Abstract:

An 88-year-old male presented with a painful, rapidly growing lesion on the left palm. On clinical examination, a solitary, red, ulcerated, exophytic, pyogenic granuloma (PG)-like polyp was noted. No other skin lesions were identified. Shave biopsy demonstrated an intradermal proliferation of plump spindle cells with slit-like vascular spaces containing erythrocytes. There was nuclear staining for human herpes virus 8 (HHV-8) by immunohistochemistry. HIV RNA PCR testing of the patient was negative. A diagnosis of pyogenic granuloma-like Kaposi sarcoma (PGLKS) was made. PGLKS is a rare variant of Kaposi sarcoma, with less than 30 cases reported to date. The majority of cases arise on the lower limbs, including the foot, and show HHV-8 positivity. Males are predominantly affected, with wide age range (25-88 years). Most PGLKS patients are HIV-negative. Only 4 previously described PGLKS tumors were located on the hand, with two on the palmar surface. The majority of these (including our case) presented as a de novo solitary polyp; and typical patch, plaque or nodular KS lesions were not identified at other cutaneous sites. PGLKS may mimic true PG or bacillary angiomatosis, with the potential for misdiagnosis and under-reporting when arising as a single polyp and/or on uncommon sites. The biological behavior of PGLKS remains to be definitively determined.

Financial Disclosure:
No current or relevant financial relationships exist.

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Savannah Alvarado, MD