Angiolymphoid Hyperplasia With Eosinophilia Workup

Updated: Apr 11, 2019
  • Author: Gauri Panse, MBBS, MD; Chief Editor: William D James, MD  more...
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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.

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Procedures

The clinical presentation of papules around the ears may suggest angiolymphoid hyperplasia with eosinophilia (ALHE), but a biopsy is required to establish the diagnosis.

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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 hobnail appearance. In addition, a perivascular and interstitial infiltrate composed primarily of lymphocytes and eosinophils (see the image below) 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. A subset of ALHE, including multiple eruptive lesions, may show increased cellularity. [22]

In 2018, immunohistochemical staining for FOSB, with nuclear staining in ALHE, was reported as a useful marker in distinguishing ALHE from its morphologic mimics. [23]

Histologically, angiolymphoid hyperplasia with eosinophilia is marked by thick-walled blood vessels with protuberant endothelium and a prominent inflammatory infiltrate, which typically includes eosinophils.

Histologically, angiolymphoid hyperplasia with eos Histologically, angiolymphoid hyperplasia with eosinophilia is marked by thick-walled blood vessels with protuberant endothelium and a prominent inflammatory infiltrate, which typically includes eosinophils.
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