Answer: C - HHV-8

This is a case of HHV8-associated intestinal Kaposi’s sarcoma, a vascular malignancy associated with HHV8 infection that is most often seen in patients with Acquired Immunodeficiency Syndrome (AIDS) . Although it is a rare entity in the gastrointestinal tract, it is the most common AIDS-associated GI malignancy. The degree of immunosuppression influences the prognosis.

Histologic findings include a spindle cell proliferation in the lamina propria with mild to moderate atypia, which are arranged in vague fascicles and separated by slit-like vessels. Extravasated red blood cells and hyaline globules are commonly seen.

The differential diagnosis include severe vascular stasis (acroangiodermatitis), hobnail hemangioma (targetoid hemosiderotic hemangioma), spindle cell hemangioma, Kaposiform hemangioendothelioma and angiosarcoma; however all these lesions are negative for HHV8 immunostain.