Absence of human herpesvirus-8 DNA in angiosarcoma

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.

Kaposi's sarcoma-associated herpesvirus: clinical, diagnostic, and epidemiological aspects

Kaposi's sarcoma-associated herpesvirus (KSHI) is one of the few viruses proven to be associated with tumorigenesis in humans. Its causal association with all clinical and epidemiological variants of Kaposi's sarcoma (KS) is well established. KSHV is also involved in the pathogenesis of primary effusion lymphoma (PEL) and a subset of multicentric Castleman's disease (MCD). Possible associations of KSHV with other clinical settings have been extensively examined. The findings from several of these studies are contradictory and are yet to be resolved. Concentrated effort over the last decade, since the initial discovery of KSHV, led to the development of several experimental systems that resulted in a better comprehension of the biological characteristics of KSHV and set the stage for the understanding of mechainisms by which diseases are induced by the virus. The development of molecular, histological, and serological tools for KSHV diagnosis allowed researchers to track the transmission and to study the epidemiology of KSHV. These assays have been applied, in particular in ambiguous cases, in order to confirm clinically and pathologically based diagnoses. Here, we review the advances in the clinical, experimental, diagnostic, and epidemiological research of KSHV.

Human herpesvirus 8 and angiosarcoma: analysis of 40 cases and review of the literature

AIMS

To prove a possible involvement of the endotheliotropic human herpesvirus 8 (HHV-8) in the pathogenesis of angiosarcoma in samples from patients in a low HHV-8 seroprevalence area.

METHODS

A comprehensive series of angiosarcomas (n = 40) as well as positive and negative control tissues from patients with Kaposi's sarcoma, human immunodeficiency virus (HIV)-associated multicentric Castleman's disease or juvenile haemangioma, respectively, was analysed with two sensitive methods: immunohistochemical staining for the HHV-8 latency-associated nuclear antigen 1 (LANA-1); and polymerase chain reaction (PCR) for HHV-8 VP23 DNA sequences.

RESULTS

None of the angiosarcoma cases and none of the negative control samples (juvenile haemangiomas) revealed positive immunohistochemical staining with the LANA-1 antibody. In contrast, HHV-8 LANA-1 was clearly detected in all analysed cases of Kaposi's sarcoma and multicentric Castleman's disease. These results were confirmed by PCR assay at the DNA level.

CONCLUSION

In conclusion, the great majority of angiosarcomas investigated to date, including the series of 40 angiosarcomas analysed here, does not contain HHV-8 DNA sequences or protein. This argues against a relevant role of the endotheliotropic HHV-8 in the pathogenesis of angiosarcoma and, for vascular diseases, speaks in favour of a relatively restricted pathogenic role of HHV-8 to Kaposi's sarcoma and multicentric Castleman's disease.

Human herpesvirus 8 investigations: a role in the clinical management of Kaposi's sarcoma?

Kaposi's sarcoma (KS) is a vascular tumour associated with infection by human herpesvirus 8 (HHV-8). Most of the recent studies on KS have focused on the epidemiology and molecular biology of HHV-8. However, the contribution of virological investigations into HHV-8 to the clinical management of KS has been poorly evaluated so far. From a diagnostic point of view, HHV-8 currently appears as a useful tool for distinguishing KS from its mimics. Seroconversion to antibodies against HHV-8 may predict the development of KS in susceptible individuals, and reduction of HHV-8 viraemia is associated with therapies effective against KS. Further prospective studies are still required to determine the role of serological or genotypic investigations into HHV-8 in the prevention of KS and in KS response to therapy.

Demonstration of human herpesvirus 8 in a case of primary vaginal epithelioid angiosarcoma by in situ hybridization, electron microscopy, and polymerase chain reaction

We demonstrate the presence of human herpesvirsus 8 (HHV-8) in a primary vaginal location of angiosarcoma (AS) by polymerase chain reaction (PCR), in situ hybridization, and ultrastructural direct visualization of viral particles. The latter two techniques for the first time confirm HHV-8 detection in an AS by PCR; these results contribute to the debate caused by the controversial data produced by the almost exclusive use of PCR for investigating the possible presence of HHV-8 in AS, and its possible implications. Moreover, the investigated AS is the seventh published primary vaginal one, and the fourth unrelated to radiotherapy. Interestingly, the affected patient had used a ring pessary for 10 years because of an uterovaginal prolapse.

Angiosarcoma in a chronically immunosuppressed renal transplant recipient: report of a case and review of the literature

Angiosarcomas are rare malignant tumors of endothelial origin that occur predominantly in the adult population. To date, only 12 cases have been described after renal transplantation. We review the literature and present an additional case of a 59-year-old patient in whom lower-extremity lesions of cutaneous angiosarcoma developed several years after transplantation. Of the 13 patients, clinical details were available in only 12 cases. There were 10 male and 2 female patients. The mean age at diagnosis was 47.6 years (age range, 28-71 years). Almost all patients were on a combination immunosuppressive regimen, and the interval between transplantation and the development of the tumor was variable in the range of 8 months to 12 years. In five patients, the tumor arose within or adjacent to an arteriovenous fistula site. Cutaneous involvement was observed in only four cases. The histologic spectrum consisted of both well-differentiated and poorly differentiated tumors. In one patient, features of the hemophagocytic syndrome were clinically present and the tumor morphologically displayed prominent erythrophagocytosis. In two of the cases, including the patient described in the current report, polymerase chain reaction was performed on lesional tissue for human herpesvirus-8 and the result was negative for the presence of viral DNA. Despite the use of multimodal aggressive therapy in most patients, death as a result of disease dissemination occurred over variable time periods (range, 1-15 months).

Spectrum of Kaposi's sarcoma-associated herpesvirus, or human herpesvirus 8, diseases

Human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV), discovered in 1994, is a human rhadinovirus (gamma-2 herpesvirus). Unlike other human herpesviruses (herpes simplex virus, Epstein-Barr virus, varicella-zoster virus, cytomegalovirus, HHV-6, and HHV-7), it is not widespread in the general population and has many unique proteins. HHV-8 is strongly associated with all subtypes of Kaposi's sarcoma (KS), multicentric Castleman's disease, and a rare form of B-cell lymphoma, primary effusion lymphoma. In addition, HHV-8 DNA sequences have been found in association with other diseases, but the role of the virus in these diseases is largely unconfirmed and remains controversial. The seroprevalence of HHV-8, based on detection of latent and lytic proteins, is 2 to 5% in healthy donors except in certain geographic areas where the virus is endemic, 80 to 95% in classic KS patients, and 40 to 50% in HIV-1 patients without KS. This virus can be transmitted both sexually and through body fluids (e.g., saliva and blood). HHV-8 is a transforming virus, as evidenced by its presence in human malignancies, by the in vitro transforming properties of several of its viral genes, and by its ability to transform some primary cells in culture. It is not, however, sufficient for transformation, and other cofactors such as immunosuppressive cytokines are involved in the development of HHV-8-associated malignancies. In this article, we review the biology, molecular virology, epidemiology, transmission, detection methods, pathogenesis, and antiviral therapy of this newly discovered human herpesvirus.