Diagnosis of Kaposi's Sarcoma
Kaposi's Sarcoma Diagnosis: Book Excerpts
Diagnostic Tests for Kaposi's Sarcoma: Online Medical Books
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Introduction: Malignant Neoplasms:
Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Kaposi's sarcoma:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
CONFIRMING DIAGNOSIS Diagnosis is made following a tissue biopsy that identifies the lesion's type and stage. Then, a computed tomography scan may be performed to detect and evaluate possible metastasis. Endoscopy shows Kaposi's lesions. (See Laubenstein's stages in Kaposi's sarcoma.)
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Multiple Somatic Complaints:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Anxiety
❑ Depression
❑ Hypothyroidism
❑ Premenstrual syndrome
❑ Hypochondriasis
❑ Somatization disorder
❑ Chronic fatigue syndrome
❑ Fibromyalgia
❑ Panic disorder
❑ Malingering
❑ Conversion reaction
Diagnostic Approach
This presentation is marked by multiple vague complaints, symptoms out of proportion to the physical findings, symptoms outside the anticipated spectrum of the organic disease, and symptoms that do not follow anatomic distributions. The patient is often more concerned with the physician accepting authenticity of symptoms than relieving them. Vague, diffuse descriptions or overly detailed and elaborate symptoms are suggestive. The patient seems to be amplifying normal bodily sensations. Psychological factors may be revealed in the symbolic choice of words (e.g., “lump in the throat”).
“Stress” for most patients is an acceptable framework within which to obtain psychological information. Care must be taken during the interview not to suggest that the symptoms are “all in the head.”
A thorough and thoughtful history and physical examination are the basis for chosing specific diagnostic tests, and signal to the patient that the complaints are being taken seriously.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Kaposi's sarcoma:
Diagnosis
(Handbook of Diseases)
The diagnosis is made following a tissue biopsy that identifies the lesion’s type and stage. Then a computed tomography scan may be performed to detect and evaluate possible metastasis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
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