Angiolymphoid hyperplasia with eosinophilia — A case report

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE), also known as epithelioid haemangioma [1, 2] or histiocytoid haemangioma, is currently considered to be a true neoplasm rather than a reactive phenomenon [3]. This entity is uncommon and has been frequently confused with Kimura's disease in the past [1, 2]. One such case encountered recently is presented. Case Report A 29 year old male presented with multiple, dome-shaped, flesh coloured nodules which were getting superficially ulcerated and crusted owing to pruritis of approximately 2 years duration. The lesions were located over concha and external auditory meatus of right ear. The largest single nodule measured 2 cms in diameter. There was no localized lymphadenopathy and peripheral eosinophilia. He was clinically treated as a case of tubercular verrucosa cutis and was administered anti-tubercular therapy for six months without any significant remission of the disease. Excision biopsy of a nodule done later, revealed a reasonably circumscribed intra-dermal mass composed of numerous, variable-sized, proliferating blood vessels (capillaries and medium sized arteries), lined by plump epithelioid endothelial cells, giving a hobnail or tombstone appearance; variable number of eosinophils (in different tissue sections); and diffuse, dense collections of lymphocytes around vessels (Fig. 1, Fig. 2). No lymphoid follicles were noted in the lesion. A diagnosis of ALHE was made. Open in a separate window Fig. 1 Tumour comprising large number of blood vessels with collection of lymphocytes and eosinophils underneath epidermis (H &E × 60)