Giant angiolymphoid hyperplasia with eosinophilia on the chest

Abstract

Angiolymphoid hyperplasia with eosinophilia is a rare vascular proliferation characterized by single or multiple purplish, brownish papules and subcutaneous nodules, sometimes associated with pain or pruritus. This rare benign process occurs with a female predominance. Approximately 85% of the lesions occur in the skin of the head and neck; most of them are around the ear or on the forehead or scalp. Whether angiolymphoid hyperplasia with eosinophilia represents a benign neoplasm or an unusual reaction to varied stimuli, including trauma, the etiology remains unclear. Histopathologically, the lesions consist of a proliferation of blood vessels of variable size lined by large epithelioid endothelial cells and a variable inflammatory infiltrate of lymphocytes and eosinophils, sometimes with lymphoid follicle formation. The lesion is benign but may be persistent and is difficult to eradicate. We report on a case of a 58‐year‐old Caucasian man who presented a purplish pink dome‐shaped tumor of size up to 8 cm in diameter located on the chest. We emphasize this case considering the unusual dimensions of the lesion (8 cm diameter) and the atypical location on the chest.

Unusual Presentation of Angiolymphoid Hyperplasia With Eosinophilia in a Thirty-Six–Year-Old Man

“…Peripheral blood eosinophilia (5 -15% WBCs) is seen in about 20% of patients (5, 6). the ALHE is usually seen in Asians (5).…”

“…Trauma, pregnancy, immunizations, and malformations may be the triggering factors for ALHE (3,5,7). Allergic reaction secondary to the immunization may induce ALHE lesions (5). Vascular endothelial growth factor and interleukin 5 are increased in some cases (5).…”

“…The etiology is unknown. The studies have explained that ALHE is not neoplastic, but it is a form of reactive hyperplastic process that may develop as a result of injury and repair of vessels (5). Trauma, pregnancy, immunizations, and malformations may be the triggering factors for ALHE (3,5,7).…”

“…It is commonly found in the head and neck with most of the lesions being presented on peri-auricular region, forehead, or scalp (5,7,8). Involvement of other organs including liver, orbit, spleen, palate, bone, heart, blood vessels, parotid gland, and colon have been reported (5, 7).…”

“…Recent reports on ALHE focus particularly on atypical sites such as the tongue, penis, and eyelids (2)(3)(4)(5)(6). Penis is an extremely rare site for ALHE lesions comprising less than 26 cases reported up to date (6).…”