CASE AND RESEARCH LETTERS 549 hemangioma (hobnail hemangioma).2,8,9 Immunohistochem-

istry with antibodies to HHV-8 plays an essential role in establishing the definitive diagnosis.6,9,10 The histogenesis of KS has been the subject of consid-erable debate; discussion centers on whether this disease is blood-borne or originates in the lymphatic endothelial cells. With regard to lymphangioma-like KS specifically, histologic findings suggest that it originates from lymphatic endothelial cells, as initially suggested by Gange and Jones.2 This inter-pretation is consistent with recent immunohistochemical findings showing intense expression of several markers that are specific for the lymphatic endothelium; this was the pat-tern we saw in the neoplastic cells from our patient. It has been postulated that chronic lymphedema or a history of radiotherapy in the affected area could increase the risk of developing lymphangioma-like KS lesions.1,5 Our patient had never received radiotherapy and did not present with chronic lymphedema. In addition, the lesion in which we detected the lymphangioma-like KS was located on the fore-arm, not on a lower limb as described in most cases of this type of KS. This new case of lymphangioma-like KS involved a his-tory of histologically classic KS with successive recurrences consisting of lesions with the same clinical appearance, but with histopathologic findings suggestive of lymphangioma. A detailed histologic study in combination with immunohisto-chemistry, such as staining for HHV-8 latent nuclear antigen, is essential for correctly diagnosing lymphangioma-like KS