Kaposi sarcoma of lung
Retroviral disease patient in late 30's. Cachexia. Abnormal chest radiograph. Small purple papules on limbs.
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Multifocal consolidation both lungs with a 'flame shaped' appearance, best observed in the upper lobes. These lie at the distal end of the bronchovascular bundles. This is both perihilar and distal in distribution.
No interlobular septal thickening.
Small volume mediastinal lymphadenopathy.
A mass formed of spindle shaped cells surrounding cleft like spaces situated in the lung. Hyperchromatic and pleomorphic nuclei. Stains for pneumocystis carinii are negative.
The spindle cells stain positively with endothelial markers C34 and factor VIII related antigen. Vimentin is positive. Desmin and SMA are negative.
Comment: The appearances are those of Kaposi’s sarcoma
Kaposi sarcoma is highly associated with patients with retroviral disease, typically involving the skin. It is a low-to-intermediate grade mesenchymal tumour that involves the lymphovascular system.
Rarely it occurs in other organs, such as the lungs.
On CT chest ill-defined (flame-shaped) nodular opacities with a bilateral and roughly symmetrical perilymphatic and peribronchovascular distribution have been documented. However, a range of other findings are also described, such as focal groundglass change and interlobular septal thickening.