Angiosarcoma in HIV-negative patients is not associated with HHV-8

BACKGROUND Angiosarcoma is an aggressive, malignant neoplasm of vascular or lymphatic origin. Herpes virus 8 (HHV-8) is a member of the herpes family with a tropism for endothelial cells and it has been proven to induce vascular neoplasms, such as Kaposi's sarcoma. The role of HHV-8 in the pathogenesis of angiosarcoma has not been well defined. OBJECTIVE To investigate the relationship between the presence of HHV-8 and angiosarcoma. METHODS In this study, the team investigated the relationship between the presence of HHV-8, as determined by polymerase chain reaction, and angiosarcoma, using samples from patients with epidemic Kaposi's sarcoma as controls. RESULTS While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was. CONCLUSION These findings support most previous studies that found no association between HHV-8 and angiosarcoma.


INTRODUCTION
Angiosarcoma (AS) is an aggressive, malignant neoplasm of vascular or lymphatic origin. It is classified as a soft tissue sarcoma and accounts for 5.4% of all cutaneous sarcomas. 1 AS is more common in the elderly, has no gender bias, and mainly affects Caucasians, with only 4% of cases involving black patients. [1][2][3] Typically, AS affects the head and neck, and most commonly the scalp. 1 Despite originating from endothelial cells, it rarely affects the great vessels or the heart. Most AS lesions have a spontaneous origin, although a number of risk factors have been identified, including chronic lymphedema, radiation therapy, genetic syndromes and occupational exposure to chemicals like vinyl chloride. 1,4,5 A notable increase in the number of AS cases over the last thirty years has emerged, which may be related to both an increased use of radiotherapy and improved diagnostic methods. 4

HHV-8 detection
Samples that were positive for human β-globin by PCR were further analyzed for the presence of four different HHV-8 genome regions. These consisted of two different fragments of the ORF-K1 variable-loop region, VR1 (380bp) and VR2 (336bp), and a 407bp fragment of the ORF-K12 region, using modified cycling conditions (initial denaturation of DNA at 95°C for 5 minutes; 40 cycles of 94°C for 50 seconds, 62°C for 50 seconds; and 72°C for 1 minute, followed by a final extension at 72°C for 10 minutes). [8][9][10] The fourth real-time PCR assay was designed to detect a fragment from the ORF-73 region. 11

RESULTS
Age, gender, ethnicity, and affected sites of the AS patients are summarized in table 1.

DISCUSSION
The patient cohort in this study broadly matched the previously described epidemiological profile of this disease, with an approximately equal distribution between men and women (9 women and 6 men), a relatively advanced mean age (72 years) and a predominance of Caucasian patients (87% of the cohort was self-classified as belonging to this ethnic group). 1-3 Likewise, with respect to tumor location, the majority of patients in this study (75%) had a primary AS in the head and neck region. The reason for this predilection is uncertain, but it is believed that ultraviolet rays may play a role. 12 1  85  female  Caucasian  scalp  2  72  male  Asian  head  3  68  female  Caucasian  head  4  69  female  Caucasian  arm  5  72  male  Caucasian  head  6  67  male  Caucasian  head  7  81  male  Caucasian  head  8  79  female  Caucasian  leg  9  66  male  Caucasian  scalp  10  70  female  Caucasian  head  11  70  female  Caucasian  leg  12  59  female  Caucasian  scalp  13  80  female  Caucasian  arm  14  75  male  Black  head  15 70 male Caucasian head

CONCLUSION
The Brazilian case series discussed in this report confirms the absence of HHV-8 in the AS lesions and adds data from a population   Confirmed  positive  ----negative  2  AS  Confirmed  positive  ----negative  3  AS  Confirmed  positive  ----negative  4  AS  Confirmed  positive  ----negative  5  AS  Confirmed  positive  ----negative  6  AS  Confirmed  positive  ----negative  7  AS  Confirmed  positive  ----negative  8  AS  Confirmed  positive  ----negative  9 AS