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Fig. 42.3A,B. Moderately early Kaposi sarcoma in a 20-year-old African. There are multiple pigmented nodules, some protruding well above the surface and others lying subcutaneously. The foot is swollen with firm edema.

Fig. 42.4. A Kaposi sarcoma nodule resembling an epithelioma. This type of nodule bleeds and ulcerates.


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Laboratory Diagnosis

In the HIV-negative patient there are no significant laboratory findings in any patients in any part of the world, other than the histopathology.

Clinical Characteristics

There are three major clinical categories of the disease without AIDS, depending on immune status.

1. The disease may be relatively benign and slowly progressive with occasional remissions. The life expectancy is usually 8-13 years and death is more often due to other causes. The majority of these patients will be in the older age group and live in temperate climates.

2. The next category presents as an acute malignant disease with multiple site involvement, leading to death in 6 months to 3 years. This form is most common in younger people in the tropics, even among those without AIDS.

3. The third category is a chronic disease associated with other malignancies, especially lymphoma; death usually follows the second malignancy and not the Kaposi sarcoma, which tends to be relatively benign.

The HIV-negative patient usually complains of a blue nodule or pigmented patch in or under the skin of one limb, usually the leg (Fig. 42.3). It is irritable and grows slowly; it is always pigmented but the color may be obscured by the thick skin overlying it. The patient may have noticed other nodules, or they may be found on clinical examination. In the majority of cases other nodules will be present either on the same or opposite limb, or scattered elsewhere over the body. Only about 17% of the nodules present originally on the trunk, the vast majority being first seen on the legs. Some of the nodules will be almost flat, giving a gray-blue cobblestone appearance to the skin, whereas others will present as individual pebbles raised above the skin surface. As they grow, they become almost polypoid and ulcerate and bleed (Fig. 42.4).

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Copyright: Palmer and Reeder