In this biopsy of a gastric nodule, the lamina propria is replaced and expanded by a spindle cell proliferation, seaparating the glands.
The spindle cells form slit-like spaces, but unfortunately, these spaces do not contain RBCs, which would have been a helpful clue. However, the clinical history in this case (male with AIDS) plus a spindled proliferation should alert you to the possibility of Kaposi sarcoma.
Kaposi is the most common HIV-associated malignancy and is related to HHV-8. Widespread visceral involvement may be seen in patients when the disease has run its full course. Lymph nodes and the GI track are the organs most commonly involved. The skin and lungs are also commonly affected sites.
May be asymptomatic or cause pain and GI bleeding. Endoscopically, the lesions may look like submucosal violet-red nodules or plaques.
Contributed by Dr. Kate Sciandra, Dept of Pathology, VAMC Albuquerque New Mexico.