Angiolymphoid Hyperplasia With Eosinophilia. F 55, Lower Lip
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Transcript of Angiolymphoid Hyperplasia With Eosinophilia. F 55, Lower Lip
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Angiolymphoid Hyperplasia withAngiolymphoid Hyperplasia with
EosinophiliaEosinophilia
Spencer Rusin M4, CUMCSpencer Rusin M4, CUMC
Deba P Sarma, MDDeba P Sarma, MDOmahaOmaha
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Patient PresentationPatient Presentation
F 55, presents with a 10F 55, presents with a 10--month history of :month history of :
NonNon--ulcerated, painless nodule (0.5 cm)ulcerated, painless nodule (0.5 cm)
on her lower lipon her lower lip No history of trauma or earNo history of trauma or ear--nosenose--throatthroat
disease.disease.
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Differential DiagnosisDifferential Diagnosis
MucoceleMucocele
Lymphocytoma cutisLymphocytoma cutis
Granuloma facialeGranuloma faciale Benign and malignant tumors of skin andBenign and malignant tumors of skin and
adnexaeadnexae
Kimura diseaseKimura disease
OthersOthers
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A well circumscribedA well circumscribed
dermal noduledermal nodule
composed of centralcomposed of centralangiomatous vascularangiomatous vascular
proliferation withproliferation with
stromal and peripheralstromal and peripheral
infiltrates ofinfiltrates of
lymphocytes andlymphocytes andeosinophils.eosinophils.
H&E: low power
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Proliferation of small blood vessels, lined by enlargedProliferation of small blood vessels, lined by enlargedendothelial cells (epitheliod in appearance) with uniform ovoidendothelial cells (epitheliod in appearance) with uniform ovoid
nuclei and intracytoplasmic vacuoles.nuclei and intracytoplasmic vacuoles.
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Prominent eosinophilic and lymphocytic infiltrationProminent eosinophilic and lymphocytic infiltration
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Lymphoid aggregate with follicle formation amongst theLymphoid aggregate with follicle formation amongst the
vascular proliferative cells.vascular proliferative cells.
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ImmunostainsImmunostains
CD 3CD 3 Peripheral lymphocytes: PositivePeripheral lymphocytes: Positive
CD 20CD 20 -- Peripheral lymphocytes: PositivePeripheral lymphocytes: Positive
CD31CD31 Vascular epitheliod endothelial cells:Vascular epitheliod endothelial cells:PositivePositive
CK AE1/3CK AE1/3 -- NegativeNegative
SS--100100 -- NegativeNegative
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CD 31 stain highlights the endothelial cells demonstrating aCD 31 stain highlights the endothelial cells demonstrating a
strong angiogenesis component to the nodule.strong angiogenesis component to the nodule.
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DiagnosisDiagnosis
Angiolymphoid hyperplasia with eosinophiliaAngiolymphoid hyperplasia with eosinophilia
(ALHE)(ALHE)
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Differential DiagnosisDifferential Diagnosis
ALHEALHE
Primarily a localizedPrimarily a localizedhyperplasiahyperplasia
InfrequentInfrequentlymphadenopathylymphadenopathy
20%20%
Rare blood eosinophliaRare blood eosinophlia
Histology:Histology:
VascularVascularproliferation>inflammaproliferation>inflammatory cellstory cells
Epitheliod endothelialEpitheliod endothelialcells lining bloodcells lining bloodvesselsvessels
Eosinophils presentEosinophils present
Kimura DiseaseKimura Disease
Systemic involvement:Systemic involvement: LymphadenopathyLymphadenopathy Blood eosinophliaBlood eosinophlia Nephrotic syndrome asNephrotic syndrome as
a result of glomerulara result of glomerularIgE deposition.IgE deposition.
Histological presentation ofHistological presentation ofKimura disease differs fromKimura disease differs from
ALHE in two factors.ALHE in two factors. Vascular proliferationVascular proliferation
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ALHEALHE
General presentation:General presentation:
Range from asymptomatic to itchy orRange from asymptomatic to itchy or
painful erythematous nodules, 2painful erythematous nodules, 2--3cm in3cm indiameter.diameter.
The nodules may pulsate or bleed.The nodules may pulsate or bleed.
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PrePre--auricular lesions of ALHE.auricular lesions of ALHE.
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ALHEALHE Hypotheses regarding ALHEs origin:Hypotheses regarding ALHEs origin:
Reactive process to insect bitesReactive process to insect bites
Hyperestrogen statesHyperestrogen states
Immunologic mechanismsImmunologic mechanisms
Reactive vascular proliferation subsequent toReactive vascular proliferation subsequent toinflammation associated with traumatized bloodinflammation associated with traumatized blood
vesselsvessels One study reported a history of trauma in only 9%One study reported a history of trauma in only 9%
of 116 patients with ALHEof 116 patients with ALHE
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ALHEALHE
Age: 20Age: 20--50 years, M = F50 years, M = F
Locations affected by ALHE:Locations affected by ALHE:
Head and neck:Head and neck:
Specifically the forehead, scalp, and skin aroundSpecifically the forehead, scalp, and skin aroundears.ears.
Trunk and genitaliaTrunk and genitalia
Three documented cases of ALHE affecting the lip.Three documented cases of ALHE affecting the lip.
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ALHEALHE
Progression of ALHE:Progression of ALHE:
Most common course: ALHE remains stableMost common course: ALHE remains stable
Infrequent outcome: ALHE spontaneouslyInfrequent outcome: ALHE spontaneouslyregressesregresses
Chronic nature of ALHE necessitates treatment.Chronic nature of ALHE necessitates treatment.
Recurrence rate ranges from 33Recurrence rate ranges from 33--50%50%
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TreatmentTreatment
Medical:Medical:
IsoretinoinIsoretinoin
CorticosteroidsCorticosteroids
interferon alfainterferon alfa--2b2b
Benefits:Benefits:
Improved cosmetic outcomesImproved cosmetic outcomes
Limitations:Limitations:
Relies on patient complianceRelies on patient compliance Not a permanent cureNot a permanent cure
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TreatmentTreatment
Surgical:Surgical:
Laser therapyLaser therapy
Carbon dioxide laserCarbon dioxide laser
Ultralong pulsed dye laserUltralong pulsed dye laser
Nd:Nd:YAG laserYAG laser
Benefits:Benefits:
Improved cosmetic outcomeImproved cosmetic outcome
Limitations:Limitations: Multiple treatmentsMultiple treatments
Adversely affected by the depth of invasion orAdversely affected by the depth of invasion orsize of vesselssize of vessels
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TreatmentTreatment
Surgical:Surgical:
ExcisionalExcisional
Simple surgical excisionSimple surgical excision
Mohs surgeryMohs surgery
Benefits:Benefits:
Excision of the arterial and venous segments atExcision of the arterial and venous segments atthe base decrease recurrencethe base decrease recurrence
Limitations:Limitations: ScarringScarring
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ReferencesReferences
S. Seregard, Angiolymphoid hyperplasia with eosinophilia should not be confused withS. Seregard, Angiolymphoid hyperplasia with eosinophilia should not be confused withKimura's disease, Acta Ophthalmologica Scandinavica, vol. 79, issue 1, pps. 91Kimura's disease, Acta Ophthalmologica Scandinavica, vol. 79, issue 1, pps. 9193, 2001.93, 2001.
S.W. Weiss, J.R. Goldblum, "Enzinger and Weiss's Soft Tissue Tumors, 4th edition," St.S.W. Weiss, J.R. Goldblum, "Enzinger and Weiss's Soft Tissue Tumors, 4th edition," St.Louis: Mosby, 2001.Louis: Mosby, 2001. 863863--864.864.
G.C. Wells, I.W. Whimster, "Subcutaneous angiolymphoid hyperplasia with eosinophilia,G.C. Wells, I.W. Whimster, "Subcutaneous angiolymphoid hyperplasia with eosinophilia,British Journal of DermatologyBritish Journal of Dermatology, vol. 81, pp 1, vol. 81, pp 1--15, 1969.15, 1969.
R.L. Moy, D.B. Luftman, Q.H. Nguyen, J.S. Amenta,"Estrogen receptors and the response toR.L. Moy, D.B. Luftman, Q.H. Nguyen, J.S. Amenta,"Estrogen receptors and the response tosex hormones in angiolymphoid hyperplasia with eosinophilia,"sex hormones in angiolymphoid hyperplasia with eosinophilia," Archives of DermatologyArchives of Dermatology,,vol 128, pp. 825vol 128, pp. 825--828, 1992.828, 1992.
R. Grimwood, J.M. Swinehart, J.L Aeling, "Angiolymphoid hyperplasia with eosinophilia,"R. Grimwood, J.M. Swinehart, J.L Aeling, "Angiolymphoid hyperplasia with eosinophilia,"Archives of DermatologyArchives of Dermatology, vol. 115, pp. 205, vol. 115, pp. 205--207, 1979.207, 1979.
P. Von den Driesch, M. Gruschwitz, H. Schell, W. Sterry, Distribution of adhesionP. Von den Driesch, M. Gruschwitz, H. Schell, W. Sterry, Distribution of adhesionmolecules, IgE, and CD23 in a case of angiolymphoid hyperplasia with eosinophilia,molecules, IgE, and CD23 in a case of angiolymphoid hyperplasia with eosinophilia,Journal of the American Academy of DermatologyJournal of the American Academy of Dermatology, vol. 26, issue 5, part 2, pp. 799, vol. 26, issue 5, part 2, pp. 799--804,804,1992.1992.
T.G. Olsen, E.B. Helwig, "Angiolymphoid hyperplasia with eosinophilia,"T.G. Olsen, E.B. Helwig, "Angiolymphoid hyperplasia with eosinophilia," Journal ofJournal ofAmerican Academy of DermatologyAmerican Academy of Dermatology, vol 12, pp. 781, vol 12, pp. 781--796, 1985.796, 1985.
P.G. Henry, J.W. Burnett, Angiolymphoid hyperplasia with eosinophilia,P.G. Henry, J.W. Burnett, Angiolymphoid hyperplasia with eosinophilia, Archives ofArchives ofDermatologyDermatology, vol. 114, no. 8, pp. 1168, vol. 114, no. 8, pp. 1168--1172, 1978.1172, 1978.
J.F. Fetsch, S.W. Weiss, Observations concerning the pathogenesis of epithelioidJ.F. Fetsch, S.W. Weiss, Observations concerning the pathogenesis of epithelioidhemangioma (angiolymphoid hyperplasia),hemangioma (angiolymphoid hyperplasia), Modern PathologyModern Pathology, vol. 4, issue 4, pp. 449, vol. 4, issue 4, pp. 449--455,455,1991.1991.
T.G. Olsen, E.B. Helwig, Angiolymphoid hyperplasia with eosinophilia. A clinicopathologicT.G. Olsen, E.B. Helwig, Angiolymphoid hyperplasia with eosinophilia. A clinicopathologicstudy of 118 patients,study of 118 patients, Journal of the American Academy of DermatologyJournal of the American Academy of Dermatology, vol. 12, issue 5,, vol. 12, issue 5,pp. 781pp. 781--796, 1985.796, 1985.
J. Scurry, G. Dennerstein, J. Brenan, Angiolymphoid hyperplasia with eosinophilia of theJ. Scurry, G. Dennerstein, J. Brenan, Angiolymphoid hyperplasia with eosinophilia of thevulva,vulva, Australian and New Zealand Journal of Obstetrics and GynaecologyAustralian and New Zealand Journal of Obstetrics and Gynaecology, vol. 35, issue 3,, vol. 35, issue 3,pp. 347pp. 347--348, 1995.348, 1995.
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References continuedReferences continued
J.R. Srigley, A.G. Ayala, N.G. Ordonez, A.W. van Nostrand, Epithelioid hemangioma of theJ.R. Srigley, A.G. Ayala, N.G. Ordonez, A.W. van Nostrand, Epithelioid hemangioma of thepenis. A rare and distinctive vascular lesion,penis. A rare and distinctive vascular lesion, Archives of Pathology and LaboratoryArchives of Pathology and LaboratoryMedicineMedicine, vol. 109, pp. 51, vol. 109, pp. 51--54, 1985.54, 1985.
J.I. Lopez, S.B. Battaglino, Angiolymphoid hyperplasia with eosinophilia of the lower lip,J.I. Lopez, S.B. Battaglino, Angiolymphoid hyperplasia with eosinophilia of the lower lip,International Journal of DermatologyInternational Journal of Dermatology, vol. 32, issue 5, pp. 361, vol. 32, issue 5, pp. 361--362, 1993.362, 1993.
H. Suzuki, A. Hatamochi, M. Horie, T. Suzuki, S. Yamazaki, A case of angiolymphoidH. Suzuki, A. Hatamochi, M. Horie, T. Suzuki, S. Yamazaki, A case of angiolymphoidhyperplasia with eosinophilia (ALHE) of the upper lip,hyperplasia with eosinophilia (ALHE) of the upper lip, Journal of DermatologyJournal of Dermatology, vol. 32, no., vol. 32, no.12, pp. 99112, pp. 991--995, 2005.995, 2005.
O.F. Salinas, Y.S. Corredoira, G.A. Rojas, O.F. Salinas, Y.S. Corredoira, G.A. Rojas, Angiolymphoid hyperplasia of the lip withAngiolymphoid hyperplasia of the lip witheosinophilia. Report of one case,eosinophilia. Report of one case, Revista Medica de ChileRevista Medica de Chile, vol. 135, no.5, pp. 636, vol. 135, no.5, pp. 636--639,639,2007. (in Spanish)2007. (in Spanish)
A. Satpathy, C. Moss, F. Raafat, R. Slator, Spontaneous regression of a rare tumour in aA. Satpathy, C. Moss, F. Raafat, R. Slator, Spontaneous regression of a rare tumour in achild: angiolymphoid hyperplasia with eosinophilia of the hand: case report and review ofchild: angiolymphoid hyperplasia with eosinophilia of the hand: case report and review ofthe literature,the literature, British Journal of Plastic SurgeryBritish Journal of Plastic Surgery, vol. 58, issue 6, pps. 865, vol. 58, issue 6, pps. 865--868, 2005.868, 2005.
B.V. Diaz, M.C. Lenoir, A. Ladoux, C. Frelin, M. Demarchez, S. Michel, Regulation ofB.V. Diaz, M.C. Lenoir, A. Ladoux, C. Frelin, M. Demarchez, S. Michel, Regulation ofvascular endothelial growth factor expression in human keratinocytes by retinoids,vascular endothelial growth factor expression in human keratinocytes by retinoids,Journal of Biological ChemistryJournal of Biological Chemistry, vol. 275, no. 1, pps. 642, vol. 275, no. 1, pps. 642--650, 2000.650, 2000.
F. El Sayed, R. Dhaybi, A. Ammoury, M. Chababi, Angiolymphoid hyperplasia withF. El Sayed, R. Dhaybi, A. Ammoury, M. Chababi, Angiolymphoid hyperplasia witheosinophilia: efficacy of isotretinoin?,eosinophilia: efficacy of isotretinoin?, Head & Face MedicineHead & Face Medicine, vol. 2, p. 32, vol. 2, p. 32--36, 2006.36, 2006. T. Kaur, K. Sandhu, S. Gupta, A.J. Kanwar, B. Kumar, Treatment of angiolymphoidT. Kaur, K. Sandhu, S. Gupta, A.J. Kanwar, B. Kumar, Treatment of angiolymphoid
hyperplasia with eosinophilia with the carbon dioxide laser,hyperplasia with eosinophilia with the carbon dioxide laser, Journal of DermatologicalJournal of DermatologicalTreatmentTreatment, vol. 15, issue 5, pps. 328, vol. 15, issue 5, pps. 328--330, 2004.330, 2004.
C. Angel, A. Lewis, T. Griffin, E. Levy, A. Benedetto, Angiolymphoid hyperplasiaC. Angel, A. Lewis, T. Griffin, E. Levy, A. Benedetto, Angiolymphoid hyperplasiasuccessfully treated with an ultralong pulsed dye laser,successfully treated with an ultralong pulsed dye laser, Dermatologic SurgeryDermatologic Surgery, vol. 31, pps., vol. 31, pps.713713--716, 2005.716, 2005.
C.J. Miller, M.D. Ioffreda, C.T. Ammirati, Mohs micrographic surgery for angiolymphoidC.J. Miller, M.D. Ioffreda, C.T. Ammirati, Mohs micrographic surgery for angiolymphoidhyperplasia with eosinophilia,hyperplasia with eosinophilia, Dermatological SurgeryDermatological Surgery, vol 30,issue 8, pps. 1169, vol 30,issue 8, pps. 1169--1173,1173,2004.2004.
T. Rohrer, A.Allan, ANgiolymphoid hyperplasia with eosinophilia successfully treated withT. Rohrer, A.Allan, ANgiolymphoid hyperplasia with eosinophilia successfully treated witha longa long--pulsed tunable dye laser,pulsed tunable dye laser, Dermatologic SurgeryDermatologic Surgery, vol. 26, issue 3, pps. 211, vol. 26, issue 3, pps. 211--214,214,