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Macrophages and vascular adhesion molecules in oral Kaposi's sarcoma

Kaposi's sarcoma (KS) is a heterogeneous tumor where spindle cells are predominant and macrophages and factor XIIIa positive dendrocytes are abundant. The origin of the macrophages and dendrocytes is unclear, although their numbers suggest a critical role in KS pathogenesis. To determine if KS macrophages are recruited from the blood stream or proliferate on‐site, we examined biopsy specimens 1) for expression and distribution of vascular adhesion molecules (PECAM‐1, ELAM‐1, ICAM‐1, VCAM‐1, P‐selectin, L‐selectin) and the macrophage‐associated adhesion‐molecule ligand, VLA‐4; 2) for dual expression of proliferation (Ki‐67) and lineage‐associated markers (KP‐1, CD34, factor XIIIa, LCA); and 3) for dual expression of macrophage (KP‐1) and endothelial cell (CD34) associated markers. Avidin‐biotin peroxidase techniques were used. Resident vessels were found to strongly express PECAM‐1, ELAM‐1, ICAM‐1, P‐selectin, and moderately express VCAM‐1 and VLA‐4. Tumor spindle cells showed less intense expression of ELAM‐1, ICAM‐1 and P‐selectin. The most frequent double‐stain combination was Ki‐67+CD34‐K In contrast, the combinations of Ki‐67+KP‐l+, Ki‐67+XIIIa+ and KJ‐67+LCA+ were rarely seen. The enhanced expression of adhesion molecules on resident vessels and the lack of evidence of macrophage proliferation suggest that the abundant macrophages in KS are recruited from the blood stream.