Signs and Symptoms of Kaposi Sarcoma

The first sign of KS is usually the development of red to brown to purple small growths on the skin. These can be anywhere, but most often are on the legs and face. Sometimes they first show up in the mouth and are found by a dentist. About 1 person in 3 with AIDS-related KS will develop mouth and throat lesions, most often on the roof of the mouth (palate) but also on the gums, tongue, tonsils, voice box (larynx), or windpipe (trachea).

Lesions on the roof of the mouth often cause no symptoms and may not be noticed. Sometimes lesions elsewhere in the mouth or throat may become tender and sore, and they may ooze or bleed. Eating, breathing, or swallowing can be uncomfortable. Lesions also may contribute to dental problems, such as loss of teeth.

There also may be some abdominal discomfort from KS in the intestinal tract. KS lesions are often present in the gastrointestinal (GI) tract when the patient is first diagnosed. This is more likely if you are severely immunosuppressed, with a low CD4 cell count. CD4 cells are a special kind of white blood cell that fights infection. Gastrointestinal KS lesions become more common with time. Sometimes lesions can develop in the GI tract even though no lesions are found on the skin. Usually GI lesions do not cause symptoms, but in some cases they cause pain and bleeding. These lesions can also interfere with the body's ability to digest and absorb nutrients from food, which in turn may lead to diarrhea. In rare cases, the lesions can completely block the digestive tract, preventing the passage of waste.

Some people with KS have lymphedema, swelling that results from blockage of the lymph nodes or lymph vessels. Such swelling may be present even though there are no lesions or only minor lesions visible on the skin. Most often the swelling is present in the legs or feet, but it can also be present in the groin, the genitals, or the skin around the eyes. Only rarely does swelling develop in the chest or arms. In severe cases, swelling in the legs makes it painful or difficult to walk, and bacterial infections may develop.

KS can also develop in the lung and produce symptoms such as coughing (sometimes with bloody sputum), shortness of breath, and fever.

Procedures Used to Diagnose Kaposi Sarcoma

Medical history and physical exam: Your doctor will take your medical history to learn about any past illnesses, operations, your sexual history, and other possible exposures to KSHV and HIV. The doctor will ask you about symptoms and about any skin tumors you have noticed. The doctor will examine your skin thoroughly as well as give you a complete physical exam. Sometimes 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.

Biopsy: Skin lesions caused by KS can resemble other kinds of skin disorders, inflammation, bacterial or fungal infections, non-Hodgkin lymphoma, or a benign tumor of the blood vessels (hemangioma). For that reason, the doctor will want to take a small sample of tissue (biopsy) from the lesion and send it to a lab to be analyzed. Under a microscope, KS cells usually have a distinctive shape and pattern of arrangement. Sometimes, though, early lesions may not reveal the characteristic cell patterns necessary to positively diagnose KS.

For skin lesions, the doctor will usually perform a punch biopsy, which removes a small round piece of tissue usually about 1/6-inch in diameter. Or the doctor may remove the entire lesion in a procedure called an excisional biopsy.

Imaging studies: The most important imaging study in KS is the chest x-ray. This can tell if KS is in the lungs.

Endoscopy: In an endoscopy procedure, the doctor uses a thin, flexible, lighted tube called an endoscope to look into your lower intestine or your stomach for lesions. This is done while you are sedated. It is also possible to biopsy these lesions using small surgical instruments operated through the endoscope.

Bronchoscopy: In this procedure a doctor looks into the breathing tubes of the lungs with a thin flexible instrument. The patient is put to sleep with light anesthesia. This procedure is usually done if you are coughing up blood. If the doctor sees a KS lesion, it will be biopsied.

Sometimes AIDS-related KS affects other organs, such as the liver, spleen, heart, or bone marrow, but in just about all cases the disease can be diagnosed from biopsies of other tissues, such as skin, lungs, or intestines.

Revised: 03/14/2006