flame-shaped hilar radiation, and poorly defined lung nodules.
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Thoracic
Kaposi Sarcoma. High-resolution chest CT, axial mediastinal window, demonstrates soft tissue density around the mediastinal broncovascular structures with right hilar radiation and irregular outlines (flame shaped). Note that there is no luminal compromise in this state.
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Pulmonary
involvement in Kaposi sarcoma: correlation between imaging and pathology. A to D. High-resolution CT scans at the level of the upper lobe (A) and the lower lobe (B), of two patients with pulmonary KS, show extensive interlobular septal and peribronchovascular thickening. Photomicrographs of histologic specimens (C and D) show thickening of interlobular septa due to edema and tumor cells infiltration (HE, ×40).
ojrd.biomedcentral.com • CC-by-2.0
Kaposi
sarcoma in foot. Coronal STIR: Foot lesion appears hyperintense with central signal void area (which corresponds to the hyperintensity on T1W).
www.eurorad.org • CC by-nc-sa-4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Kaposi sarcoma is a low-to-intermediate grade mesenchymal tumor that involves the lymphovascular system. The tumor can involve the pulmonary, gastrointestinal, cutaneous and musculoskeletal systems.

Pathology

There are four recognized variants :

  • classic (chronic): multiple distal lower extremity predominant purple skin plaques and rarely involve visceral organs
  • endemic (lymphadenopathic): common in equatorial Africa
  • iatrogenic (organ transplant-related)
  • AIDS-related (epidemic): usually requires the CD4 count to drop <200 cells/mm; may develop in up to 35% of patients with AIDS  and when developed it is considered an AIDS-defining illness

The latter two variants are much more common.

Etiology

An etiological association with human herpes virus type 8 (HHV8) has been postulated. The AIDS-related and post-transplant variants are also associated with immunosuppressive states.

Histology

Histologically can comprise of sheets of plump spindle-shaped cells surrounding and lining slit-like vascular spaces.

Associations
  • lymphoproliferative disorders (particularly with the classic form)

Radiographic features

There is a wide spectrum of imaging findings depending on which organ is involved. However, most features are non-specific but may assist in diagnosis if relevant clinical risk factors (e.g. background AIDS history) are evident. In 30% of cases, there is no concurrent cutaneous involvement .

Plain radiograph

The following features may be seen on chest radiographs:

  • parenchymal nodular or reticular opacities with a predilection towards perihilar mid to lower zones; has two major patterns
  • linear interstitial nodules
  • fluffy ill-defined nodules
  • pleural effusion(s)
  • mediastinal and/or hilar lymphadenopathy
CT

On HRCT of the chest:

On liver CT:

  • ill-defined multifocal peripheral portal nodules with variable attenuation (commonest hepatic neoplasm in AIDS patients) 
Nuclear medicine

Scintigraphy may be useful if concurrent opportunistic infection or lymphoma is suspected:

  • thallium-201: usually positive in both lymphoma and Kaposi sarcoma
  • gallium-67: usually negative in Kaposi sarcoma but positive in lymphoma and infection

History and etymology

This condition was first described by Moritz Kaposi (1837-1902), an Austro-Hungarian dermatologist, in 1872.

Differential diagnosis

For thoracic involvement consider:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Kaposisarkom:
Pleuraerguss
 
Wikipedia • CC BY-SA 3.0
Milchglasverschattungen
 
insightsimaging.springeropen.com • CC-by-2.0
verdickte
interlobuläre Septen
ojrd.biomedcentral.com • CC-by-2.0
Pneumocystis
jiroveci
Wikipedia • CC-BY-SA-3.0
Kaposisarkom
der Lunge
casesjournal.biomedcentral.com • CC-by-2.0