What is the role of biopsy in the workup of dermatologic manifestations of Kaposi sarcoma (KS)?

Updated: Mar 26, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Evaluation for Kaposi sarcoma should include a complete physical examination and a biopsy of suspected lesions including lymph nodes. CT scan used to guide a fine needle for tissue specimens appears promising.

The cell of origin in Kaposi sarcoma remains a subject of dispute, although the following tests may be useful:

  • Ultrastructural and immunohistochemical testing favor the endothelial cell.

  • The presence of factor VIII–related antigen, human leukocyte antigen DR (HLA-DR), von Willebrand factor, and the lectin Ulex europaeus I (which all are markers for endothelial cells) is highly suggestive.

  • Reactivity with 2 monoclonal antibodies (EN4 and PAL E) implies that Kaposi sarcoma is derived from endothelium of lymphatic origin; however, Kaposi sarcoma spindle cells express CD34 antigen, a glycoprotein expressed by endothelial cells of small blood vessels (but not those of lymphatic origin).


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