Case Number : Case 1768 - 8 March - Dr Hafeez Diwan Posted By: Guest

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Geoff Cross - DermpathPRO Projects

A challenging case. I'm torn between something like interstitial granulomatous dermatitis, but I don't see any convincing floating collagen sign...and a patch stage of KS, but no convincing promontory sign...

In fig 3 there is a cytoplasmic vacuole that makes me favor a verrucous variant of Kaposis Sarcoma. 

Vascular lesion. Agree with possible Kaposi. I see subtle slit vascular lumina, hemosiderin, hemosiderophages. D240, CD31 and HHV8 would be helpful

Agree this is a difficult case.  I had a few thoughts but top considerations for me were lipodermatosclerosis and KS.

Im glad I was not the only one finding this case challenging. After spending a bit of time my impression was Kaposi

I see a vascular lesion, with clefts between collagen bundles, and hemossiderophages. I cannot see promontory sign. I think it's a kaposi sarcoma. I would ask for IHC CD31 and HHV-8. 

I would go for a Kaposi's sarcoma.

Kaposi sarcoma.  I left out some information.  The patient is HIV positive, with a CD4 count of 8.  HHV-8 was positive.

COMPLICADO

Any plasma cells?