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Cancer-like disease that can be genetically
transmitted or acquired, in association with acquired immunodeficiency
syndrome (AIDS).
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Kaposi Tumor; Kaposi Malignancy; Multiple Idiopathic
Pigmented Hemangiosarcoma.
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Idiopathic multiple pigment sarcoma described initially in
1872 by the Hungarian dermatologist Moritz Kaposi (1837-1902).
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Varies dramatically according to geography. Most common
AIDS-associated malignancy in the United States: 73,000-fold more frequent
in homosexual HIV-infected men than in the general population; in other
HIV-transmission groups, Kaposi sarcoma (KS) affects 1 to 3% of persons
other than male homosexuals (however, there is a 10,000-fold increase in
HIV-infected women and nonhomosexual men). Two times more frequent in white
population men than in black population men.
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Rare autosomal dominant forms (rarely
familial); mostly acquired (associated with herpes virus 8 infection in AIDS
patients, but overexposure to nitrite might be an alternate cause).
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Formed by proliferation of abnormal vascular
endothelial cells. This has been established by histochemical demonstration
of factor VIII-related antigen in both the cells lining the vascular
channels and in the spindle-cell component of both classic and AIDS-related
Kaposi sarcoma. The tumors appear in a multicentric fashion, although
metastatic lesions may develop. The cutaneous distribution is occasionally
symmetrical and tends to follow the path of superficial veins.
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Lesions have two predominant histologic features: (a)
accumulation of spindle cells and (b) presence of vascular elements. The
only specific vascular element is the presence of erythrocyte-containing
clefts or slits, loosely outlined by tumor cells. Other vascular elements
are ectatic capillaries and lymphatics and wide-lumen sinuses.
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Classic KS: Multiple red or purple dermal plaques, nodules,
and tumors. Lesions occur most commonly on the lower limbs, but may also
occur on the upper limbs, trunk, head, neck, and genitalia. Edema is common
and hemorrhage of lesions may occur. Involvement of internal organs may
occur; in fact, the disease may be exclusively visceral with no cutaneous
lesions. The condition is slowly progressive, with death occurring from
generalized disease with cachexia, hemorrhages, or impairment of vital organ
function by tumor growth.
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Endemic KS: Nodular, florid, infiltrative, or
lymphadenopathic lesions. The lymphadenopathic type occurs most frequently
in children and young adults and may resemble lymphoma.
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Epidemic KS: Associated with
AIDS. Small, slowly enlarging, rounded tumors distributed over the body.
Associated with lymphadenopathy.
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Full history of disease progression,
including previous anesthesia and present medication. Check complete blood cell count,
coagulation status, and serum electrolytes. Assess airway, together with
cardiac and respiratory function.
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Difficult venous access. Difficulties
with tracheal intubation because of involvement of oral mucosa, tonsils, and
vocal cords.
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Effects of chemotherapy on cardiac
and respiratory function.
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Bacillary Angiomatosis: This is an infectious capillary
proliferation and neutrophilic inflammation caused by the slow-growing
gram-negative bacillus Rochalimaea, and difficult to distinguish from KS (skin
biopsy is required).
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Hemangiomas and Dermatofibroma: Might occasionally and ...