Medical history and physical exam

Your doctor will ask about your medical history to learn about any illnesses, operations, your sexual activity, and other possible exposures to Kaposi sarcoma herpesvirus and HIV. The doctor will ask you about symptoms and about any skin tumors you have noticed. The doctor will examine your skin thoroughly and give you a complete physical exam. Sometimes Kaposi sarcoma (KS) lesions develop inside the rectum (the part of the large intestine just inside the anus). A doctor may be able to detect such lesions during an exam with a gloved finger. The doctor may also check the stool for occult (unseen) blood, since KS in the intestines can cause bleeding.

Biopsy

To be sure that a lesion is caused by KS, the doctor will need to take a small sample of tissue from the lesion and send it to a lab to be analyzed. This is called a biopsy. Looked at under a microscope, KS cells usually are arranged in a distinctive shape and pattern. Sometimes, though, early lesions may not show the characteristic cell patterns needed to positively diagnose KS.

For skin lesions, the doctor will usually perform a punch biopsy, which removes a tiny round piece of tissue. If the entire lesion is removed, it is called an excisional biopsy. These procedures are often able to be done with just local anesthesia (numbing medicine).

Chest x-ray

An x-ray of the lungs may be done to see if KS is there. If the x-ray shows something abnormal, other tests will be needed to tell for sure if it is KS or some other condition. If someone is known to have KS in the lung, chest x-rays can be used to see how the disease is responding to treatment.

Bronchoscopy

This procedure lets the doctor look into the lungs. It is often done if the patient is having problems such as shortness of breath or coughing up blood, or if the chest x-ray shows something abnormal. Any of these could mean that KS is in the lungs. Before starting the bronchoscopy, the patient is put to sleep with a light anesthesia. Then the doctor inserts the bronchoscope (a thin, flexible lighted tube) through the mouth, down the windpipe, and into the lungs. If the doctor sees a KS lesion, it can be biopsied through the bronchoscope. Bronchoscopy with biopsies can also be used to help diagnose other lung problems seen in AIDS patients, such as pneumonia.

Gastrointestinal endoscopy

This is used when the doctor suspects that KS is in the stomach or intestines and is causing problems.

Three types of endoscopy are used to look at the stomach and intestines.

• Upper endoscopy (also called esophogastroduodenoscopy, or EGD) is used to examine the esophagus, the stomach, and the first part of the small intestine. For this procedure, the patient is first given medicines to make them sleepy. Then, the doctor guides the endoscope (a thin, flexible, lighted tube) through the mouth and esophagus and into the stomach. This allows the doctor to see things like ulcers, infections, and KS lesions. If a lesion is seen, the doctor can use small surgical instruments through the endoscope to biopsy it.

• Colonoscopy is used to look inside the large intestine (colon). Before this test can be done, the colon must be cleaned out to remove any stool. This often involves drinking a large amount of a liquid laxative the night before and the morning of the procedure. Sometimes enemas are used as well.. Just before the procedure, the patient is given medicine into a vein to make him or her sleepy. Then a colonoscope (a long, flexible, tube with a light or camera on the end) is inserted through the rectum and into the colon. Any lesion seen can be biopsied.

• Capsule endoscopy is a way to look at the small intestine. It is not truly a type of endoscopy, since it doesn't use an endoscope. Instead, this procedure uses a capsule (about the size of a large vitamin pill) that contains a light source and a very small camera. The patient swallows the capsule. Like any other pill, the capsule goes through the stomach and into the small intestine. As it travels through the small intestine (usually over the course of about 8 hours), it takes thousands of pictures. These images are transmitted electronically to a device worn around the person's waist, while he or she goes on with normal daily activities. The pictures can then be downloaded onto a computer, where the doctor can look at them as a video. The capsule passes out of the body during a normal bowel movement and is flushed away.

• Double balloon enteroscopy: This is a newer way of looking at the small intestine. Regular endoscopy cannot look very far into the small intestine because it is too long (20 feet) and has too many curves. This method gets around these problems by using a special endoscope that is made up of 2 tubes, one inside the other. First the inner tube, which is an endoscope, goes forward about a foot, and then a balloon at its end is inflated to anchor it. Then the outer tube goes forward to near the end of the inner tube and it is then anchored in place with a balloon. This process keeps being repeated over and over, letting the doctor see the intestine a foot at a time. The doctor can even take a biopsy if something abnormal is seen. This procedure is done after the patient is given drugs to make him or her sleepy. This procedure is more involved than capsule endoscopy, but it has the advantage of allowing the doctor to biopsy any lesions seen.

KS can also affect other organs, such as the liver, spleen, heart, or bone marrow. These areas do not often need to be biopsied to know if a patient has KS, as the disease can usually be diagnosed from biopsies of other tissues, such as skin, lungs, or intestines.

Last Medical Review: 09/17/2009
Last Revised: 09/17/2009