Kaposi's sarcoma
Introduction
Introduction to Kaposi's sarcoma Kaposissarcoma, also known as multiple idiopathic hemorrhagic sarcoma (Multipleidiopathichemorrhagicsarcoma), is the most common malignant tumor of AIDS patients and is a multicentric vascular tumor. It is rare in clinical practice, and men who are more than 50 years old are also common in AIDS patients. In the early clinical stage, the colored papules or plaques in the limbs are the main manifestations, and gradually develop into large plaques or nodules, which may be accompanied by obvious local edema and visceral damage. The radiation therapy is sensitive and can be combined with surgery and chemotherapy. basic knowledge The proportion of illness: 0.002%-0.005% (more common in HIV-infected patients) Susceptible people: men who are more than 50 years old Mode of transmission: sexual transmission, blood transmission, mother-to-child transmission complication:
Cause
Kaposi's sarcoma
(1) Causes of the disease
Typical classic and graft-related Kaposi's sarcoma, the inspection program is based on the check box "A"; high-risk population or HIV-positive people with Kaposi's sarcoma or AIDS-type Kaposi's sarcoma, inspection project It should include the check boxes "A" and "B" and "C".
The cause is unknown and is generally considered to be related to the following factors:
1. Genetic susceptibility.
2. Geographical environmental factors such as cold and other external environmental impacts.
3. Endocrine disorders.
4. Viral infection may be related to viral infection. In recent years, cytomegalovirus can be found in various types of tumors.
5. Cellular immunodeficiency Kaposi sarcoma of AIDS is caused by HIV infection and destruction of CD4 cells leading to immune deficiency.
(two) pathogenesis
The herpesvirus-like DNA sequence of human herpesvirus 8 has been isolated from AIDS-associated Kaposi sarcoma, African Kaposi sarcoma and Mediterranean Kaposi sarcoma, highly suggestive of its pathogenesis on Kaposi sarcoma, which is characterized by criss-crossing spindle cells. The vascular structure of reticular fibers and collagen fibers. The nucleus of spindle cells varies in size and shape. Early tissues can be seen as endothelial cells protruding into the vascular lumen in granulation tissue, and there are overflowing red blood cells. And hemosiderin, a wide range of connective tissue hyperplasia in the late stage, is indistinguishable from general sarcoma (Figure 1).
Histopathology: There are most regular fissures in the tumor. The lining is slender, mildly atypical cells. Red blood cells and phagocytosis of hemosiderin cells can be seen in the fissures. There are still a number of spindle cells, some of which are large and not large. Rules, have a profile.
Prevention
Kaposi sarcoma prevention
Long-term use of immunosuppressive agents for organ transplantation or other diseases should be monitored for the long-term monitoring of Kaposi's sarcoma. Sexually transmitted diseases, pre-pregnancy women and high-risk groups should be tested for HIV antibodies.
Complication
Kaposi sarcoma complications Complication
When the condition progresses slowly, new nodules appear and gradually increase, ulcers can occur, and even gangrene occurs, requiring amputation and opportunity to infect.
Symptom
Kaposi's sarcoma symptoms Common symptoms Spotted upper lip near the nose, nose... Red or purple, slightly... Itchy ulcer pain White halo Osteoporosis Oral mucosa ulcers Pharyngeal ulcers Appearance is a cauliflower
In elderly people without AIDS, Kaposi's sarcoma usually occurs in the toes and legs, showing purple or dark brown plaques or nodules, which are fungal-like growth or infiltration of soft tissues and invasion of bone tissue, about 5% to 10%. There will be dissemination of lymph nodes and internal organs.
Kaposi's sarcoma with AIDS may be the first symptom. It only appears as a bulging purple, pink or red papule, or a round, oval brown or purple plaque, often first appearing on the upper part of the torso or Mucosa. Can spread widely on the skin, accompanied by visceral damage and lymph node metastasis. There may be extensive bleeding including visceral bleeding.
Can be divided into the following five subtypes:
1. Classic Kaposi sarcoma classic Kaposi sarcoma)
Early damage is most common in the toes and ankles. It is light red, purple or blue-black spots and patches, and expands and fuses to form nodules or plaques. It has a rubber-like hardness and looks like a dark purple hemangioma. There is edema, and later plaques and nodules can also occur in the arms, hands, and even extend to the face, ears, trunk or mouth, especially soft palate, the course of the disease is slowly progressive, can cause significant thickening of the lower limbs, early disease, Skin lesions can be relieved periodically, nodules can naturally subside, leaving scars of atrophic and pigmentation deepening, gastrointestinal tract is the most common site of visceral involvement, lung, heart, liver, combined membrane and abdominal lymph nodes can also be affected, bone The changes are characteristic and diagnostic. The bone involvement is characterized by osteoporosis, cyst and cortical erosion. The bone damage is an indication of widespread spread of the disease. The disease progresses slowly, the viscera and lymph nodes are rarely invaded, and the prognosis is good.
Its characteristics can be summarized as follows:
(1) More common in older men aged 50-70 years.
(2) Skin lesions are common in the distal extremities, hands, forearms, etc., and can appear in the face, ears, trunk and mouth later, especially in soft palate.
(3) The skin damage is red, purple red, light blue black, green red papules or plaques, gradually enlarged into large plaques, nodules, nodules are as hard as rubber, and obvious local lymphedema may appear.
(4) can affect the internal organs, bones, internal organs are most common in the gastrointestinal tract, in addition, heart, lung, liver, adrenal gland and abdominal lymph nodes can also be involved, bone involvement manifested as osteoporosis, cysts, and even erosion of the cortex, bone changes rich Characteristic, has diagnostic value.
(5) Conscious burning, itching or pain.
2. African cutaneous kaposi sarcoma (African cutaneous kaposi sarcoma)
Common in men aged 20 to 50 years, there are nodular and invasive vascular masses in the extremities. This type of Kaposi sarcoma is prevalent in tropical Africa and is locally invasive, often accompanied by significant edema of the lower extremities and bone involvement.
3. African lymphadenopathic kaposi sarcoma (African lymphadenopathic kaposi sarcoma)
Occurred in children under 10 years of age, lymph node involvement, with or without skin damage, invasive, often died within two years after the onset of the disease, lymph nodes before skin lesions, especially cervical lymphadenopathy, damage also seen in the eyelids and binding membrane Hemorrhagic tissue mass and drooping, often accompanied by lacrimal gland, parotid gland and submandibular gland enlargement, similar to Mikulicz syndrome.
4. AIDS-associated Kaposi sarcoma
Occurs in the head, neck, trunk and mucous membranes, the skin lesions start with 1 or a few red to purple spots, and then rapidly progress to papules, nodules and plaques, with less damage, widespread distribution, rapid progress, and fulminant There may be lymph nodes and systemic involvement, visceral involvement, the most common are lung (37%), gastrointestinal (50%), lymph nodes (50%).
Its characteristics can be summarized as follows:
(1) Mainly seen in young adults aged 20 to 50 who are AIDS patients.
(2) Skin lesions are widely distributed, mostly in the head, neck, trunk, and sole of the foot.
(3) The skin lesion is red rash, surrounded by pale halo; later becomes purple or brown plaque or nodules, pale halo disappears; skin lesions are small, about 1cm in diameter, symmetrically distributed.
(4) may have oral mucosa and gastrointestinal damage.
(5) Rapid development and high mortality.
5. Immunosuppression related to Kaposi's sarcoma (immunosuppresSion-associated Kaposi sarcoma)
The damage is similar to the classic Kaposi's sarcoma, the difference in the location of the disease is large, and the ratio of visceral involvement varies.
3. Histopathology suggests a malignant tumor of ischemic vascular endothelial cells.
Examine
Examination of Kaposi's sarcoma
1. Leukocyte differential counts When the lymphatic system is involved, monocytes increase, followed by eosinophilia.
2. Histopathological examination Histopathology The skin tissue pathology of each type of Kaposi's sarcoma is basically the same. The dermis can be seen as a cluster of tumor tissue. There are many irregular fissures in the tumor. The endothelium is mainly composed of endothelial cells, and the cavity is obvious. The red blood cells can be seen in a number of spindle cells, with large nuclei, irregular, deep staining, and atypia. Generally, in the damage of Kaposi's sarcoma, there are two types of histological changes: 1 angiogenesis, significant endothelial cells; 2 spindle cells formed, containing vascular fissures, early granulation tissue, vascular expansion in the dermis, increased in number, endothelial cells increased and protruded into the lumen, in addition, some endothelial cells clustered, tending to form new blood vessels, common red blood cells were small Sexual spillover and hemosiderin deposition, with varying degrees of perivascular or diffuse cell infiltration, vascular accumulation in plaque and nodular lesions, spindle cells around the endothelial cells proliferate in a strip-like shape, irregularly surrounding Expansion, nucleus slender, size and degree of staining, a small number of mitotic figures, interstitial often contain spilled red blood cells and hemosiderin Product, diagnosis of this disease is very important, also, endothelial cells were aggregated entity shape, wherein some of fusiform endothelial cells.
X-ray: Osteoporosis, cysts, or even erosion of the cortex can be seen when the bone is affected.
Diagnosis
Diagnosis and identification of Kaposi's sarcoma
diagnosis
The clinical manifestations of skeletal changes, with characteristic and diagnostic significance, combined with the characteristics of histopathological examination, can be diagnosed.
1. Patients with medical history have megavirus, history of HIV infection, or trauma.
2. Clinical features of the elderly, occurred in the toes, arch parts, multiple invasive dark red nodules, easy to rupture, conscious pain.
Differential diagnosis
1. Lymphatic sarcoma This disease occurs mostly after surgical treatment of female breast cancer, the lesion is blue or red nodules, histopathological examination is the lumen of many proliferating endothelium, surrounded by focal infiltration of lymphocytes, intradermal There is red blood cell overflow.
2. Angiosarcoma skin lesions are gray, gray-black or purple-blue invasive nodules or fusion plaques, may be associated with hemorrhage and ulcers, histopathological examination of the dermis has irregular vascular lumen, endothelial cell proliferation, with It has a heteromorphism and is partially seen as a tumor mass composed of spindle cells and epithelial cells.
3. It is differentiated from basal cell carcinoma and squamous cell carcinoma in skin cancer, and is also differentiated from seborrheic keratosis, skin carcinoma in situ, and discoid lupus erythematosus.
