Angiolymphoid Hyperplasia With Eosinophilia (Epithelioid Hemangioma) of the Lung

Abstract

Two cases of primary angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) (ALHE/EH) of the lung are described. Both patients are white, a 60-year-old man and a 27-year-old woman. One patient had a long-standing history of asthma, and the other had symptomatology related to the pulmonary mass. Wedge resections were performed in both cases, and both lesions shared similar histopathologic changes, mainly the presence of a tumor mass with a marked presence of eosinophils in the background, lymphoid hyperplasia, and marked proliferations of small-caliber vessels. Immunohistochemical studies using leukocyte common antigen, L-26, and UCHL-1 nicely stained the lymphoid component of the lesion, and CD31 clearly outlined the vascular component of the process. Clinical follow-up demonstrated that the woman died of status asthmaticus, and the man was alive and well 1 year after surgical resection of the lesion. Both cases highlight the ubiquitous distribution of ALHE/EH and underscore the importance of keeping these lesions in the differential diagnosis of vascular and lymphoid lesions of the lung.

Radicular cyst in primary dentition showing angiolymphoid hyperplasia with eosinophilia (ALHE)-like features

“…A relationship between ALHE with asthma is not clear. Moran et al (2005) 7 reported two ALHE (EH) cases affecting the lung; of them, only one patient had a long-standing history of asthma 7 . Differently, Galindo-Ferreiro et al (2016) 8 assessed ALHE cases with orbital and adnexal involvement, and none of them had asthma 8 .…”

Angiolymphoid Hyperplasia with Eosinophilia—A Case Report

“…The reactive blood vessels are often epithelioid, leading to the terms "histiocytoid" or, more recently "epithelioid" haemangioma [6]. Immunohistochemical stains usually show a major population of T-Lymphocytes [5] with occasional B cells forming lymphoid follicles [6]. Since the description of the initial large series [6], there have been numerous reports of this condition, with lesions occurring in a variety of organs, including disseminated disease [1,[9][10][11][12][13][14][15].…”

“…It is rare in elderly patients and in the non-Asian paediatric population. ALHE is somewhat more common in females; however, a male predominance has been noted in selected Asian studies [5]. It presents most commonly in patients aged 20 -50 years, with a mean onset of 30 -33 years [5].…”

Angiolymphoid hyperplasia with eosinophilia and Kimura disease overlap, with evidence of diffuse visceral involvement

“…ALHE and KD both rarely involve visceral organs including lungs, spleen, and liver. [12][13][14][15] KD in particular is associated with proteinuria and nephrotic syndrome. 16 The differential diagnosis of KD and ALHE with multisystem involvement includes IgG4-RD.…”