Pyogenic Granuloma-like Kaposi Sarcoma Research Articles

Pyogenic granuloma-like Kaposi sarcoma: A case report with dermatoscopical and histopathological characteristics

Pyogenic granuloma-like Kaposi sarcoma: A case report with dermatoscopical and histopathological characteristics

Pyogenic Granuloma like Kaposi Sarcoma: A Diagnosis Easily Missed

Pyogenic granuloma-like Kaposi sarcoma (PG-like KS) is a clinicopathologic variant of Kaposi sarcoma (KS), a vascular tumor caused by human herpesvirus-8 (HHV-8). PG-like KS is a challenging entity to diagnose because its clinical and histological features encompass features of both pyogenic granuloma (PG) and KS Distinction between the two entities is clinically important as the management is different. KS patients requires evaluation of their immunodeficiency status and follow-up. Throwing a HHV-8 LNA-1 immunohistochemistry helps in clinching the diagnosis. Recognition of the precise histological features and clinical correlation can facilitate the correct diagnosis.

An unusual case of pyogenic granuloma-like Kaposi sarcoma

Kaposi sarcoma (KS) is not typically included in the differential diagnosis of lesions with clinical characteristics of pyogenic granuloma. However, cases of pyogenic granuloma-like Kaposi sarcoma have been reported in the literature. This variant is extremely rare and possesses clinical and histological findings consistent with both conditions. We report an elderly, immunocompetent man with pyogenic granuloma-like Kaposi sarcoma, which was clinically consistent with a pyogenic granuloma and possessed histological findings consistent with Kaposi sarcoma and pyogenic granuloma.

Sensitivity and specificity of D2-40 in differentiating Kaposi sarcoma from its mimickers

Background Kaposi sarcoma (KS) is a low-grade malignant vascular neoplasm, whose etiology is associated with human herpes virus 8 (HHV8). Owing to its broad clinicopathological spectrum, KS mimics a variety of non-KS vascular lesions both clinically and histologically, thus posing a diagnostic challenge. Immunohistochemical markers are needed to confirm diagnosis. Objective To study the sensitivity and specificity of D2-40 in comparison with HHV8-latent nuclear antigen 1 to identify KS among other cutaneous vascular proliferative lesions. Patients and methods The present study was carried out on 50 cases with cutaneous vascular proliferation. Examination of hematoxylin and eosin-stained sections was done for all cases to verify the diagnosis. Additional sections of all cases were subjected to immunohistochemical stains for the following primary antibodies: HHV8 and D2-40 monoclonal antibody. Results The study included 19 KS cases and 31 non-KS. Among KS lesions 15.8% were patch stage, 26.3% plaque stage, 36.84% nodular stage, 10.5% pyogenic granuloma-like KS, and 10.5% intravascular KS. All KS cases stained positive for HHV8-latent nuclear antigen 1, whereas none of other vascular lesions showed positive staining. Immunohistochemistry using D2-40 showed positive staining in 70% (n=35) and negative staining in 30% (n=15) of the total cases. All KS lesions expressed D2-40 in both endothelial lining and spindle cells. A total of 16 cases of non-KS vascular lesions expressed D2-40 in endothelial lining only. D2-40 positivity of both endothelial lining and spindle cells was found to be equally sensitive and specific to HHV8 for diagnosis of KS. Conclusion D2-40 positivity of both vascular lining and spindle cells can be considered both sensitive and specific stain to differentiate KS from other vascular lesions.

Pyogenic granuloma-like Kaposi sarcoma: Case report and review of literature

Pyogenic granuloma-like Kaposi sarcoma (PGLKS) is an uncommon variant of Kaposi sarcoma (KS), which mimics benign pyogenic granuloma both clinically and histologically. We report a case of PGLKS of the toe occurring in a HIV-positive individual. It presented as a 2cm skin swelling of 2 weeks’ duration which was clinically felt to be a pyogenic granuloma. Histopathological examination revealed a polypoid atypical vascular lesion with overlying peripheral epidermal collarette. Spindle cell proliferation typically seen in KS was also identified, which was positive for human herpesvirus 8 (HHV8) by immunohistochemistry, confirming the diagnosis of PGLKS. Upon review of the literature, our case is the 29th case of PGLKS reported to date, and only the sixth in Asian population. Particular attention to histomorphology, and demonstration of HHV8 in lesional tissue will aid accurate diagnosis of this rare entity.

Multifocal Pyogenic Granuloma-Like Kaposi Sarcoma

Background: Kaposi sarcomais a low-grade malignant vascular lesion, which has different histological variants. Pyogenic granuloma-like Kaposi sarcoma is an unusual type of this tumor, which presents as anexophytic small nodule surrounded by an epidermal collaret mimicking pyogenic granuloma yet it has immunohistopathologic features of Kaposi sarcoma. Case Presentation: A 57-year old male with 2 exophytic lesions on the left hand and left foot for 3 months was presented to our center. Both lesions were excised and diagnosis of Kaposi sarcoma was confirmed by histopathology and immunohistochemistry. Human herpesvirus 8 DNA was detected by the polymerase chain reaction in the lesions. Conclusions: Immunostaining methods should be considered in pyogenic granuloma-like lesions with unusual presentation.

Pyogenic granuloma-like Kaposi's sarcoma

A 30-year-old man presented to the primary care clinic in June, 2015, with a 3 month history of a painful, foul-smelling mass between the second and third toes of his right foot that had been slowly increasing in size. The mass had begun as a small nodule and had originally been treated with antibiotics for presumed infection without success. On examination he had a red, fi rm mass about 3 cm diameter growing from the lateral aspect of the second toe (fi gure), which was tender to palpation and had a small amount of seropurulent discharge. Its appearance was suggestive of pyogenic granuloma with secondary infection. On questioning, the patient denied any medical or surgic al history, or tingling or numbness in the toes. A radiograph showed a soft tissue mass without extension into the bone. The patient was referred for surgical resection of the mass, at which time he admitted to a 5 year history of HIV. He had been off highly active antiretroviral therapy (HAART) for 2 years because of non-compliance and insurance issues. Histological examination of the resected mass showed nodules of spindle cells mixed with red blood cells; tumour cell immunohistochemistry was positive for CD34 and human herpesvirus (HHV-8), consistent with Kaposi’s sarcoma. Microscopy also showed colonies of Gram-positive cocci suggesting secondary infection. Further history and examination showed no other skin changes suggestive of Kaposi’s sarcoma. We diagnosed pyogenic granuloma-like Kaposi’s sarcoma. The patient was restarted on HAART and has needed no further treatment. Kaposi’s sarcoma is a vascular tumour caused by HHV-8. Although it is the most common neoplasm in patients with HIV/AIDs, it is quite rare (prevalence about 2% in patients with HIV/AIDS in USA). Pyogenic granuloma-like Kaposi’s sarcoma is a rare variant of Kaposi’s sarcoma. Lesions are superfi cial and protrude from the skin. Superimposed ulceration and secondary infection can give the appearance of pyogenic granuloma, and diagnosis of pyogenic granuloma-like Kaposi’s sarcoma can be challenging because it has histological features of both pyogenic granuloma and Kaposi’s sarcoma. Diagnosis is made by positive immunohistochemistry staining for CD34 and HHV-8. Kaposi’s sarcoma can present in diff erent forms, from classic purple rash to lesions that mimic diff erent skin disorders, such as pyogenic granuloma. Clinicians should maintain a high level of suspicion and seek early tissue diagnosis so as not to miss Kaposi’s sarcoma, especially in HIV-positive patients.

D2-40 negative pyogenic granuloma-like Kaposi's sarcoma: Diagnostic features and histogenetic hypothesis of an uncommon skin tumor in HIV-negative patients

Pyogenic granuloma-like Kaposi's sarcoma (PGLKS) is a recently described skin tumor showing features both of pyogenic granuloma (PG) and Kaposi's sarcoma (KS). The differential diagnosis is often challenging. We reviewed a series of 50 PG and 23 Ks located on distal extremities with the aid of an immunohistochemical panel comprising CD34, CD31, FVIII, SMA, D2-40, HHV8.After revision, 6/50 PG lesions previously diagnosed as PG, showed positive immunostaining for LNA1-HHV8 and focal positivity for CD31 and FVIII in the endothelial cells of the proliferating vessels, with some SMA positive pericytes. D2-40, a marker of lymphatic endothelium positive in KS, stained negatively. These lesions were renamed PGLKS. Of note, in our series, PGLKS represented the only form of KS localized in the hand; all the patients were HIV-negative, older than PG patients, with a prevalence for male gender.PGLKS and PG need a different management and a follow-up is advisable for PGLKS, as for the other variants of KS. To date, D2-40 negative immunostaining has not yet been reported in PGLKS and should not lead to a misdiagnosis of PG. The morphological similarities with PG and the immunohistochemical findings, showing a defective phenotype of the neoplastic cells, suggest a histogenetic hypothesis in which D2-40 negative PGLKS could represent an early stage of HHV8 infection of a pre-existing PG, whose vessels loose progressively their blood vascular markers but have not still acquired the lymphatic ones.

Pyogenic granuloma-like Kaposi sarcoma: A diagnostic pitfall

Pyogenic granuloma-like Kaposi sarcoma (PG-like KS) is a clinicopathologic variant of Kaposi sarcoma (KS), a vascular tumor caused by human herpesvirus-8 (HHV-8). PG-like KS is a challenging entity to diagnose because its clinical and histological features encompass both pyogenic granuloma (PG) and KS characteristics. Immunhistochemical staining with HHV-8 latent nuclear antigen-1 (LNA-1) has been shown to exhibit high sensitivity and specificity for diagnosing KS. Therefore, the integration of clinical features and context, histopathogical findings, and immunohistochemical analysis is important in obtaining the correct diagnosis of PG-like KS. We report a case of PG-like KS in an HIV-positive man.

Les exostoses sous-unguéales

Pyogenic granuloma-like Kaposi's sarcoma (PGLKS) is a recently described skin tumor showing features both of pyogenic granuloma (PG) and Kaposi's sarcoma (KS). The differential diagnosis is often challenging. We reviewed a series of 50 PG and 23 Ks located on distal extremities with the aid of an immunohistochemical panel comprising CD34, CD31, FVIII, SMA, D2-40, HHV8.After revision, 6/50 PG lesions previously diagnosed as PG, showed positive immunostaining for LNA1-HHV8 and focal positivity for CD31 and FVIII in the endothelial cells of the proliferating vessels, with some SMA positive pericytes. D2-40, a marker of lymphatic endothelium positive in KS, stained negatively. These lesions were renamed PGLKS. Of note, in our series, PGLKS represented the only form of KS localized in the hand; all the patients were HIV-negative, older than PG patients, with a prevalence for male gender.PGLKS and PG need a different management and a follow-up is advisable for PGLKS, as for the other variants of KS. To date, D2-40 negative immunostaining has not yet been reported in PGLKS and should not lead to a misdiagnosis of PG. The morphological similarities with PG and the immunohistochemical findings, showing a defective phenotype of the neoplastic cells, suggest a histogenetic hypothesis in which D2-40 negative PGLKS could represent an early stage of HHV8 infection of a pre-existing PG, whose vessels loose progressively their blood vascular markers but have not still acquired the lymphatic ones.

Detection of HHV-8 in Pyogenic Granuloma-like Kaposi Sarcoma

Kaposi sarcoma (KS) is a low-grade vascular neoplasm associated with human herpesvirus-8 (HHV-8) infection. Clinically, lesions commence as blue-red macules that may develop into plaques and eventually into nodules. The histologic appearance spans a broad spectrum and varies with the stage of the lesion. At each stage, KS has significant morphologic overlap with other vasoproliferative lesions. Recently, we encountered 6 KS tumors that histologically mimicked pyogenic granuloma (PG), a common benign vascular tumor of the skin that usually does not figure in the histologic differential diagnosis of KS. We stained 6 PG-like KS and 28 PGs with a mouse monoclonal antibody (13B10) against HHV-8 latent nuclear antigen-1 (LNA-1) to determine the utility of immunoperoxidase staining in distinguishing KS from PG. All 6 PG-like KS demonstrated nuclear staining for HHV-8 LNA-1. No staining was identified in any of the 28 PGs. Histologic criteria often used to differentiate between these two entities were not helpful in our cases. The only distinguishing feature was the presence or absence of HHV-8 LNA-1 staining. The presence of HHV-8 LNA-1 nuclear staining seems to be a specific marker for KS when comparing PGs and PG-like KS. Immunoperoxidase staining for HHV-8 LNA-1 is a useful diagnostic tool in this setting.