Etiology and Pathology

In non-AIDS patients is a striking difference in the age distribution of Kaposi sarcoma in different parts of the world. In America and Europe it rarely occurs in children, is uncommon under the age of 40 years, and is frequently seen in the sixth and seventh decades. In tropical Africa it appears in a younger age group, peaking in the fourth decade. In North and South Africa it is again a disease of older persons. When it does occur in children, either in Europe or America, it tends to be much more malignant. The highest childhood frequency without AIDS is in Uganda, where 4% of all cases are under the age of 11 years. In most parts of the world it is slightly more common in men than in women, but in children the reverse is true. There is a similar change in the sex ratio in South Africa. Familial cases are exceptionally rare.

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Fig. 42.1 A-D. The pigmented hemangiosarcoma described by Kaposi. (A) Below the knee on white Caucasian skin. (B,C) On the sole of the foot of black Africans. (D) On the conjunctiva of a 13-year-old black African girl.