Lymph nodes - not lymphoma
Inflammatory disorders
Angiolymphoid hyperplasia with eosinophilia

Topic Completed: 1 August 2017

Revised: 4 February 2019, last major update August 2017

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Lymph nodes [title] angiolymphoid hyperplasia with eosinophilia

Jayalakshmi Balakrishna, M.D.
Page views in 2018: 6,628
Page views in 2019 to date: 5,854
Cite this page: Balakrishna J. Angiolymphoid hyperplasia with eosinophilia. website. Accessed October 18th, 2019.
Definition / general
  • Low grade vascular tumor characterized by proliferation of blood vessels lined by plump endothelial cells
Essential features
  • Vascular proliferation
  • Histiocytoid endothelial cells with hobnail appearance
  • Mixed inflammatory infiltrate consisting of lymphocytes, plasma cells and eosinophils
  • Angiolymphoid hyperplasia with eosinophilia
  • Epitheliod hemangioma
  • Obsolete terms
    • Histiocytoid hemangioma
    • Angiomatous nodule
    • Pseudopyogenic granuloma
    • Inflammatory angiomatous nodule
ICD coding
  • L98.8 (ILDS L98.812)
  • Young to middle aged adults
  • Some reports show female preponderance and some show no clear gender predilection
  • Most patients are of Asian origin or Caucasian
  • Predominantly head and neck
  • Other sites reported: trunk, extremities, hands, penis, oral mucosa, colon
  • Accompanying inflammatory infiltrate is thought to play a role in the pathogenesis of vascular proliferation
  • Inflammatory cells generate a proliferative stimulus to which the endothelial cells respond and cause vascular proliferation
  • Other possible contributing factors are
    • Arteriovenous shunting
    • Local trauma
    • Elevated serum estrogen levels
  • Not known currently
  • Theories include: a reactive process, infectious etiology, immunologic process or neoplastic process
Clinical features
  • Lesions occur as
    • Single or multiple
    • Nondescript
    • Flesh to plum colored papules or nodules
    • Ranging in size from a few to several centimeters
  • No associated symptoms are present in most cases
  • Some patients may experience tenderness, pulsation, pruritus, bleeding, either spontaneously or after minor trauma
  • Peripheral blood eosinophilia and regional lymphadenopathy are also reported
  • Biopsy and histopathologic examination
  • Ancillary studies to rule out other causes of vascular proliferation and eosinophilia
  • Eosinophilia reported in majority of the cases
Prognostic factors
  • Benign lesion
  • Does not regress without intervention
  • Incomplete surgical excision may lead to recurrence
Case reports
  • Total surgical excision is the current treatment of choice
Clinical images

Images hosted on other servers:

Erythematous nodule on right cheek

Erythematous nodules in occipital region

Coalescing nodules

Gross description
  • Single or multiple, dome shaped, light pink to red brown papules or subcutaneous masses with no specific distinguishing surface features
  • There might be erosion or crust formation of the surface
Microscopic (histologic) description
  • Predominantly in the dermis and subcutaneous tissue
  • Proliferation of vascular channels with accompanying mixed inflammatory infiltrate seen as nests and cords of endothelial cell proliferations with admixed lymphocytes, plasma cells and eosinophils, accompanied by hemorrhage and proliferation of thick and thin walled blood vessels
  • Endothelial cells show large vesicular nuclei with acidophilic and sometimes vacuolated cytoplasm, imparting a hobnail appearance
  • Mitoses can be seen but lack atypical features and anaplasia
Microscopic (histologic) images

Images hosted on other servers:

Proliferation of blood vessels

H&E various magnification

Inflammatory infiltrate rich in lymphocytes

Numerous secondary lymphoid follicles

CD20 positive lymphoid follicles

BCL2 negative follicles

Prominent vascular proliferation

Polymorphous inflammatory infiltrate

"Hobnail" endothelial cells

Distortion and reduplication of internal elastic lamina

Tombstone-like arrangement


Left: inflammatory infiltrate
with vascular proliferation
Right: prominent endothelial
cells without atypia


Arm mass with intense eosinophilia
and prominent vessels lined by
prominent endothelial cells with
occasional cytoplasmic vacuoles

Positive stains
  • Vascular / endothelial markers
Negative stains
Board review question #1
Which of the following histopathological findings helps most to differentiate angiolymphoid hyperplasia with eosinophilia from Kimura disease?

  1. Eosinophilia
  2. Lymphoid follicles
  3. Prominent histiocytoid endothelial cells
  4. Vascular proliferation
Board review answer #1
C. Prominent histiocytoid endothelial cells; the presence of these cells with a hobnail appearance is the characteristic histologic finding of angiolymphoid hyperplasia with eosinophilia.
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