Diagnosis: Angiolymphoid hyperplasia with eosinophilia (ALHE)
It is also known as epithelioid hemangioma .This is a rare lesion commonly seen in the head-neck region and characterized by single or multiple smooth-top papules or nodules of varying color. Microscopically, well circumscribed lesions usually located in the dermis and subcutis, atypical vascular proliferations and varying degrees of nodular and diffuse lymphocytic infiltrates with eosinophils. The vessels are lined by plump endothelial cells with abundant eosinophilic cytoplasm with occasional cytoplasmic vacuoles. There is fibromyxoid matrix in the wall and inflammatory infiltrate surrounding the vessels. Thick-walled vessels near thin walled vessels.
Differential Dx: Kimura's disease (KD)
The common features: predilection for the head and neck regions, tendency to recur, and vascular nature of the lesion with lymphoid and eosinophilic infiltrates.
Difference:
Histopathological: "histiocytoid" or "epithelioid" blood vessels in ALHE but not in KD. KD characterized by florid lymphoid infiltrate with prominent lymphoid follicles, vascularization of germinal centers, germinal center necrosis, marked eosinophilia with or without eosinophil abscess formation, eosinophilic folliculolysis, IgE deposits in the germinal centers; and frequent involvement of regional lymph nodes.
Clinical: KD for younger individuals (young Asian male) for a longer duration, deeply seated, large soft-tissue mass, often accompanied by peripheral blood eosinophilia and elevated serum IgE. ALHE: small dermal papular or nodular eruptions observed, older patients and present for a shorter duration; less frequently accompanied by peripheral blood eosinophilia.
It is also known as epithelioid hemangioma .This is a rare lesion commonly seen in the head-neck region and characterized by single or multiple smooth-top papules or nodules of varying color. Microscopically, well circumscribed lesions usually located in the dermis and subcutis, atypical vascular proliferations and varying degrees of nodular and diffuse lymphocytic infiltrates with eosinophils. The vessels are lined by plump endothelial cells with abundant eosinophilic cytoplasm with occasional cytoplasmic vacuoles. There is fibromyxoid matrix in the wall and inflammatory infiltrate surrounding the vessels. Thick-walled vessels near thin walled vessels.
Differential Dx: Kimura's disease (KD)
The common features: predilection for the head and neck regions, tendency to recur, and vascular nature of the lesion with lymphoid and eosinophilic infiltrates.
Difference:
Histopathological: "histiocytoid" or "epithelioid" blood vessels in ALHE but not in KD. KD characterized by florid lymphoid infiltrate with prominent lymphoid follicles, vascularization of germinal centers, germinal center necrosis, marked eosinophilia with or without eosinophil abscess formation, eosinophilic folliculolysis, IgE deposits in the germinal centers; and frequent involvement of regional lymph nodes.
Clinical: KD for younger individuals (young Asian male) for a longer duration, deeply seated, large soft-tissue mass, often accompanied by peripheral blood eosinophilia and elevated serum IgE. ALHE: small dermal papular or nodular eruptions observed, older patients and present for a shorter duration; less frequently accompanied by peripheral blood eosinophilia.
Ann Dermatol. 2010 Feb;22(1):57-60
IJDVL