Kaposi sarcoma (KS) is a complex disease with aspects of virology (human herpesvirus-8, HHV-8, and human immunodeficiency virus, HIV), immunology (immunodeficiency), hyperplasia (multiple widely spaced de novo lesions), and neoplasia (metastases) that has always been the most common AIDS-defining malignancy. The lesional spindle cell has been classified as being derived from either blood vascular or, more recently, lymphatic endothelial cell origin. This study revealed a spectrum of endothelial cell ultrastructure from lymphatic to blood vascular. It demonstrated frequent Weibel-Palade bodies and gap junctions. The spindle cells were shown to behave as facultative phagocytes, internalizing and processing necrotic cells and leaked red blood cells (RBCs). Fragmented RBCs were equivalent to the "hyaline droplets" seen by light microscopy. The final stages of RBC disintegration were hemosiderin and ferritin. Most significantly, this study disclosed that KS is actually composed of a single type of randomly oriented spindle cell forming vessels of varying size and integrity.