PMC4624891_01
CT scans of the chest and abdomen show large bilateral pleural effusions (a) and severe ascites (b). There is a 4.2 cm mass in the head of the pancreas (c).
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fig1
CT of the chest revealed bilateral pleural effusions, severe ascites, and an enlarged head of the pancreas (Figure 1).
Cytologic evaluation of the pleural fluid shows large atypical lymphoid cells (arrows) ((a) H&E, x100) expressing HHV8, CD30, and CD138 ((b), (c), and (d), resp.). The atypical cells show high proliferation index highlighted by Ki-67 immunostain (e) and positive staining for Epstein-Barr Virus (EBV) by in situ hybridization (f).
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fig2
Further cytologic evaluation of the pleural and ascitic fluid revealed scattered large atypical lymphoid cells expressing HHV-8, CD30, CD79A, MUM-1, CD56, and CD138 (Figure 2).
The cut surface of liver shows a well-demarcated perivascular infiltration marked by reddish-brown tumorous tissue (arrows) (a). The head of the pancreas shows a reddish-brown infiltrating lesion (arrows) (d). Representative microscopic sections show spindle cells proliferation involving hepatic lobules ((b) H&E, x20) and pancreatic acini ((e) H&E, x10) with positive staining for HHV-8 antibody consistent with Kaposi's sarcoma ((c), (f)).
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The liver showed a well-demarcated perivascular infiltration marked by reddish-brown tumorous tissue (Figure 3). The head of the pancreas showed a 4 x 5 cm reddish-brown infiltrating lesion (Figure 3). CD34 and HHV-8 immunostains provided a positive result confirming the diagnosis (Figure 3).
Kaposi's sarcoma with well-circumscribed areas of raised hemorrhagic mucosa in large intestine ((a), (b)) and stomach ((c), (d)).
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The small and large intestine, along with stomach, showed widely separated, well-circumscribed, and circumferential areas of raised hemorrhagic mucosa (Figure 4).