Angiocentric Lesions of the Head and Neck

Abstract

Angiocentric lesions of the head and neck encompass a variety of benign and malignant lesions. Not unexpectedly the sequelae of an angiocentric process independent of its benign or malignant nature is one of tissue ischemia with a potential for either breakdown or reparative fibrosis. Therefore, the clinical presentations can be very similar despite a varied pathogenesis. Among the benign reactive infiltrates that will be considered are angiocentric eosinophilic fibrosis, Wegener's granulomatosis, microscopic polyangiitis and cocaine associated mid line facial destruction. We will discuss other conditions which enter into the differential diagnosis either clinically or histologically including Erdheim Chester disease and mid line facial undermining unrelated to an angiocentric event specifically in the context of trigeminal trophic ulcer and relapsing polychondritis. The two main neoplastic conditions exhibiting angiocentricity are in the context of lymphomatoid granulomatosis and NK/T cell lymphoma; hence these two particular hematologic dyscrasias will be discussed in some detail in this review.

Myocbacterium-Avium Intracellulare Associated Inflammatory Pseudotumor of the Anterior Nasal Cavity

“…This includes angiocentric eosinophilic fibrosis, Wegener's granulomatosis, and microscopic polyangiitis [27]. Microscopically, a pauci-cellular necrosis of the nasal mucosa with associated vasculitis is usually seen.…”

Pathology of toxic leucoencephalopathy in drug abuse supports hypoxic‐ischemic pathophysiology/etiology

“…There are many different pathological changes associated with different pharmacological effects of cocaine on cerebral vasculatures. Cocaine may lead to ischemic stroke as a result of vasoconstriction, vasospasm and thrombosis secondary to endothelial injury or vasculitis . It is also commonly associated with hemorrhagic stroke as a result of vasospasm, hypertension and impaired cerebral auto‐regulation of cerebral blood flow .…”

Nasal Eosinophilic Angiocentric Fibrosis with Orbital Extension

“…The late lesions are composed of dense fibrosis with angiocentric pattern and mixed inflammatory cells. The fibrous component has a concentric layered onion-skin-type perivascular arrangement, which is characteristic of EAF and are useful for making the histologic diagnosis of EAF [1,2,6,17]. EAF is now considered a part of IgG4-related disease spectrum [18,19].…”

“…The differential diagnosis of EAF include Churg-Strauss syndrome, Wegener's granulomatosis (WG), microscopic polyangitis, cocaine associated midline facial destruction, sarcoidosis, infectious granulomatous conditions, Sjogren's syndrome, angiolymphoid hyperplasia with eosinophilia (AHLE), erythema elevatum diutinum (EED), Kimura disease, Erdheim-Chester disease, inflammatory pseudotumor, trigeminal trophic ulcer, and relapsing polychondritis, and two neoplastic conditions are lymphomatoid granulomatosis and NK/T cell lymphoma [7,14,17].…”