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<title xml:lang="en">Angiosarcoma in HIV-negative patients is not associated with HHV-8
<xref ref-type="fn" rid="fn1">*</xref>
</title>
<author>
<name sortKey="Avancini, Joao" sort="Avancini, Joao" uniqKey="Avancini J" first="João" last="Avancini">João Avancini</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sanches, Jose Antonio" sort="Sanches, Jose Antonio" uniqKey="Sanches J" first="José Antonio" last="Sanches">José Antonio Sanches</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cherubim, Andre Pires Zanata" sort="Cherubim, Andre Pires Zanata" uniqKey="Cherubim A" first="Andre Pires Zanata" last="Cherubim">Andre Pires Zanata Cherubim</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pazzini, Renato" sort="Pazzini, Renato" uniqKey="Pazzini R" first="Renato" last="Pazzini">Renato Pazzini</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Oliveira, Cristina Mendes" sort="De Oliveira, Cristina Mendes" uniqKey="De Oliveira C" first="Cristina Mendes" last="De Oliveira">Cristina Mendes De Oliveira</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sumita, Laura Masami" sort="Sumita, Laura Masami" uniqKey="Sumita L" first="Laura Masami" last="Sumita">Laura Masami Sumita</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Valente, Neusa Yuriko Sakai" sort="Valente, Neusa Yuriko Sakai" uniqKey="Valente N" first="Neusa Yuriko Sakai" last="Valente">Neusa Yuriko Sakai Valente</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pannuti, Claudio Sergio" sort="Pannuti, Claudio Sergio" uniqKey="Pannuti C" first="Claudio Sergio" last="Pannuti">Claudio Sergio Pannuti</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Festa Neto, Cyro" sort="Festa Neto, Cyro" uniqKey="Festa Neto C" first="Cyro" last="Festa Neto">Cyro Festa Neto</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
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<idno type="wicri:source">PMC</idno>
<idno type="pmid">28099593</idno>
<idno type="pmc">5193183</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193183</idno>
<idno type="RBID">PMC:5193183</idno>
<idno type="doi">10.1590/abd1806-4841.20164730</idno>
<date when="2016">2016</date>
<idno type="wicri:Area/Pmc/Corpus">003B00</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003B00</idno>
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<title xml:lang="en" level="a" type="main">Angiosarcoma in HIV-negative patients is not associated with HHV-8
<xref ref-type="fn" rid="fn1">*</xref>
</title>
<author>
<name sortKey="Avancini, Joao" sort="Avancini, Joao" uniqKey="Avancini J" first="João" last="Avancini">João Avancini</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sanches, Jose Antonio" sort="Sanches, Jose Antonio" uniqKey="Sanches J" first="José Antonio" last="Sanches">José Antonio Sanches</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Cherubim, Andre Pires Zanata" sort="Cherubim, Andre Pires Zanata" uniqKey="Cherubim A" first="Andre Pires Zanata" last="Cherubim">Andre Pires Zanata Cherubim</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pazzini, Renato" sort="Pazzini, Renato" uniqKey="Pazzini R" first="Renato" last="Pazzini">Renato Pazzini</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="De Oliveira, Cristina Mendes" sort="De Oliveira, Cristina Mendes" uniqKey="De Oliveira C" first="Cristina Mendes" last="De Oliveira">Cristina Mendes De Oliveira</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Sumita, Laura Masami" sort="Sumita, Laura Masami" uniqKey="Sumita L" first="Laura Masami" last="Sumita">Laura Masami Sumita</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Valente, Neusa Yuriko Sakai" sort="Valente, Neusa Yuriko Sakai" uniqKey="Valente N" first="Neusa Yuriko Sakai" last="Valente">Neusa Yuriko Sakai Valente</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Pannuti, Claudio Sergio" sort="Pannuti, Claudio Sergio" uniqKey="Pannuti C" first="Claudio Sergio" last="Pannuti">Claudio Sergio Pannuti</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Festa Neto, Cyro" sort="Festa Neto, Cyro" uniqKey="Festa Neto C" first="Cyro" last="Festa Neto">Cyro Festa Neto</name>
<affiliation>
<nlm:aff id="aff1"> Universidade de São Paulo (USP) – São Paulo (SP), Brazil</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Anais Brasileiros de Dermatologia</title>
<idno type="ISSN">0365-0596</idno>
<idno type="eISSN">1806-4841</idno>
<imprint>
<date when="2016">2016</date>
</imprint>
</series>
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<front>
<div type="abstract" xml:lang="en">
<sec>
<title>BACKGROUND</title>
<p>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.</p>
</sec>
<sec>
<title>OBJECTIVE</title>
<p>To investigate the relationship between the presence of HHV-8 and angiosarcoma.</p>
</sec>
<sec>
<title>METHODS</title>
<p>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.</p>
</sec>
<sec>
<title>RESULTS</title>
<p>While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was.</p>
</sec>
<sec>
<title>CONCLUSION</title>
<p>These findings support most previous studies that found no association between HHV-8 and angiosarcoma.</p>
</sec>
</div>
</front>
<back>
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</author>
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</author>
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</author>
<author>
<name sortKey="Marasa, L" uniqKey="Marasa L">L Marasà</name>
</author>
</analytic>
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</author>
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<name sortKey="Miettinen, M" uniqKey="Miettinen M">M Miettinen</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
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<name sortKey="Palacios, I" uniqKey="Palacios I">I Palacios</name>
</author>
<author>
<name sortKey="Umbert, I" uniqKey="Umbert I">I Umbert</name>
</author>
<author>
<name sortKey="Celada, A" uniqKey="Celada A">A Celada</name>
</author>
</analytic>
</biblStruct>
<biblStruct>
<analytic>
<author>
<name sortKey="Fink Puches, R" uniqKey="Fink Puches R">R Fink-Puches</name>
</author>
<author>
<name sortKey="Zochling, N" uniqKey="Zochling N">N Zöchling</name>
</author>
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<name sortKey="Wolf, P" uniqKey="Wolf P">P Wolf</name>
</author>
<author>
<name sortKey="B Ck, B" uniqKey="B Ck B">B Bäck</name>
</author>
<author>
<name sortKey="Kerl, H" uniqKey="Kerl H">H Kerl</name>
</author>
<author>
<name sortKey="Soyer, Hp" uniqKey="Soyer H">HP Soyer</name>
</author>
</analytic>
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<biblStruct>
<analytic>
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</author>
<author>
<name sortKey="Ablashi, Dv" uniqKey="Ablashi D">DV Ablashi</name>
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<name sortKey="Kinjo, T" uniqKey="Kinjo T">T Kinjo</name>
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</div1>
</back>
</TEI>
<pmc article-type="research-article">
<pmc-dir>properties open_access</pmc-dir>
<front>
<journal-meta>
<journal-id journal-id-type="nlm-ta">An Bras Dermatol</journal-id>
<journal-id journal-id-type="iso-abbrev">An Bras Dermatol</journal-id>
<journal-id journal-id-type="publisher-id">abd</journal-id>
<journal-title-group>
<journal-title>Anais Brasileiros de Dermatologia</journal-title>
</journal-title-group>
<issn pub-type="ppub">0365-0596</issn>
<issn pub-type="epub">1806-4841</issn>
<publisher>
<publisher-name>Sociedade Brasileira de Dermatologia</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="pmid">28099593</article-id>
<article-id pub-id-type="pmc">5193183</article-id>
<article-id pub-id-type="doi">10.1590/abd1806-4841.20164730</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Investigation</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Angiosarcoma in HIV-negative patients is not associated with HHV-8
<xref ref-type="fn" rid="fn1">*</xref>
</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Avancini</surname>
<given-names>João</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
<xref ref-type="corresp" rid="c1"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sanches</surname>
<given-names>José Antonio</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cherubim</surname>
<given-names>Andre Pires Zanata</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pazzini</surname>
<given-names>Renato</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>de Oliveira</surname>
<given-names>Cristina Mendes</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Sumita</surname>
<given-names>Laura Masami</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Valente</surname>
<given-names>Neusa Yuriko Sakai</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Pannuti</surname>
<given-names>Claudio Sergio</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Festa Neto</surname>
<given-names>Cyro</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<aff id="aff1">
<label>1</label>
Universidade de São Paulo (USP) – São Paulo (SP), Brazil</aff>
</contrib-group>
<author-notes>
<corresp id="c1">
<bold>Mailing address:</bold>
João de Magalhães Avancini Ferreira Alves, Av. Dr. Enéas de Carvalho Aguiar, 255, 3º andar Cerqueira César, 05403-900 - São Paulo - SP Brazil, E-mail:
<email>joao.avancini@hc.fm.usp.br</email>
</corresp>
</author-notes>
<pub-date pub-type="epub-ppub">
<season>Nov-Dec</season>
<year>2016</year>
</pub-date>
<pmc-comment>Fake ppub date generated by PMC from publisher pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub">
<season>Nov-Dec</season>
<year>2016</year>
</pub-date>
<volume>91</volume>
<issue>6</issue>
<fpage>738</fpage>
<lpage>741</lpage>
<history>
<date date-type="received">
<day>18</day>
<month>5</month>
<year>2015</year>
</date>
<date date-type="accepted">
<day>11</day>
<month>1</month>
<year>2016</year>
</date>
</history>
<permissions>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/">
<license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract>
<sec>
<title>BACKGROUND</title>
<p>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.</p>
</sec>
<sec>
<title>OBJECTIVE</title>
<p>To investigate the relationship between the presence of HHV-8 and angiosarcoma.</p>
</sec>
<sec>
<title>METHODS</title>
<p>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.</p>
</sec>
<sec>
<title>RESULTS</title>
<p>While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was.</p>
</sec>
<sec>
<title>CONCLUSION</title>
<p>These findings support most previous studies that found no association between HHV-8 and angiosarcoma.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Hemangiosarcoma</kwd>
<kwd>Herpesvirus 8, human</kwd>
<kwd>HIV</kwd>
</kwd-group>
</article-meta>
</front>
<body>
<sec sec-type="intro">
<title>INTRODUCTION</title>
<p>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.
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
</sup>
AS is more common in the elderly, has no gender bias, and mainly affects Caucasians, with only 4% of cases involving black patients.
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
-
<xref rid="r3" ref-type="bibr">3</xref>
</sup>
</p>
<p>Typically, AS affects the head and neck, and most commonly the scalp.
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
</sup>
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.
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
,
<xref rid="r4" ref-type="bibr">4</xref>
,
<xref rid="r5" ref-type="bibr">5</xref>
</sup>
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.
<sup>
<xref rid="r4" ref-type="bibr">4</xref>
,
<xref rid="r5" ref-type="bibr">5</xref>
</sup>
The contribution of immunosuppression to this is uncertain, with only a few reported cases of AS in transplant or AIDS patients.
<sup>
<xref rid="r5" ref-type="bibr">5</xref>
</sup>
</p>
<p>Herpes virus 8 (HHV-8), a member of the
<italic>Herpesviridae</italic>
family with a tropism for endothelial cells, is associated with vascular neoplasms in immunosuppressed patients, including those with epidemic Kaposi's sarcoma (EKS) or Castleman's disease, as well as the elderly (classic Kaposi's sarcoma). The role of HHV-8 in the etiology of AS remains unclear.
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
,
<xref rid="r6" ref-type="bibr">6</xref>
,
<xref rid="r7" ref-type="bibr">7</xref>
</sup>
Thus, in this study, the team evaluated the association between HHV-8 and AS in Brazilian patients.</p>
<p>The aim of this study was to identify HHV-8 DNA in tumor samples from patients with AS and HIV-infected patients with EKS from a tertiary hospital in the city of São Paulo, Brazil.</p>
</sec>
<sec sec-type="methods">
<title>METHODS</title>
<p>The team retrospectively analyzed data from patients with AS or EKS whose diagnoses were based on clinical suspicion and confirmed through histopathological examination between 1992 and 2013. A total of 15 tissue samples from AS patients were selected. All AS patients were HIV-negative. Samples from 12 EKS patients were selected to match the AS samples in the same period. Histopathological samples from all patients were reviewed by an experienced dermatopathologist.</p>
<sec>
<title>DNA extraction</title>
<p>Four slices, each 10µm-thick, were cut from a formalin-fixed, paraffin-embedded tissue block and used for DNA extraction with the NucleoSpin Tissue Kit (Macherey-Nagel, Germany), following the manufacturer's instructions.</p>
</sec>
<sec>
<title>Human β-globin polymerase chain reaction</title>
<p>To assess DNA quality and integrity, all samples were analyzed by polymerase chain reaction (PCR), using the PCO3+/ PCO4+ primers, to detect the presence of a 110 base pair (bp) fragment of the human β
<italic>-globin</italic>
gene.
<sup>
<xref rid="r8" ref-type="bibr">8</xref>
</sup>
</p>
</sec>
<sec>
<title>HHV-8 detection</title>
<p>Samples that were positive for human β
<italic>-globin</italic>
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).
<sup>
<xref rid="r8" ref-type="bibr">8</xref>
-
<xref rid="r10" ref-type="bibr">10</xref>
</sup>
The fourth real-time PCR assay was designed to detect a fragment from the ORF-73 region.
<sup>
<xref rid="r11" ref-type="bibr">11</xref>
</sup>
</p>
</sec>
</sec>
<sec sec-type="results">
<title>RESULTS</title>
<p>Age, gender, ethnicity, and affected sites of the AS patients are summarized in
<xref ref-type="table" rid="t1">table 1</xref>
.</p>
<table-wrap id="t1" orientation="portrait" position="float">
<label>Table 1</label>
<caption>
<p>Angiossarcoma patients: age, gender, ethnicity, and affected sites</p>
</caption>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col width="20%" span="1"></col>
<col width="20%" span="1"></col>
<col width="20%" span="1"></col>
<col width="20%" span="1"></col>
<col width="20%" span="1"></col>
</colgroup>
<thead>
<tr style="border-bottom:hidden">
<th align="center" rowspan="1" colspan="1">Patient</th>
<th align="center" rowspan="1" colspan="1">Age (years)</th>
<th align="left" rowspan="1" colspan="1">Gender</th>
<th align="left" rowspan="1" colspan="1">Ethnicity</th>
<th align="left" rowspan="1" colspan="1">Affected site</th>
</tr>
</thead>
<tbody>
<tr>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">85</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">scalp</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">2</td>
<td align="center" rowspan="1" colspan="1">72</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Asian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">3</td>
<td align="center" rowspan="1" colspan="1">68</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">69</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">arm</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">5</td>
<td align="center" rowspan="1" colspan="1">72</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">6</td>
<td align="center" rowspan="1" colspan="1">67</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">7</td>
<td align="center" rowspan="1" colspan="1">81</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">79</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">leg</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">9</td>
<td align="center" rowspan="1" colspan="1">66</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">scalp</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">10</td>
<td align="center" rowspan="1" colspan="1">70</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">11</td>
<td align="center" rowspan="1" colspan="1">70</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">leg</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">12</td>
<td align="center" rowspan="1" colspan="1">59</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">scalp</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">13</td>
<td align="center" rowspan="1" colspan="1">80</td>
<td align="left" rowspan="1" colspan="1">female</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">arm</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">14</td>
<td align="center" rowspan="1" colspan="1">75</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Black</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
<tr>
<td align="center" rowspan="1" colspan="1">15</td>
<td align="center" rowspan="1" colspan="1">70</td>
<td align="left" rowspan="1" colspan="1">male</td>
<td align="left" rowspan="1" colspan="1">Caucasian</td>
<td align="left" rowspan="1" colspan="1">head</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>One of the 12 EKS samples and one of the 15 AS samples were excluded because no β
<italic>-globin</italic>
DNA could be detected (patients 14 and 25), indicating the absence of intact human DNA. Of the 11 samples from EKS patients tested for the presence of HHV-8 DNA, 10 entailed positive results. The patient sample that tested negative for HHV-8 DNA also had a very low level of β
<italic>-globin</italic>
DNA, which may explain why no viral DNA could be detected. The remaining 10 patients were used as positive controls.</p>
<p>In contrast to the samples from EKS patients, the 14 AS patient samples were all negative for HHV-8. These findings are summarized in
<xref ref-type="table" rid="t2">table 2</xref>
.</p>
<table-wrap id="t2" orientation="portrait" position="float">
<label>Table 2</label>
<caption>
<p>HHV-8 analysis in patients presenting AS and EKS</p>
</caption>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
<col width="11%" span="1"></col>
</colgroup>
<thead>
<tr style="border-bottom:hidden">
<th align="left" rowspan="1" colspan="1">Patient</th>
<th align="left" rowspan="1" colspan="1">Diagnosis</th>
<th align="left" rowspan="1" colspan="1">Histological review</th>
<th align="left" rowspan="1" colspan="1">β-globin</th>
<th align="left" rowspan="1" colspan="1">VR1</th>
<th align="left" rowspan="1" colspan="1">VR2</th>
<th align="left" rowspan="1" colspan="1">ORF-73</th>
<th align="left" rowspan="1" colspan="1">K12</th>
<th align="left" rowspan="1" colspan="1">HHV-8 result</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">3</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">4</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">5</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">6</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">7</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">8</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">9</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">11</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">12</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">13</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">14</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">negative</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">excluded</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">AS </td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">16</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">17</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">18</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">19</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">20</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">21</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">22</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">23</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">24</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">25</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">negative</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">excluded</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">26</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">positive</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">+</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">positive</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">27</td>
<td align="left" rowspan="1" colspan="1">EKS</td>
<td align="left" rowspan="1" colspan="1">Confirmed</td>
<td align="left" rowspan="1" colspan="1">low</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">-</td>
<td align="left" rowspan="1" colspan="1">negative</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TFN1">
<p>AS, angiosarcoma; EKS, epidemic Kaposi´s sarcoma; HHV-8, herpes virus 8</p>
</fn>
</table-wrap-foot>
</table-wrap>
</sec>
<sec sec-type="discussion">
<title>DISCUSSION</title>
<p>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).
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
-
<xref rid="r3" ref-type="bibr">3</xref>
</sup>
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.
<sup>
<xref rid="r12" ref-type="bibr">12</xref>
</sup>
Four patients presented with AS lesions on the limbs, and the team identified chronic lymphedema in patients 8 and 11, a risk factor described for AS (
<xref ref-type="fig" rid="f1">Figure 1</xref>
).
<sup>
<xref rid="r1" ref-type="bibr">1</xref>
</sup>
</p>
<p>
<fig id="f1" orientation="portrait" position="float">
<label>Figure 1</label>
<caption>
<p>Angiosarcoma lesion in a patient with chronic lymphedema</p>
</caption>
<graphic xlink:href="abd-91-06-0738-g01"></graphic>
</fig>
</p>
<p>A number of studies have investigated whether HHV-8 plays a role in the pathogenesis of AS, on the basis that this virus has a tropism for endothelial cells. HHV-8 was first isolated from patients with Kaposi's sarcoma (KS) and AIDS in 1994.
<sup>
<xref rid="r13" ref-type="bibr">13</xref>
</sup>
It has oncogenic properties, but unlike other oncogenic viruses, it has a complex DNA-based genome, and infection not only leads to cell (endothelial) morphological changes, an increased growth rate, and extended life span, but it also causes the deregulation of angiogenesis, inflammation, and modulation of the immune system in favor of tumor growth.
<sup>
<xref rid="r14" ref-type="bibr">14</xref>
</sup>
</p>
<p>KS is a neoplasm with vascular proliferation that can present conventionally in immunosupressed patients or in patients who have previously undergone cancer treatment. It is endemic in some regions, but it can also occur epidemically due to HIV infection in immunosuppressed individuals. In all variants of KS, HHV-8 is implicated as the agent-inducing disease. The team therefore looked for a possible relationship between HHV-8 and other vascular neoplasms (such as AS), using EKS patient samples as positive controls for HHV-8 involvement.
<sup>
<xref rid="r13" ref-type="bibr">13</xref>
</sup>
</p>
<p>Soon after a relationship was discovered between HHV-8 and KS, McDonagh
<italic>et al.</italic>
<sup>
<xref rid="r7" ref-type="bibr">7</xref>
</sup>
published the first report on an association between AS and HHV-8 in 1996. Of the 24 cases selected from AS patients, 7 were positive for the presence of HHV-8 (29%), as were all the KS controls.
<sup>
<xref rid="r7" ref-type="bibr">7</xref>
</sup>
This involved a series of cases, but subsequent positivity of HHV-8 in AS samples have only been reported in isolated cases, and there have been no further studies to corroborate this finding.
<sup>
<xref rid="r7" ref-type="bibr">7</xref>
,
<xref rid="r15" ref-type="bibr">15</xref>
-
<xref rid="r20" ref-type="bibr">20</xref>
</sup>
Indeed, other studies have failed to find this association between HHV-8 and AS.
<sup>
<xref rid="r21" ref-type="bibr">21</xref>
-
<xref rid="r28" ref-type="bibr">28</xref>
</sup>
A possible explanation for why only McDonagh
<italic>et al.</italic>
have found this association may be the higher prevalence of HHV-8 in Italy and Turkey, where the study was conducted.
<sup>
<xref rid="r29" ref-type="bibr">29</xref>
</sup>
</p>
<p>In 2005, Schmid and Zietz performed a study with 40 AS patients and also failed to find an association between HHV-8 and AS, although all the KS cases in this study were positive for the virus.
<sup>
<xref rid="r6" ref-type="bibr">6</xref>
</sup>
<xref ref-type="table" rid="t3">Table 3</xref>
summarizes the previously published studies regarding the relationship between HHV8 and AS.
<sup>
<xref rid="r30" ref-type="bibr">30</xref>
</sup>
</p>
<table-wrap id="t3" orientation="portrait" position="float">
<label>Table 3</label>
<caption>
<p>Previously published studies regarding the relationship between HHV-8 and AS</p>
</caption>
<table frame="hsides" rules="groups">
<colgroup span="1">
<col width="33%" span="1"></col>
<col width="33%" span="1"></col>
<col width="33%" span="1"></col>
</colgroup>
<thead>
<tr>
<th align="left" rowspan="1" colspan="1">Authors</th>
<th align="left" rowspan="1" colspan="1">Number
<break></break>
of cases</th>
<th align="center" rowspan="1" colspan="1">Positivity for HHV-8
<break></break>
in AS % (n)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" rowspan="1" colspan="1">Mc Donagh
<italic>et al.</italic>
<sup>
<xref rid="r7" ref-type="bibr">7</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">24</td>
<td align="left" rowspan="1" colspan="1">29 (7/24)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Tomita
<italic>et al.</italic>
<sup>
<xref rid="r21" ref-type="bibr">21</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">35</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Dictor
<italic>et al.</italic>
<sup>
<xref rid="r22" ref-type="bibr">22</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Jin
<italic>et al.</italic>
<sup>
<xref rid="r23" ref-type="bibr">23</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">15</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Koizumi
<italic>et al.</italic>
<sup>
<xref rid="r15" ref-type="bibr">15</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">2</td>
<td align="left" rowspan="1" colspan="1">50 (1/2)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Gyulai
<italic>et al.</italic>
<sup>
<xref rid="r16" ref-type="bibr">16</xref>
</sup>
, 1996</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">100 (1/1)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Gyulai
<italic>et al.</italic>
<sup>
<xref rid="r17" ref-type="bibr">17</xref>
</sup>
, 1997</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">100 (1/1)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Takata
<italic>et al.</italic>
<sup>
<xref rid="r24" ref-type="bibr">24</xref>
</sup>
, 1997</td>
<td align="left" rowspan="1" colspan="1">10</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Viviano
<italic>et al.</italic>
<sup>
<xref rid="r25" ref-type="bibr">25</xref>
</sup>
, 1997</td>
<td align="left" rowspan="1" colspan="1">17</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Lasota
<italic>et al.</italic>
<sup>
<xref rid="r26" ref-type="bibr">26</xref>
</sup>
, 1999</td>
<td align="left" rowspan="1" colspan="1">33</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Palacios
<italic>et al.</italic>
<sup>
<xref rid="r27" ref-type="bibr">27</xref>
</sup>
, 1999</td>
<td align="left" rowspan="1" colspan="1">11</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Karpati
<italic>et al.</italic>
<sup>
<xref rid="r18" ref-type="bibr">18</xref>
</sup>
, 2000</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">100 (1/1)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Remick
<italic>et al.</italic>
<sup>
<xref rid="r19" ref-type="bibr">19</xref>
</sup>
, 2000</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">100 (1/1)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Fink-Puches
<italic>et al.</italic>
<sup>
<xref rid="r28" ref-type="bibr">28</xref>
</sup>
, 2002</td>
<td align="left" rowspan="1" colspan="1">19</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Gessi
<italic>et al.</italic>
<sup>
<xref rid="r20" ref-type="bibr">20</xref>
</sup>
, 2002</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">100 (1/1)</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Kamiyama
<italic>et al</italic>
.
<sup>
<xref rid="r30" ref-type="bibr">30</xref>
</sup>
, 2004</td>
<td align="left" rowspan="1" colspan="1">1</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">Schmid
<italic>et al</italic>
.
<sup>
<xref rid="r6" ref-type="bibr">6</xref>
</sup>
, 2005</td>
<td align="left" rowspan="1" colspan="1">40</td>
<td align="left" rowspan="1" colspan="1">none</td>
</tr>
<tr>
<td align="left" rowspan="1" colspan="1">TOTAL</td>
<td align="left" rowspan="1" colspan="1">222</td>
<td align="left" rowspan="1" colspan="1">0.06 (13/222)</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="TFN2">
<p>AS, angiosarcoma; HHV-8, herpes virus 8</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>In our study, none of the 14 AS cases was positive for HHV-8, in contrast to the EKS control cases, which were all positive for HHV-8. This is consistent with the findings of numerous other studies from different countries, which could not establish an association between HHV-8 and AS. Amongst the studies that did not identify HHV-8-positive AS, HIV serology was not addressed in 4 articles, which could make it more difficult to distinguish between AS and EKS.
<sup>
<xref rid="r7" ref-type="bibr">7</xref>
,
<xref rid="r15" ref-type="bibr">15</xref>
,
<xref rid="r17" ref-type="bibr">17</xref>
,
<xref rid="r18" ref-type="bibr">18</xref>
</sup>
</p>
<p>The rate of HHV-8 infection varies worldwide, and the absence of HHV-8 in the AS lesions of the Brazilian patients described here reflects the findings of other studies in countries where the virus has a low prevalence.</p>
</sec>
<sec sec-type="conclusions">
<title>CONCLUSION</title>
<p>The Brazilian case series discussed in this report confirms the absence of HHV-8 in the AS lesions and adds data from a population not yet reported. Hence, despite the characteristic endothelial tropism of HHV-8 and its association with some vascular tumors, such as KS, it does not seem to be involved in the pathogenesis of AS.</p>
</sec>
</body>
<back>
<fn-group>
<fn fn-type="COI-statement">
<p>Conflict of Interest: None</p>
</fn>
<fn fn-type="supported-by">
<p>Financial Support: None</p>
</fn>
<fn fn-type="other" id="fn1">
<label>*</label>
<p>Work performed at the Universidade de São Paulo (USP) – São Paulo (SP), Brazil.</p>
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