EPITHELIOID ANGIOSARCOMA ARISING IN A SURGICALLY CONSTRUCTED ARTERIOVENOUS-FISTULA - A RARE COMPLICATION OF CHRONIC IMMUNOSUPPRESSION IN THE SETTING OF RENAL-TRANSPLANTATION

Immunosuppression in the setting of solid organ transplantation is ass ociated with the development of a variety of malignant tumors, most co mmonly squamous carcinomas and non-Hodgkin's lymphomas. Sarcomas, apar t from Kaposi's sar coma, are relatively infrequent. We recently encou ntered a 71-year-old man with chronic renal failure, treated by allogr aft kidney transplantation, who developed a high-grade epithelioid ang iosarcoma at the site of a nonfunctioning arteriovenous fistula, previ ously constructed for hemodialysis. At diagnosis, the patient had nume rous satellite nodules of angiosarcoma involving the distal skin, soft tissues, and bones. After a below-elbow amputation, there was a rapid local recurrence at the amputation stump. Currently, the patient is a live with numerous pulmonary metastases, 6 months after amputation. A Literature review identified three recently reported identical cases o f epithelioid angiosarcoma arising in nonfunctioning arteriovenous Fis tulae. All three patients had been treated by kidney transplantation f or renal failure, suggesting a possible causal association between the se events. We performed polymerase chain reaction for human herpes vir us 8. the recently recognized herpes virus proposed as a major etiolog ic agent of Kaposi's sarcoma, and possibly some conventional angiosarc omas, but we failed to identify any viral DNA within the tumor.