green-red papules
Introduction
Introduction The skin lesions of Kaposi's sarcoma are red, purple, light blue, black and red papules or plaques, gradually increasing into large plaques, nodules, and nodules as rubber.
Cause
Cause
(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-related Kaposi sarcoma, African Kaposi sarcoma and Mediterranean Kaposi sarcoma, and is highly suggestive of its pathogenesis on Kaposi sarcoma. The tumor consists of vascular structures in the cross-staggered spindle cells, 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, with spilled red blood cells and hemosiderin. In the advanced stage, there is extensive connective tissue hyperplasia, which is indistinguishable from general sarcoma.
Histopathology: There are most regular fissures in the tumor, which are lined with 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.
Examine
an examination
Related inspection
Sarcoidosis antigen (Kveim) test
In the elderly without AIDS
Kaposi's sarcoma usually occurs in the toes and legs, showing purple or dark brown plaques or nodules, which grow like fungi-like or infiltrate soft tissues and invade bone tissue. About 5% to 10% of them have lymph nodes and internal organs. Scattered.
Patient with AIDS
Kaposi's sarcoma may be the first symptom. It is only a purple, pink or red papule, or a round, oval or purple plaque, often appearing on the skin or mucous membrane above the trunk. It can spread widely on the skin with 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: Early damage is most common in the toes and ankles, with reddish, purple or blue-black spots and patches, and expands and fuses to form nodules or plaques. It has rubber hardness and looks like a dark purple hemangioma. The affected limb may have edema. Plaques and nodules can also occur in the arms, hands, and even to the face, ears, torso, or mouth. Especially soft cockroaches. The course of the disease is slowly progressive, which can cause significant thickening of the lower extremities. In the early stage of the disease, the skin lesions can be relieved periodically, and the nodules can naturally resolve, leaving scars of atrophic and pigmentation deep. The gastrointestinal tract is the most common site of visceral involvement. Lung, heart, liver, binding membrane and abdominal lymph nodes can also be affected. Skeletal changes are characteristic and diagnostic. Bone involvement manifests as osteoporosis, cysts and cortical erosion. Bone damage is an indication of widespread spread of the disease. The disease progresses slowly, the internal organs 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, and nodules are as hard as rubber. Significant localized lymphedema can occur.
(4) can involve internal organs and bones. The internal organs are most common in the gastrointestinal tract. In addition, heart, lung, liver, adrenal gland and abdominal lymph nodes can also be involved. Skeletal involvement manifests as osteoporosis, cysts, and even erosion of the cortex. Skeletal changes are characteristic and have diagnostic value.
(5) Consciously burning, itching or pain.
2. African cutaneous kaposi sarcoma: common in men aged 20 to 50 years, showing nodular, invasive vascular masses in the extremities. This type of Kaposi sarcoma is prevalent in tropical Africa. Locally invasive. Often accompanied by significant lower extremity edema, bone involvement.
3. African lymphadenopathic kaposi sarcoma: occurs in children under 10 years of age, with lymph node involvement, with or without skin damage. Invasive, often die within two years after the onset of illness. Lymph node before skin lesions, especially cervical lymphadenopathy. The damage is also seen in the eyelids and the combined membrane, which is a hemorrhagic tissue mass that sag. 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. Skin lesions begin with 1 or a few red to purple spots, which in turn rapidly progress to papules, nodules, and plaques. The damage is small, widespread and rapid. Outbreaks can have 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 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 Kaposi sarcoma (immunosuppres Sion-associated Kaposi sarcoma): damage similar to classic Kaposi's sarcoma. The location of the disease is quite different. The visceral involvement rate varies.
Clinical manifestations of skeletal changes have characteristic and diagnostic implications. Combined with the characteristics of histopathological examination, it can be diagnosed.
Diagnosis
Differential diagnosis
Skin tumor showing papules
1. Pigment sputum: also known as cancer cell disease. The skin lesions are maculopapular rashes, papules are nipples, strong, nodules, etc., which occur in the face, neck and trunk. Light brown or dark brown.
2. Hemangioma: A papular-like lesion that is high in the needle, miliary, large or larger, red or purple.
3. Sweat tube tumor: better at the moment, forehead, for the pale yellow surface waxy luster pimples, needle to miliary slightly flat.
4. Mildew rash: for the white needle of the face to the miliary papules, it occurs in the skin around the eyes, the surface is smooth, and the white matter can be picked up with the needle tip.
5. Seborrheic keratosis: also known as senile sputum. Occasionally on the face, back of the hand, forearm, etc., brown flat papules or patches.
6. Hair epithelial tumor: also known as cystic adenoid epithelioma, which occurs on the face and is a hard pimples with a complexion.
7. Nodular sclerosis: also known as sebaceous adenoma. For dominant inheritance, it occurs in the lower part, which is a tough, yellow capillary dilatation papule with mental retardation and epilepsy.
8. Lymphatic reticular tumors, the skin lesions can also be expressed as papules. For example, in the early stage of mycosis fungoides, the lesions are pleomorphic, which may be erythema, papules, wheal, etc., lymphoma-like papules, or may be reddish-brown papules.
