Epithelioid hemangioma / angiolymphoid hyperplasia with eosinophils

Skin nonmelanocytic tumor

Vascular tumors

Hemangioma variants

Author: Christopher S. Hale, M.D.

Topic Completed: 1 July 2012

Minor changes: 15 October 2020

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed search: epithelioid [title] hemangioma skin

Page views in 2019: 5,348

Page views in 2020 to date: 2,059

Table of Contents

Cite this page: Hale CS. Epithelioid hemangioma / angiolymphoid hyperplasia with eosinophils. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/skintumornonmelanocytichemangiomaepithelioid.html. Accessed October 26th, 2020.

Definition / general

Also called histiocytoid hemangioma, angiolymphoid hyperplasia with eosinophilia (ALHE)
All racial groups
Head and neck nodules, often periauricular
Benign in skin
May be reactive
May occur in bone
No / rare regional lymphadenopathy
Normal serum eosinophils, IgE

Case reports

51 year old male with 8 × 6 cm subcutaneous mass in right cheek (Int J Surg Case Rep 2011;2:258)

Gross description

Small, superficial, dermal papulonodules, frequently erythematous, with bleeding

Microscopic (histologic) description

Proliferation of blood vessels with epithelioid endothelial cells exhibiting abundant eosinophilic cytoplasm with variable cytoplasmic vacuoles resembling intracytoplasmic lumina and large vesicular nuclei with variable atypia
Usually heavy infiltrate of eosinophils and lymphocytes with germinal centers
May have lobular solid pattern

Microscopic (histologic) images

Images hosted on PathOut server:

Courtesy of Mark R. Wick, M.D.

Images hosted on other servers:

Aggregate of lymphoid tissue

Blood vessels lined by cuboidal endothelial cells

Differential diagnosis

Epithelioid angiosarcoma: marked atypia
Epithelioid hemangioendothelioma: usually not cutaneous
Kimura's disease: usually Asians with elevated serum eosinophils and IgE, usually regional lymphadenopathy
Lobular pyogenic granuloma: no epithelioid endothelial cells