대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Kaposi Sarcoma

Radiologic Findings

He was diagnosed as the HIV-positive patient, and CD4 count was 49 cell/mm3 at admission. CPA shows multiple patchy opacities and interstitial infiltrations in the bilateral lungs. Contrast enhanced CT scan demonstrates bilateral multiple nodules with irregular margins in the peribronchovascular locations. Skin biopsy was performed and he was confirmed as having a Kaposi’s sarcoma. Actually he did not undergo the pathologic examination for the lung nodules, however, we thought that the lung lesions should be the involvement of Kaposi sarcoma.

Brief Review

Kaposi sarcoma (KS) was named for Dr. Moritz Kaposi who first described it in 1872. For decades KS was considered a rare disease that mostly affected elderly men of Mediterranean or Jewish heritage, organ transplant patients, or young adult African men. This type is called classic Kaposi sarcoma. In the last 20 years, however, most KS cases have developed in association with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS). This is called AIDS-related Kaposi sarcoma (epidemic KS). Epidemic KS spreads through the whole body and causes widespread lesions that develop not only on the skin and in the mouth, but also the lymph nodes and other organs, usually the gastrointestinal tract, lung, liver, and spleen. In contrast, classic KS usually affects only one or a few areas of skin, most often the lower legs. KS does become life threatening when it is in the lungs, liver, or gastrointestinal tract. KS in the gastrointestinal tract can produce bleeding, while tumors in the lungs may cause difficulty breathing.

Pulmonary involvement occurs initially in the interstitial tissue of the bronchovascular bundles, interlobular septa, and pleura. Infiltration into the adjacent lung parenchyma may result in nodules or poorly defined areas of consolidation. The most common radiographic abnormality consists of nodular opacities usually measuring 1 to 2 cm in diameter and having irregular or poorly defined margins. The abnormalities tend to be bilateral and symmetric and in 90% of patients involve mainly the perihilar regions, other common findings are bronchial wall thickening and thickening of interlobular septa.

HRCT demonstrates bronchial wall thickening, peribronchial consolidation, and multiple bilateral nodules with irregular margins in a predominantly peribronchovascular distribution. The nodules usually have markedly irregular (flame-shaped) or poorly defined margins, reflecting the extension of tumor within the peribronchovascular interstitial tissue.

References

1. Muller NL, Fraser RS, Lee KS, Johkoh T. Miscellaneous Neoplasm. In: Muller NL, Fraser RS, Lee KS, Johkoh T, eds. Diseases of the Lung: Radiologic and Pathologic Correlations. Philadelphia: Lippincott Williams &Wilkins, 2003:115-117

2. What Is Kaposi Sarcoma? Http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_is_Kaposis_Sarcoma_21.asp

Keywords

Lung, Malignant tumor,