Bullous Lesions in Kaposi's Sarcoma: Case Report

Abstract

Bullous lesions have been only rarely described in Kaposi's sarcoma (KS), and their histopathologic features have never been described in detail. We report a case of bullous lesions of KS in an 82-year-old Italian woman. The patient had typical smooth pale reddish-grey slightly-raised KS plaques on the legs, present for at least 10 years. Several dull grayish-pink blisters (0.5 to 2 cm in diameter) affected both dorsa of her feet and ankles symmetrically. Two punch biopsies were taken, one from an infiltrated KS plaque on the right buttock and the other from a bullous lesion on the right foot. Histopathologically, the late KS plaque on the buttock showed typical features of KS, with an increased number of spindle cells arranged in short bundles and extravasation of erythrocytes. The bullous lesion on the foot showed a full-thickness vascular neoplasm involving the upper and lower dermis and the subcutaneous fat. The upper portion of the lesion contained many newly formed, highly-dilated blood vessels, touching the overlying epidermis and separated from it by a narrow band of collagen and endothelial cells; wide, empty spaces characterized the superficial dermis, in which preexisting venules and bands of collagen associated with non-atypical endothelial cells floated. All these findings would suggest a lymphangiomatous lesion, if the presence of specific diagnostic criteria of KS were not recognizable at a deeper level of the lesion. Various criteria actually suggest that the bullous lesion may be regarded as an epiphenomenon of a KS plaque lesion: (a) full-thickness involvement of the reticular dermis and, in this case, also of the subcutaneous fat; (b) dense and patchy lymphoplasmocytic infiltrate typical of plaque lesions and, much less frequently, of patch lesions; (c) presence of ectatic blood vessels, filled with plasma and erythrocytes (pseudoangiomatous findings), a nonpathognomonic but highly characteristic finding of the plaque lesion; and (d) as in the KS plaque lesions, in the bullous lesion as well the reticular dermis was characterized by an increased number of anastomosing bizarrely shaped vascular spaces lined by non-atypical endothelial cells. We hypothesize that the prevalence of lymphangiomatous differentiation in the upper dermis represents one of the many features of KS lesions. When present, it may correlate with the clinical feature of a blister.

Variable clinical presentations of Classic Kaposi Sarcoma in Turkish patients

“…Aggressive CKS in immunocompetent patients has been very rarely reported in the literature. 15,16 In addition, while the involvement of the head and neck is 40-67% in HIV infected patients, it has been reported in only 14% of cases with CKS. 17 Sikora et al suggested that even though most cases of KS are associated with immunodeficiency, clinical and laboratory proofs of this may remain inadequate; thus susceptibility to KS may be based on another unknown factor or inherited defect in host defence.…”

“…14,15 Although, it was reported that bullae might be clinical hallmark of this type's histopathology, there are also another reports in which lymphoedematous type of KS histopathology had accompanied to marked lymphoedema clinically. 14,15,[18][19][20][21][22] The fourth case was interesting for very extensive lesions involving big sized plaques and also the existence of mucosal lesion. Clinical extensiveness and mucosal involvement may be unusual for a 5 years period of CKS in which a slow progression is anticipated.…”

Histological Subgroups in Classic Kaposi Sarcoma

“…PBS ile y›kand› ve protein blokaj› sonras›nda primer antikor ile ile oda s›cakl›¤›nda 1 saat inkübe edildi. S›ras›yla sekonder antikor, streptavidin peroksidaz kompleksi ve renklendirmek icin 6,[9][10][11][12][13][14][15][16] . En s›k görülen his- …”

“…Bu grupta yer alan olgular›n %26,4'ü makül, %37,6's› plak ve %36's› nodüler evre lezyonlard›r. Serimizde olgular›n %17,2'si histopatolojik özellikleri aç›s›n-dan literatürde tan›mlanan alt tipler ile uyum göstermekte-dir 6,[9][10][11][12][13][14][15][16] . En s›k görülen histolojik alt tip lenfanjiyektatik varyant (%7,3) olup, bunu s›ras›yla büllöz (%2,6), lenfanjiyom benzeri (%2,6), intravasküler (%2) ve piyojenik granülom benzeri (%2) varyantlar izlemektedir.…”

“…Ektatik lenfatik damarlar d›fl›nda ola¤an KS'nun tüm histolojik özelliklerini içeren bu lezyonlarda, peritümöral stromada ülserasyona ikincil geliflen mikst inflamatuvar yan›t izlenmektedir. KS hastalar›nda büllöz deri lezyonlar› ilk olarak 20. yüzy›l›n ortalar›nda tan›mlanm›flt›r 11 . Büllöz KS adland›rmas› histolojik isimlendirmeden çok klinik bir tan›mlamad›r.…”