eMedicine Specialties > Dermatology > Diseases of the Vessels

Angiolymphoid Hyperplasia With Eosinophilia: Differential Diagnoses & Workup

Author: Sarah K Taylor, MD, Staff Physician, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Coauthor(s): Jon H Meyerle, MD, Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Consulting Staff, Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center; Earl J Glusac, MD, Professor, Departments of Pathology and Dermatology, Yale University School of Medicine
Contributor Information and Disclosures

Updated: Dec 11, 2008

Differential Diagnoses

Granuloma Faciale
Insect Bites
Kimura Disease
Lymphocytoma Cutis
Pyogenic Granuloma (Lobular Capillary Hemangioma)
Sarcoidosis

Other Problems to Be Considered

Angiosarcoma
Hemangioendothelioma
Hemangioma
Metastatic carcinoma to the skin
Kaposi sarcoma8

Workup

Laboratory Studies

A CBC count reveals eosinophilia in approximately 20% of patients with angiolymphoid hyperplasia with eosinophilia (ALHE). Given that some patients with ALHE have also been found to have renal disease, urinalysis could be considered.

Procedures

The clinical presentation of papules around the ears may suggest ALHE, but a biopsy is required to establish the diagnosis.

Histologic Findings

Angiolymphoid hyperplasia with eosinophilia (ALHE) shows characteristic histologic features, including a proliferation of small blood vessels, many of which are lined by enlarged endothelial cells with uniform ovoid nuclei and intracytoplasmic vacuoles. These distinctive endothelial cells have been described as having a cobblestone appearance. In addition, a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils (see Media File 3) is present. Eosinophils typically comprise 5-15% of the infiltrate. Rarely, they can account for as much as 50% of the infiltrate. Occasionally, the infiltrate is devoid of eosinophils. Lymphoid aggregates with or without follicle formation are typical.

More on Angiolymphoid Hyperplasia With Eosinophilia

Overview: Angiolymphoid Hyperplasia With Eosinophilia
Differential Diagnoses & Workup: Angiolymphoid Hyperplasia With Eosinophilia
Treatment & Medication: Angiolymphoid Hyperplasia With Eosinophilia
Follow-up: Angiolymphoid Hyperplasia With Eosinophilia
Multimedia: Angiolymphoid Hyperplasia With Eosinophilia
References
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References

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  2. Arnold M, Geilen CC, Coupland SE, Krengel S, Dippel E, Spröder J, et al. Unilateral angiolymphoid hyperplasia with eosinophilia involving the left arm and hand. J Cutan Pathol. Oct 1999;26(9):436-40. [Medline].

  3. Chan JK, Hui PK, Ng CS, Yuen NW, Kung IT, Gwi E. Epithelioid haemangioma (angiolymphoid hyperplasia with eosinophilia) and Kimura's disease in Chinese. Histopathology. Dec 1989;15(6):557-74. [Medline].

  4. Googe PB, Harris NL, Mihm MC Jr. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two distinct histopathological entities. J Cutan Pathol. Oct 1987;14(5):263-71. [Medline].

  5. Tsuboi H, Masuzawa M, Katsuoka K. Angiolymphoid hyperplasia with eosinophilia affecting the nail bed and underlying bone. J Dermatol. Jun 2006;33(6):399-402. [Medline].

  6. Esmaili DD, Chang EL, O'Hearn TM, Smith RE, Rao NA. Simultaneous presentation of Kimura disease and angiolymphoid hyperplasia with eosinophilia. Ophthal Plast Reconstr Surg. Jul-Aug 2008;24(4):310-1. [Medline].

  7. Zarrin-Khameh N, Spoden JE, Tran RM. Angiolymphoid hyperplasia with eosinophilia associated with pregnancy: a case report and review of the literature. Arch Pathol Lab Med. Sep 2005;129(9):1168-71. [Medline].

  8. Angiolymphoid Hyperplasia with Eosinophilia and Kimura Disease. In: Wolff, Goldsmith, Katz, Gilchrest, Paller, Leffell, eds. Fitzpatrick's Dermatology in General Medicine. Vol 1. 7th ed. New York, NY: McGraw-Hill Medical; 2008:313-14.

  9. Joshi R. Angiolymphoid hyperplasia with follicular mucinosis. Indian J Dermatol Venereol Leprol. Sep-Oct 2007;73(5):346-7. [Medline].

  10. Gonzalez-Cuyar LF, Tavora F, Zhao XF, Wang G, Auerbach A, Aguilera N, et al. Angiolymphoid hyperplasia with eosinophilia developing in a patient with history of peripheral T-cell lymphoma: evidence for multicentric T-cell lymphoproliferative process. Diagn Pathol. May 29 2008;3:22. [Medline].

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  13. Abrahamson TG, Davis DA. Angiolymphoid hyperplasia with eosinophilia responsive to pulsed dye laser. J Am Acad Dermatol. Aug 2003;49(2 Suppl Case Reports):S195-6. [Medline].

  14. Fetsch JF, Weiss SW. Observations concerning the pathogenesis of epithelioid hemangioma (angiolymphoid hyperplasia). Mod Pathol. Jul 1991;4(4):449-55. [Medline].

  15. Mehregan AH, Shapiro L. Angiolymphoid hyperplasia with eosinophilia. Arch Dermatol. Jan 1971;103(1):50-7. [Medline].

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Further Reading

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Keywords

angiolymphoid hyperplasia with eosinophilia, ALHE, epithelioid hemangioma, histiocytoid hemangioma, pseudopyogenic granuloma, papular angioplasia, inflammatory angiomatous nodule, inflammatory arteriovenous hemangioma, intravenous atypical proliferation.

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Contributor Information and Disclosures

Author

Sarah K Taylor, MD, Staff Physician, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Disclosure: Nothing to disclose.

Coauthor(s)

Jon H Meyerle, MD, Assistant Professor, Department of Dermatology, Johns Hopkins University School of Medicine; Consulting Staff, Laboratory Director, Department of Dermatology, Walter Reed Army Medical Center and National Naval Medical Center
Jon H Meyerle, MD is a member of the following medical societies: American Academy of Dermatology and Sigma Xi
Disclosure: Nothing to disclose.

Earl J Glusac, MD, Professor, Departments of Pathology and Dermatology, Yale University School of Medicine
Earl J Glusac, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Warren R Heymann, MD, Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey
Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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