Pseudo-Kaposi Sarcoma (Acroangiodermatitis) Workup

Updated: Jan 08, 2018
  • Author: Zoltan Trizna, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Laboratory Studies

Rule out HIV-positive status, especially if Kaposi sarcoma is suspected.


Imaging Studies

Use plethysmography, Doppler ultrasonography, and oscillography to assess the venous flow and to detect underlying vascular malformations. Use arteriography to demonstrate arteriovenous fistulae.


Other Tests

Transcutaneous oxygen pressure can detect hypoxia at the edge of the lesions. Polymerase chain reaction for human herpesvirus 8 can help in differentiating acroangiodermatitis from Kaposi sarcoma; however, this investigational method is not routinely available.



Obtain a biopsy sample for dermatopathologic evaluation.


Histologic Findings

In early lesions, a proliferation of capillaries exists deeper in the dermis; the papillary dermis is also affected later on. The neovascularization is accompanied by fibrosis with spindle cells, extravasation of red blood cells, and deposition of hemosiderin. Venules and deeper vertical small veins can also become tortuous and hypertrophic. A few interspersed inflammatory cells and eosinophils may be noted. A mixed perivascular infiltrate is sometimes present. An edematous matrix typically separates the capillary proliferations. Acroangiodermatitis is usually associated with minimal epidermal changes.

Immunohistochemically, the proliferative fibroblastlike spindle cells around the vessels are positive for antifactor XIIIa antibody. Immunostaining for the CD34 antigen demonstrated a strong labeling of endothelial cells of hyperplastic vessels in acroangiodermatitis. [14]

Note the images below.

Acroangiodermatitis on histopathologic examination Acroangiodermatitis on histopathologic examination.
Example of acroangiodermatitis on histopathologic Example of acroangiodermatitis on histopathologic examination.
Higher-power view of acroangiodermatitis on histop Higher-power view of acroangiodermatitis on histopathologic examination.
Classic Kaposi sarcoma on histopathologic examinat Classic Kaposi sarcoma on histopathologic examination.