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7/29/2019 Angiolymphoid Hyperplasia With Eosinophilia, F 55, Lower Lip, PPT
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Angiolymphoid Hyperplasia with
Eosinophilia
Spencer Rusin M4, CUMC
Deba P Sarma, MDOmaha
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Patient Presentation
F 55, presents with a 10-month history of :
Non-ulcerated, painless nodule (0.5 cm)on her lower lip
No history of trauma or ear-nose-throatdisease.
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Differential Diagnosis
Mucocele
Lymphocytoma cutis
Granuloma faciale Benign and malignant tumors of skin and
adnexae
Kimura disease
Others
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A well circumscribed
dermal nodule
composed of central
angiomatous vascular
proliferation with
stromal and peripheral
infiltrates of
lymphocytes andeosinophils.
H&E: low power
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Proliferation of small blood vessels, lined by enlargedendothelial cells (epitheliod in appearance) with uniform ovoid
nuclei and intracytoplasmic vacuoles.
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Prominent eosinophilic and lymphocytic infiltration
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Lymphoid aggregate with follicle formation amongst the
vascular proliferative cells.
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Immunostains
CD 3Peripheral lymphocytes: Positive
CD 20 - Peripheral lymphocytes: Positive
CD31Vascular epitheliod endothelial cells:Positive
CK AE1/3 - Negative
S-100 - Negative
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CD 31 stain highlights the endothelial cells demonstrating a
strong angiogenesis component to the nodule.
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Diagnosis
Angiolymphoid hyperplasia with eosinophilia
(ALHE)
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Differential Diagnosis
ALHE
Primarily a localizedhyperplasia
Infrequentlymphadenopathy
20%
Rare blood eosinophlia
Histology:
Vascularproliferation>inflammatory cells
Epitheliod endothelialcells lining bloodvessels
Eosinophils present
Kimura Disease
Systemic involvement: Lymphadenopathy
Blood eosinophlia Nephrotic syndrome as
a result of glomerularIgE deposition.
Histological presentation ofKimura disease differs fromALHE in two factors.
Vascular proliferation
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ALHE
General presentation:
Range from asymptomatic to itchy orpainful erythematous nodules, 2-3cm indiameter.
The nodules may pulsate or bleed.
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Pre-auricular lesions of ALHE.
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ALHE Hypotheses regarding ALHEs origin:
Reactive process to insect bites
Hyperestrogen states
Immunologic mechanisms
Reactive vascular proliferation subsequent toinflammation associated with traumatized blood
vessels One study reported a history of trauma in only 9%
of 116 patients with ALHE
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ALHE
Age: 20-50 years, M = F
Locations affected by ALHE:
Head and neck:
Specifically the forehead, scalp, and skin aroundears.
Trunk and genitalia
Three documented cases of ALHE affecting the lip.
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ALHE
Progression of ALHE:
Most common course: ALHE remains stable
Infrequent outcome: ALHE spontaneously
regresses Chronic nature of ALHE necessitates treatment.
Recurrence rate ranges from 33-50%
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Treatment
Medical:
Isoretinoin
Corticosteroids
interferon alfa-2b Benefits:
Improved cosmetic outcomes
Limitations:
Relies on patient compliance Not a permanent cure
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Treatment
Surgical:
Laser therapy
Carbon dioxide laser
Ultralong pulsed dye laser Nd:YAG laser
Benefits:
Improved cosmetic outcome
Limitations: Multiple treatments
Adversely affected by the depth of invasion orsize of vessels
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Treatment
Surgical:
Excisional
Simple surgical excision
Mohs surgery Benefits:
Excision of the arterial and venous segments atthe base decrease recurrence
Limitations:
Scarring
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References
S. Seregard, Angiolymphoid hyperplasia with eosinophilia should not be confused withKimura's disease, Acta Ophthalmologica Scandinavica, vol. 79, issue 1, pps. 9193, 2001.
S.W. Weiss, J.R. Goldblum, "Enzinger and Weiss's Soft Tissue Tumors, 4th edition," St.Louis: Mosby, 2001. 863-864.
G.C. Wells, I.W. Whimster, "Subcutaneous angiolymphoid hyperplasia with eosinophilia,British Journal of Dermatology, vol. 81, pp 1-15, 1969.
R.L. Moy, D.B. Luftman, Q.H. Nguyen, J.S. Amenta,"Estrogen receptors and the response to
sex hormones in angiolymphoid hyperplasia with eosinophilia,"Archives of Dermatology,vol 128, pp. 825-828, 1992. R. Grimwood, J.M. Swinehart, J.L Aeling, "Angiolymphoid hyperplasia with eosinophilia,"
Archives of Dermatology, vol. 115, pp. 205-207, 1979. P. Von den Driesch, M. Gruschwitz, H. Schell, W. Sterry, Distribution of adhesion
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P.G. Henry, J.W. Burnett, Angiolymphoid hyperplasia with eosinophilia,Archives ofDermatology, vol. 114, no. 8, pp. 1168-1172, 1978. J.F. Fetsch, S.W. Weiss, Observations concerning the pathogenesis of epithelioid
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f i d
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References continued
J.R. Srigley, A.G. Ayala, N.G. Ordonez, A.W. van Nostrand, Epithelioid hemangioma of thepenis. A rare and distinctive vascular lesion,Archives of Pathology and LaboratoryMedicine, vol. 109, pp. 51-54, 1985.
J.I. Lopez, S.B. Battaglino, Angiolymphoid hyperplasia with eosinophilia of the lower lip,International Journal of Dermatology, vol. 32, issue 5, pp. 361-362, 1993.
H. Suzuki, A. Hatamochi, M. Horie, T. Suzuki, S. Yamazaki, A case of angiolymphoidhyperplasia with eosinophilia (ALHE) of the upper lip, Journal of Dermatology, vol. 32, no.
12, pp. 991-995, 2005. O.F. Salinas, Y.S. Corredoira, G.A. Rojas, Angiolymphoid hyperplasia of the lip with
eosinophilia. Report of one case, Revista Medica de Chile, vol. 135, no.5, pp. 636-639,2007. (in Spanish)
A. Satpathy, C. Moss, F. Raafat, R. Slator, Spontaneous regression of a rare tumour in achild: angiolymphoid hyperplasia with eosinophilia of the hand: case report and review ofthe literature, British Journal of Plastic Surgery, vol. 58, issue 6, pps. 865-868, 2005.
B.V. Diaz, M.C. Lenoir, A. Ladoux, C. Frelin, M. Demarchez, S. Michel, Regulation ofvascular endothelial growth factor expression in human keratinocytes by retinoids,Journal of Biological Chemistry, vol. 275, no. 1, pps. 642-650, 2000.
F. El Sayed, R. Dhaybi, A. Ammoury, M. Chababi, Angiolymphoid hyperplasia witheosinophilia: efficacy of isotretinoin?, Head & Face Medicine, vol. 2, p. 32-36, 2006. T. Kaur, K. Sandhu, S. Gupta, A.J. Kanwar, B. Kumar, Treatment of angiolymphoid
hyperplasia with eosinophilia with the carbon dioxide laser, Journal of DermatologicalTreatment, vol. 15, issue 5, pps. 328-330, 2004.
C. Angel, A. Lewis, T. Griffin, E. Levy, A. Benedetto, Angiolymphoid hyperplasiasuccessfully treated with an ultralong pulsed dye laser, Dermatologic Surgery, vol. 31, pps.713-716, 2005.
C.J. Miller, M.D. Ioffreda, C.T. Ammirati, Mohs micrographic surgery for angiolymphoidhyperplasia with eosinophilia, Dermatological Surgery, vol 30,issue 8, pps. 1169-1173,2004.
T. Rohrer, A.Allan, ANgiolymphoid hyperplasia with eosinophilia successfully treated witha long pulsed tunable dye laser Dermatologic Surgery vol 26 issue 3 pps 211 214