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CORRESPONDENCE
Year : 2014  |  Volume : 59  |  Issue : 4  |  Page : 415-416
Pseudo-Kaposi's sarcoma of the hand associated with acquired iatrogenic arteriovenous fistula


1 Department of Dermatology, Shiga University of Medical Science, Setatsukinowacho, Otsu, Shiga Prefecture 520-2121, Japan
2 Department of Dermatology, Osaka Red Cross Hospital, Osaka, Japan
3 Department of Urology, Toyosato Hospital, Inukami-Gun, Japan

Date of Web Publication27-Jun-2014

Correspondence Address:
Gen Nakanishi
Department of Dermatology, Shiga University of Medical Science, Setatsukinowacho, Otsu, Shiga Prefecture 520-2121
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.135511

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How to cite this article:
Nakanishi G, Tachibana T, Soga H, Fujimoto N, Tanaka T. Pseudo-Kaposi's sarcoma of the hand associated with acquired iatrogenic arteriovenous fistula. Indian J Dermatol 2014;59:415-6

How to cite this URL:
Nakanishi G, Tachibana T, Soga H, Fujimoto N, Tanaka T. Pseudo-Kaposi's sarcoma of the hand associated with acquired iatrogenic arteriovenous fistula. Indian J Dermatol [serial online] 2014 [cited 2021 Apr 17];59:415-6. Available from: https://www.e-ijd.org/text.asp?2014/59/4/415/135511


Sir,

Pseudo-Kaposi's sarcoma is considered an acquired benign reactive vascular proliferation that clinically resembles Kaposi's sarcoma. [1] It can appear in various vascular conditions such as Stewart-Bluefarb syndrome [2] and chronic venous insufficiency of the lower extremities called acroangiodermatitis of Mali, [3] and limb anomalies. There are reported cases of pseudo-Kaposi's sarcoma of the hand associated with acquired iatrogenic arteriovenous fistula for hemodialysis. [4] This study reports the case of pseudo-Kaposi's sarcoma of the hand that healed after changing the position of the AV-shunt for hemodialysis.

A 66-year-old man was first evaluated for diabetes at the age of 56 in 1998. End-stage renal disease probably secondary to diabetes developed in 2000. Subsequently, hemodialysis was required, which led to creation of an AV-shunt (side-to-side radial artery-to-cephalic vein anastomosis) on his left wrist in 2003.

In 2009, edematous, crusted, violaceous, and pigmented plaques developed on his left fourth and fifth fingers [Figure 1]a associated with slight intermittent pain. Further examination revealed a pulsatile, non tender, aneurismal dilation of the AV-shunt on the radial aspect of the left distal forearm [Figure 1]b black arrow)]. A skin biopsy specimen from the dorsum of the fourth finger showed hyperkeratosis, irregular acanthosis, prominent proliferation of small dilated vessels in the upper and mid dermis, and extravasated erythrocytes [Figure 1]c without vascular slits and atypical endothelial cells. Immunohistochemical analysis showed CD34-positive endothelial cells, but CD34-negative perivascular cells [Figure 1]d. Some vessels had CD31-positive [Figure 1]e and D2-40-positive cells [Figure 1]f. Four months later, the initial AV-shunt was obstructed, and a new AV-shunt was created around the proximal part of the wrist about 10 cm away from the initial site [Figure 1]g (white arrow). After 1 year, edema and crusts on the fingers disappeared [Figure 1]h. Three years later, discoloration on the fingers completely improved [Figure 1]j.
Figure 1: (a) Clinical appearance. (b) AV - shunt: initial site, black arrow (?#189;), and secondary site, white arrow (?#197;). (c) Histological examination. (d) Immunostain for CD34. (e) CD31. (f) D2 - 40. (g, h, i, j) Clinical appearance during 3 years

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In most cases of pseudo-Kaposi's sarcoma, surgical intervention is not feasible, because the congenital malformation variety consists of multiple small distal lesions. Compression stockings as supportive measures may limit venous stasis and local wound care for ulcers. Various medical treatments, e.g. oral erythromycin, [4] have been tried with favorable results but options are limited. In our case, the resolution was probably due to the obstruction of the initial AV-shunt. The new AV-shunt did not cause recurrence of the lesions. Changing the site of the AV-shunt may be optional.

Immunohistochemical staining with CD34 has been performed in sections of pseudo-Kaposi's sarcoma to distinguish between pseudo-Kaposi's sarcoma and Kaposi's sarcoma because only plump endothelial cells are positive in the former, while perivascular and endothelial cells are positive in the latter. [5] In our study, in addition to CD34 staining, immunohistochemical staining with CD31 and D2-40 demonstrated vessels with D2-40-positive and CD31-positive cells. To our knowledge, there are no reports about immunohistochemical analysis using the specific antibody for lymphatic vessels in pseudo-Kaposi's sarcoma. This study indicates that pseudo-Kaposi's sarcoma could be the cutaneous-reactive lymphangiomatosis induced by vascular abnormality and lymphedema.

 
   References Top

1.George M, Carr RA, Gee BC. Acroangiodermatitis of Mali. Clin Exp Dermatol 2010;35:94-6.  Back to cited text no. 1
    
2.Agrawal S, Rizal A, Agrawal CS, Anshu A. Pseudo-Kaposi's sarcoma (Bluefarb-Stewart type). Int J Dermatol 2005;44:136-8.  Back to cited text no. 2
    
3.Zutt M, Emmert S, Moussa I, Haas E, Mitteldorf C, Bertsch HP, et al. Acroangiodermatitis Mali resulting from arteriovenous malformation: Report of a case of Stewart-Bluefarb syndrome. Clin Exp Dermatol 2008;33:22-5.  Back to cited text no. 3
    
4.Goldblum OM, Kraus E, Bronner AK. Pseudo-Kaposi's sarcoma of the hand associated with an acquired, iatrogenic arteriovenous fistula. Arch Dermatol 1985;121:1038-40.  Back to cited text no. 4
    
5.Kanitakis J, Narvaez D, Claudy A. Expression of the CD34 antigen distinguishes Kaposi's sarcoma from pseudo-Kaposi's sarcoma (acroangiodermatitis). Br J Dermatol 1996;134:44-6.  Back to cited text no. 5
    


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