Kaposi Sarcoma as Initial Presentation of HIV Infection

CONTEXT: Kaposi's sarcoma (KS), a vascular tumor that manifests as nodular lesions on the skin and to a lesser extent, the visceral organs, is the most common neoplasm encountered in human immunodeficiency virus (HIV)-infected patients. It consists of an angiosarcomatous change of not only the epithelial and mucous membrane-associated connective tissue in various sites, for example, skin, gastrointestinal system, lungs, and so on, but may also involve non-epithelial organs, such as lymph nodes. Surgical excision is the line of management for the tumor. CASE REPORT: We present one case of a 65-year-old heterosexual Indian male, clinically unsuspected for acquired immunodeficiency syndrome (AIDS) who presented with multiple non-blanching, bluish-red nodules on all extremities, chest, back and bilateral submandibular and cervical lymphadenopathy. Fine needle aspiration cytology (FNAC) was performed from subcutaneous nodule and lymph node. Smears showed hypercellular plump spindle cell groups in a hemorrhagic background. Diagnosis was given as low-grade spindle cell neoplasm consistent with KS, which was later confirmed on histopathology. CONCLUSION: The first line diagnostic aid of FNAC has several advantages over the traditional biopsy in testing such vascular tumors. The latter is generally needed for confirmation of KS. However, FNAC of such vascular tumors has advantages of better patient compliance, ease of procedure, no recurrences, and safety in immuno-compromised patients. Ancillary studies can be done on aspirates along with polymerase chain reaction (PCR) amplification techniques in confirming the detection of associated human herpes virus-8 (HHV-8) infection with KS.