Angiolymphoid hyperplasia with eosinophilia versus Kimura's disease: a case report and a clinical and histopathological comparison

Abstract Angiolymphoid hyperplasia with eosinophilia is a rare and benign vascular tumor whose etiology remains uncertain. It clinically presents itself by angiomatous papules or nodules located on the head and neck. Many controversies in the literature are found in relation to angiolymphoid hyperplasia with eosinophilia and Kimura's disease - its main differential diagnosis - due to their clinical and histopathological similarities. However, currently, most studies agree that they are distinct diseases. The present case illustrates a characteristic description of angiolymphoid hyperplasia with eosinophilia and also highlights the main differences with Kimura's disease.

Caso para diagnóstico / Case for diagnosis

Descreve-se um paciente com características clínicas e histopatológicas típicas da hiperplasia angiolinfoide com eosinofilia. Trata-se de uma hiperplasia vascular benigna que importa reconhecer e distinguir da doença de Kimura.

This report describes a patient with clinical and histopathological findings compatible with angiolymphoid hyperplasia with eosinophilia. This benign vascular hyperplasia should be recognized and differentiated from Kimura's disease.

Angiolymphoid hyperplasia with eosinophilia: improvement in a recurrent case with isotretinoin

Angiolymphoid hyperplasia with eosinophilia [ALHE], characterized by dermal and subcutaneous nodules in head and neck areas, is often very disfiguring. There are different modalities of treatment but surgery seems to be the best. We report a 31-year-old man with recurrent ALHE showing considerable improvement with isotretinoin

Epithelioid hemangioma of the colon: a case report / Hemangioma epitelióide do cólon: relato de caso

CONTEXT: Epithelioid hemangioma or angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular neoplasm that is usually located on the face or neck. Exceptionally, it has been described affecting the colon, with only two such cases described in the worldwide literature. The aim here was to present a case of primary epithelioid hemangioma of the sigmoid colon with confirmation by immunohistochemical examination. CASE REPORT: A 37-year-old woman had had a complaint of intermittent abdominal pain for six months. Two months after the condition started, she began to present changes in her intestinal habit, with evacuations containing blood and mucus and a weight loss of 4 kg over this period. At physical examination, a palpable mass was noted in the lower left quadrant of the abdomen. Neoplasia of the colon was clinically suspected and she underwent colonoscopy. This demonstrated the presence of a vegetating sessile lesion of approximately 5 cm in diameter, at a distance of 36 cm from the anal margin. It occupied 80 percent of the intestinal lumen. A biopsy collected during the examination suggested a diagnosis of neoplasia of vascular origin. After surgical resection, histopathological examination of the resected specimen confirmed the diagnosis of epithelioid hemangioma of the colon, which was backed up by the immunohistochemical panel (factor VIII, Ki-67, CD-34). At present, three years after the surgery, the patient is asymptomatic, she has recovered her normal weight and she has normal findings from control colonoscopy. Despite the rarity of neoplasia of vascular origin, this possibility should be considered in the differential diagnosis for colorectal tumors.

CONTEXTO: Hemangioma epitelióide ou hiperplasia angiolinfóide com eosinofilia são neoplasias vasculares benignas raras, habitualmente localizadas na face e pescoço. O acometimento do intestino grosso é excepcionalmente descrito, existindo apenas dois casos descritos na literatura mundial. O objetivo deste artigo é apresentar um caso de hemangioma epitelióide primário do sigmóide com diagnóstico histopatológico confirmado por meio de estudo imunoistoquímico. RELATO DE CASO: Mulher de 37 anos apresentou queixa de dor abdominal de forte intensidade, intermitente, localizada no hipogástrio. Dois meses após o início do quadro, notou alteração do hábito intestinal, evacuações com sangue, muco e perda ponderal de 4 quilos no período. Ao exame físico abdominal, identificou-se massa palpável no quadrante inferior esquerdo. Com suspeita clínica de neoplasia de cólon foi submetida a colonoscopia, que demonstrou presença de lesão vegetante de aproximadamente cinco centímetros de diâmetro, ocupando cerca de 80 por cento da luz colônica. A biópsia mostrou a presença de neoplasia de origem vascular. Após a ressecção cirúrgica, o exame histopatológico do espécime extirpado estabeleceu o diagnóstico de hemangioma epitelióide do cólon, confirmado por meio de painel imunoistoquímico (fator VIII, Ki-67, CD-34). No momento, a paciente encontra-se bem, tendo recuperado o peso inicial três anos após a cirurgia e apresenta resultado de colonoscopia de controle normal. Não obstante a raridade, deve-se considerar a possibilidade das neoplasias de origem vascular no diagnóstico diferencial dos tumores colorretais.

Angiolymphoid hyperplasia with eosinophilia [pseudopyogenic granuloma] among Iraqi patients

Angiolymphoid hyperplasia with eosinophilia [ALHE] [pseudopyogenic granuloma] is a benign locally proliferating lesion composed of vascular channels with a surrounding infiltrate of lymphocytes and eosinophils. ALHE is a rare disease but in Iraq it apparently seems to be more common than expected, for this reason the present work was arranged to evaluate the clinical and histopathological aspects of the disease. This case descriptive study was conducted in the Department of Dermatology and Venereology- Baghdad Teaching Hospital during the period between June 1982- March 2005. Sixteen patients with this skin problem, were included in this study. All demographic points related to the disease were obtained from each case through detailed history, close clinical and histopathological means. Sixteen patients with ALHE were evaluated. Their ages of patients ranged from 20-50 years with a mean +/- SD of 35.73 +/- 8.72 years, they were 14 females and two males. The duration of the disease ranged from 1-15 [6.4 +/- 4.42] years. The clinical picture consisted of multiple dull to pinkish red angiomatous papules and nodules affecting the head only mostly around the scalp and ears. The histopathological examination revealed a proliferation and ectasia of blood vessels with eosinophilic infiltrate of the dermis. This study revealed that angiolymphoid hyperplasia with eosinophilia [ALHE] in Iraq, is a disease predominantly of adult females only affecting the head, with no lymphadenopathy and typical histopathology without lymphoid follicle formation. This is the first report describing this disease in Iraq and seems to be more common than European countries

Hiperplasia angiolinfoidea con eosinofilia: Presentación de un caso en cavidad oral y revisión de la literatura / Angiolymphoid hyperplasia of the lip with eosinophilia: Report of one case

We report a 33 year-old female presenting with a 2 cm tumor of the upper lip lasting one year. The tumor was excised and the pathological examination showed multiple blood vessels with thickened walls, prominent endothelial cells, lymphoid follicles and an increased number of eosinophils. The final diagnosis was an angiolymphoid hyperplasia with eosinophilia. Six months after surgery, the patient was free of disease. This is a rare condition that must be distinguished from Kimura disease.

Hiperplasia angiolinfoide con eosinofilia: a propósito de dos casos / Angiolymphoid hyperplasia with eosinophilia: a propos of two cases

La Hiperplasia Angiolinfoide con Eosinofilia (HALE) es una proliferación vascular benigna, poco frecuente, que se caracteriza por nódulos localizados preferentemente en el cuero cabelludo, región periauricular y cuello, en adultos jóvenes. La histopatología muestra proliferación de vasos sanguíneos con endotelio prominente, acompañada de un infiltrado inflamatorio que incluye eosinófilos y linficitos. El tratamientos de elección es la resección quirúrgica; sin embargo, las recurrencias son frecuentes. Se presentan dos casos clínicos, se revisa la literatura y se discute la relación entre HALE y enfermedad de Kimura.

Hiperplasia angiolinfoide con eosinofilia: sobre 4 observaciones / Angiolymphoid hyperplasia with eosinophilia

La hiperplasia angiolinfoide con eosinofilia es una patología infrecuente de origen desconocido, que se caracteriza clínicamente por presentar nódulos ubicados en cabeza o cuero cabelludo de adultos jóvenes. Presentamos cuatro casos clínicos, tres de ellos con lesiones múltiples y uno solitario

Hiperplasia angiolinfoide con eosinofilia: casos clínicos y revisión de la literatura / Angiolymphoid hyperplasia with eosinophilia: report of 2 cases and a review of the literature

La hiperplasia angiolinfoide con eosinofilia (HALE) es una entidad clínica benigna, infrecuente, que se manifiesta con nódulos subcutáneos únicos o múltiples localizados de preferencia en la cabeza y cuello de adultos jóvenes. Se caracteriza en su histopatología por células endoteliales prominentes y un infiltrado inflamatorio con predominio de linfocitos, eosinofilos e histiocitos. La observación de dos pacientes con HALE, nos permite precisar la clínica, características histopatológicas e inmunología

Cytodiagnosis of Kimura's disease.

Kimura's Disease, a rare chronic inflammatory disorder with a benign course affecting the lymphoid tissue is reported hare in an 18 year old South Indian male who presented with bilateral solitary swelling over the mastoid region. Its fine needle aspiration cytology characterised by the Warthin-Finkeldey type giant cells against a background of a bimodal population of lymphocytes and eosinophils prompted the diagnosis of Kimura's disease at cytology itself. This was confirmed at histology. This is the third cytological report of its kind being reported in English literature. Literature with regard to the cytological appearances of Kimura's disease has been reviewed and the various differential diagnoses discussed.

Enfermedad de Kimura-HAE / HAE-Kimura's disease

Se presenta el caso de un paciente de sexo masculino con enfermedad de Kimura. A propósito del mismo se recuerdan las principales características clínico-patológicas de la enfermedad de Kimura y la hiperplasia angiolinfoide con eosinofilia, destacando en este paciente la necesidad de descartar distintos tipos de paniculitis

Hiperplasia angiolinfoide con eosinofilia: presentación de dos casos / Angiolymphoid hyperplasia with eosinophilia: two cases

Presentan dos casos de hiperplasia angiolinfoide con eosinofilia (HAE). Pacientes de sexo femenino de 79 y 35 años de edad, la primera con una lesión tumoral en cuero cabelludo y la segunda con pápulas y nódulos en pabellón auricular. El diagnóstico se confirmó por histopatología. El objetivo de este trabajo es comentar las características principales de esta entidad, destacar sus diferencias con la enfermedad de Kimura y plantear la fotocoagulación con láser de CO2 como alternativa terapéutica de interés

Angiolymphoid hyperplasia with eosinophilia and Kimura's disease: a clinicopathological study

In this work, the clinical and histopathological features of 10 cases of angiolymphoid hyperplasia with eosinophilia and 5 cases of Kimura's disease are described and a comparison between the features of the two lesions is presented. Angiolymphoid hyperplasia showed exuberant proliferation of vessels lined by plump endothelial cells with irregular nuclei and cytoplasmic vacuoles, together with fibromyxiod matrix and inflammatory cells infiltrate containing eosinophils. Involvement of muscular coat of blood vessels or even growth entirely within a vessel was a common feature. It occurred in the skin and subcutaneous tissue. Kimura's disease occurred in the parotid gland and the subcutaneous tissues. It was characterized by florid lymphoid infiltrate with prominent lymphoid follicle, vascularization of germinal centres, germinal centre necrosis with eosinophilic material [folliculolysis], and marked eosinophilia with or without eosinophil abscess formation

Hiperplasia angiolinfoide: consideraciones clínico-patológicas / Angiolymphoid hyperplasia: clinico-pathological considerations

Se presenta dos casos de Hiperplasia Angiolinfoide con eosinofilia o Enfermedad de Kimura. La forma de presentación fueron la nodular y la papuloide. En la primera, la expresión histológica del componente vascular y celular se ubicaba en la epidermis, mientras que en la segunda la localización era en la dermis. Se realizan consideraciones clínico-patológicas para diferenciar ambas enfermedades. Debido a la superposición de ciertos criterios se considera que se trata de una misma enfermedad en distintos estadios