Pseudo-Kaposi Sarcoma (Acroangiodermatitis) Workup

  • Author: Zoltan Trizna, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 3, 2012
 

Laboratory Studies

Rule out HIV-positive status, especially if Kaposi sarcoma is suspected.

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Imaging Studies

Use plethysmography, Doppler ultrasonography, and oscillography to assess the venous flow and to detect underlying vascular malformations. Use arteriography to demonstrate arteriovenous fistulae.

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Other Tests

Transcutaneous oxygen pressure can detect hypoxia at the edge of the lesions. Polymerase chain reaction for human herpesvirus 8 can help in differentiating acroangiodermatitis from Kaposi sarcoma; however, this investigational method is not routinely available.

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Procedures

Obtain a biopsy sample for dermatopathologic evaluation.

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Histologic Findings

In early lesions, a proliferation of capillaries exists deeper in the dermis; the papillary dermis is also affected later on. The neovascularization is accompanied by fibrosis with spindle cells, extravasation of red blood cells, and deposition of hemosiderin. Venules and deeper vertical small veins can also become tortuous and hypertrophic. A few interspersed inflammatory cells and eosinophils may be noted. A mixed perivascular infiltrate is sometimes present. An edematous matrix typically separates the capillary proliferations. Acroangiodermatitis is usually associated with minimal epidermal changes.

Immunohistochemically, the proliferative fibroblastlike spindle cells around the vessels are positive for antifactor XIIIa antibody. Immunostaining for the CD34 antigen demonstrated a strong labeling of endothelial cells of hyperplastic vessels in acroangiodermatitis.[9]

Note the images below.

Acroangiodermatitis on histopathologic examinationAcroangiodermatitis on histopathologic examination. Example of acroangiodermatitis on histopathologic Example of acroangiodermatitis on histopathologic examination. Higher-power view of acroangiodermatitis on histopHigher-power view of acroangiodermatitis on histopathologic examination. Classic Kaposi sarcoma on histopathologic examinatClassic Kaposi sarcoma on histopathologic examination.
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Contributor Information and Disclosures
Author

Zoltan Trizna, MD, PhD  Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: American Academy of Dermatology and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD  Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Specialty Editor Board

Shyam Verma  MBBS, DVD, FAAD, Clinical Associate Professor, Department of Dermatology, University of Virginia; Adjunct Associate Professor, Department of Dermatology, State University of New York at Stonybrook, Adjunct Associate Professor, Department of Dermatology, University of Pennsylvania

Shyam Verma is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Gucluer H, Gurbuz O, Kotiloglu E. Kaposi-like acroangiodermatitis in an amputee. Br J Dermatol. Aug 1999;141(2):380-1. [Medline].

  2. Sbano P, Miracco C, Risulo M, Fimiani M. Acroangiodermatitis (pseudo-Kaposi sarcoma) associated with verrucous hyperplasia induced by suction-socket lower limb prosthesis. J Cutan Pathol. Jul 2005;32(6):429-32. [Medline].

  3. Landthaler M, Langehenke H, Holzmann H, Braun-Falco O. [Mali's acroangiodermatitis (pseudo-Kaposi) in paralyzed legs]. Hautarzt. May 1988;39(5):304-7. [Medline].

  4. Kim TH, Kim KH, Kang JS, Kim JH, Hwang IY. Pseudo-Kaposi's sarcoma associated with acquired arteriovenous fistula. J Dermatol. Jan 1997;24(1):28-33. [Medline].

  5. Larralde M, Gonzalez V, Marietti R, Nussembaum D, Peirano M, Schroh R. Pseudo-Kaposi sarcoma with arteriovenous malformation. Pediatr Dermatol. Jul-Aug 2001;18(4):325-7. [Medline].

  6. Lyle WG, Given KS. Acroangiodermatitis (pseudo-Kaposi's sarcoma) associated with Klippel-Trenaunay syndrome. Ann Plast Surg. Dec 1996;37(6):654-6. [Medline].

  7. Zutt M, Emmert S, Moussa I, et al. Acroangiodermatitis Mali resulting from arteriovenous malformation: report of a case of Stewart-Bluefarb syndrome. Clin Exp Dermatol. Jan 2008;33(1):22-5. [Medline].

  8. Kazakov DV, Sima R, Michal M. Hemosiderotic fibrohistiocytic lipomatous lesion: clinical correlation with venous stasis. Virchows Arch. Jul 2005;447(1):103-6. [Medline].

  9. Kanitakis J, Narvaez D, Claudy A. Expression of the CD34 antigen distinguishes Kaposi's sarcoma from pseudo-Kaposi's sarcoma (acroangiodermatitis). Br J Dermatol. Jan 1996;134(1):44-6. [Medline].

  10. Pires A, Depairon M, Ricci C, Krayenbuhl B, Panizzon RG. Effect of compression therapy on a pseudo-Kaposi sarcoma. Dermatology. 1999;198(4):439-41. [Medline].

  11. Rashkovsky I, Gilead L, Schamroth J, Leibovici V. Acro-angiodermatitis: review of the literature and report of a case. Acta Derm Venereol. Nov 1995;75(6):475-8. [Medline].

  12. Pimentel MI, Cuzzi T, de Azeredo-Coutinho RB, Vasconcellos Éde C, Benzi TS, de Carvalho LM. Acroangiodermatitis (pseudo-Kaposi sarcoma): a rarely-recognized condition. A case on the plantar aspect of the foot associated with chronic venous insufficiency. An Bras Dermatol. Jul-Aug 2011;86(4 Suppl 1):S13-6. [Medline].

 
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The physical findings in this patient who is HIV negative remained the same over a 3-year period.
Lesions on the shin of a patient who is HIV negative.
Acroangiodermatitis on histopathologic examination.
Example of acroangiodermatitis on histopathologic examination.
Higher-power view of acroangiodermatitis on histopathologic examination.
Classic Kaposi sarcoma on the foot of an elderly patient who is HIV negative. Compare this photo to the clinical photos of acroangiodermatitis.
Classic Kaposi sarcoma on histopathologic examination.
 
 
 
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