The histological features of 168 lesions of Kaposi's sarcoma from 159 patients in Malawi, where the disease is commoner than elsewhere, were characteristic. All showed well-developed areas of tumour and could be grouped fairly readily into those with a mixed pattern, a predominantly spindle cell pattern, and an anaplastic group, though intermediate patterns were seen. Hyaline bodies were present in nearly all tumours of skin. The cell of origin of Kaposi's sarcoma is uncertain and possibly has multipotential capabilities. Differential diagnosis may be difficult. Clinically the lesion may be confused with granuloma pyogenicum and may also be like it histologically. The presence of hyaline bodies and deposits of haemosiderin indicate Kaposi's sarcoma. The spindle cell predominant type may be confused with leiomyoma, leiomyosarcoma, or fibrosarcoma. The presence of hyaline bodies and the formation of vascular channels between spindle cells point to a diagnosis of Kaposi's sarcoma.
Biopsy of lymph nodes containing Kaposi's sarcoma from 16 patients showed that the tumour is identical in appearance with that of Kaposi's sarcoma of the skin, regardless of the age of the patient or the mode of presentation. Spread of tumour along sinusoids throughout the lymph node was seen only in the cases of two children with generalised lymphadenopathy, but discrete deposits were present both in lymph nodes regional to skin lesions and in lymph nodes from patients who had presented with primary lymphadenopathy. The reaction of the remainder of incompletely involved nodes was variable. No transition was seen between Kaposi's sarcoma and malignant lymphoma.
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