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Nayani D, Pitale Ashok RK, Loka SR, Maley S. Angiolymphoid Hyperplasia with Eosinophilia of the External Auditory Canal. Indian J Otolaryngol Head Neck Surg 2024; 76:1037-1039. [PMID: 38440633 PMCID: PMC10908676 DOI: 10.1007/s12070-023-04100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/17/2023] [Indexed: 03/06/2024] Open
Abstract
Angiolymphoid hyperplasia with eosinophilia is a rare, benign, vaso-proliferative disease with a dense eosinophilic inflammatory infiltrate seen in the intradermal or subcutaneous region. It is also termed an epitheloid hemangioma, and it mostly affects females rather than males. It is seen as reddish to brown, fleshy, proliferative, papular, or nodular lesion affecting the head and neck region, most commonly the auricular and periauricular regions. The aetiology is unknown, but the most likely causes are trauma, infection, and hyperestrogenic condition like pregnancy or the use of oral contraceptive agents. It usually measures about 2-3 cm in size. It should be differentiated from Kimura disease, which is characterized by chronic inflammation and large subcutaneous nodules in the head and neck region. Here is a rare case report of angiolymphoid hyperplasia in a middle-aged male patient involving the external auditory canal of the left ear.
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Affiliation(s)
- Divya Nayani
- Department of Otorhinolaryngology, Government ENT Hospital, Osmania Medical College, Door No 5-1-174, Opposite State Bank of India Head Office, Bank Street Road, Koti, Hyderabad, 500095 India
| | - Rahul Kumar Pitale Ashok
- Department of Otorhinolaryngology, Government ENT Hospital, Osmania Medical College, Door No 5-1-174, Opposite State Bank of India Head Office, Bank Street Road, Koti, Hyderabad, 500095 India
| | - Sudarshan Reddy Loka
- Department of Otorhinolaryngology, Government ENT Hospital, Osmania Medical College, Door No 5-1-174, Opposite State Bank of India Head Office, Bank Street Road, Koti, Hyderabad, 500095 India
| | - Sai Maley
- Research Pathologist NSABP Foundation, Inc. NRG Oncology, Hillman Cancer Center, 1307 Federal St, Suite 303, Pittsburgh, PA 15212 USA
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Benign Subcutaneous Nodules and Hypereosinophilic Syndrome: A Rare Presentation of an Uncommon Entity. Case Rep Med 2019; 2019:2387832. [PMID: 31827521 PMCID: PMC6885811 DOI: 10.1155/2019/2387832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 10/04/2019] [Accepted: 10/19/2019] [Indexed: 12/04/2022] Open
Abstract
A 40-year-old gentleman presented with a history of multiple swellings involving his face, scalp, left axilla, back, and right thigh for the past 8 years. For the last 6 months, he developed intermittent low-grade fever, anorexia, weight loss, and gradually worsening breathlessness. On evaluation, the patient was found to have abnormally elevated absolute eosinophil count. Workup for the etiology of eosinophilia was unrewarding. All investigations related to an underlying myeloproliferative disorder were negative. Hence, a clinical possibility of angiolymphoid hyperplasia with eosinophilia (ALHE) was kept which was confirmed on histopathology. In the absence of other causes of hypereosinophilia, a clinical diagnosis of “associated hypereosinophilic syndrome” secondary to ALHE was made. He was managed with oral corticosteroids. The absolute eosinophil count reduced markedly, while the swellings showed a more gradual response, shrinking in size by about 50% following two months of therapy. The index case thus highlights a rather unusual presentation of ALHE.
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Abstract
Angiolymphoid Hyperplasia with Eosinophilia (AHLE) is a rare benign vascular disorder of unknown etiology. While World Health Organization recognizes it as a benign neoplasm, its progressive nature and high recurrence rate are consistent with being a locally malignant tumor. It may present as solitary or multiple nodules with more predilection to head and neck region, especially auricular area. Despite variety of available treatment options, high recurrence rate remains a compelling issue. The spectrum of these treatment modalities includes topical or systemic steroids use, intralesional injection of certain materials such as Bleomycin, Vinblastine or interferon, or even surgical excision.In our study, the authors present a case of middle-aged female with recurrent AHLE in left concha and preauricular region. Excision of the lesion with 4 mm of the normal surrounding skin, preserving auricular cartilage, was done while the resultant defect was covered by grafted Temporoparietal Fascia Flap. Our 1-year follow-up period showed aesthetically accepted outcome with no recurrence.The authors hypothesize that treating AHLE as a locally malignant tumor by excising the lesion with 4 mm safety margin decreases recurrence rates. Moreover, reconstruction by grafted temporoparietal fascia flap achieves a reasonable aesthetic outcome with minimal donor site morbidity.
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Wu L, Li F, Shi W, Su J, Chen M, Chen X, Zhao S. Combination of electrocoagulation and photodynamic therapy for angiolymphoid hyperplasia with eosinophilia in the external ear. Photodiagnosis Photodyn Ther 2019; 27:449-451. [PMID: 31362108 DOI: 10.1016/j.pdpdt.2019.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/28/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
Abstract
Angiolymphoid hyperplasia with eosinophilia (ALHE) is an inflamed vascular tumefaction of uncertain pathogenesis and is characterized by higher recurrence rates after surgical excision or other approaches. In the present study, we performed a new approach by combining electrocoagulation with photodynamic therapy (PDT) for the treatment of two ALHE patients. They had multiple treatments in the past and had poor therapeutic effects with relapse each time. After informed consent was obtained, electrocoagulation was used to remove the superficial lesions of ALHE, and the first session of PDT was immediately applied to the lesion. A total of three sessions of PDT were applied to each patient with an interval of 7-10 days. Through more than 12 months of follow-up, the two patients showed complete regression, and no recurrence was observed. Meanwhile, patients were very satisfied with the cost and cosmetic outcomes of the combination treatment. Based on our results, we strongly recommend the combination of electrocoagulation with PDT as a favourable treatment for ALHE, especially in the external ear and other areas that are inconvenient for routine surgery.
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Affiliation(s)
- Lisha Wu
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Fangfang Li
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 41008, China.
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Zhang J, Li Y, Wen G, Deng Y, Yao H. Novel Application of 32P Brachytherapy: Treatment of Angiolymphoid Hyperplasia with Eosinophilia in the Right Auricle with 8-Year Follow-Up. Cancer Biother Radiopharm 2018; 33:282-284. [PMID: 29957026 PMCID: PMC6148720 DOI: 10.1089/cbr.2018.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Angiolymphoid hyperplasia with eosinophilia (ALHE) is a distinctive benign vascular disease that can be challenging to treat due to inconsistent results for various treatment modalities such as surgical excision, corticosteroids, radiotherapy, laser therapy, and other therapies, so novel approaches are needed to improve treatment outcomes. MATERIALS AND METHODS ALHE on the right auricle of a 54-year-old Chinese woman underwent brachytherapy using 32P simple drug membranes for five times. The 32P brachytherapy involving simple drug membranes of brachytherapy began by diluting a 32P solution with 0.9% NaCl solution to produce a radioactivity of 69.2-74.7 MBq/mL(1.87-2.02 mCi/mL). The drug membranes were removed between 48 and 72h after application. There were intervals ranging from 65 to 72d between the membrane application periods, and the last treatment was in June 2010. RESULTS After the 32P brachytherapy, follow-up results over the course of 8 years were promising. The regional symptoms disappeared, the right preauricular swelling decreased, the subcutaneous nodules decreased in size, the exudate disappeared, and the skin appearance improved. CONCLUSIONS This case indicated that 32P brachytherapy may represent a novel ALHE treatment method that produces a favorable long-term outcome.
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Affiliation(s)
- Jinshan Zhang
- Department of Radiation Oncology and Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, P.R. China
| | - Yuan Li
- Department of Radiation Oncology and Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, P.R. China
| | - Ge Wen
- Department of Radiation Oncology and Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, P.R. China
| | - Yongmei Deng
- Department of Radiation Oncology and Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, P.R. China
| | - Hongxia Yao
- Department of Radiation Oncology and Nuclear Medicine, The Third Affiliated Hospital of Guangzhou Medical University , Guangzhou, P.R. China
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Tokat F, Lehman JS, Sezer E, Cetin ED, Ince U, Durmaz EO. Immunoreactivity of Wilms tumor 1 (WT1) as an additional evidence supporting hemangiomatous rather than inflammatory origin in the etiopathogenesis of angiolymphoid hyperplasia with eosinophilia. Dermatol Pract Concept 2018; 8:28-32. [PMID: 29445571 PMCID: PMC5808368 DOI: 10.5826/dpc.0801a06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/14/2017] [Indexed: 11/21/2022] Open
Abstract
Background Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare vascular proliferative disorder mainly located in the periauricular region. The etiopathogenesis of ALHE is unknown, and it is still controversial as to whether the entity represents a benign vascular neoplasm or an inflammatory process. Aim Recently, the intracytoplasmic staining pattern of Wilms tumor 1 (WT1) on immunohistochemistry has highlighted true vascular neoplasms, such as microvenular hemangioma, tufted angioma, and spindle cell hemangioma, which has made it helpful to distinguish ALHE from vascular malformations, as there is a negative staining pattern in the other entities. We aimed to investigate the immunoreactivity of ALHE specimens for WT1 as well as glucose transporter protein 1 (GLUT1) immunohistochemistry, an important and sensitive marker for the diagnosis of infantile hemangioma, which recently has been described to label other hemangiomas, such as verrucous hemangioma. Material and methods Clinical data and histopathological specimens from patients diagnosed with ALHE were reviewed, and immunohistochemical staining and microscopic analysis for WT-1 and GLUT1 were performed. Results Intracytoplasmic endothelial staining of WT1 was detected in 19 of 20 ALHE specimens. GLUT1 was not detected in any ALHE specimen. Conclusions We conclude that ALHE may represent a true hemangioma (i.e., benign vascular neoplasia) characterized by an eosinophil- and lymphocyte-rich inflammatory component as opposed to the reactive inflammatory dermatosis with a positive intracytoplasmic staining pattern for WT1. As far as we are aware, WT1 staining for ALHE has not been described to date.
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Affiliation(s)
- Fatma Tokat
- Department of Pathology Acibadem University School of Medicine, Istanbul, Turkey
| | - Julia S Lehman
- Department of Dermatopathology Mayo Clinic, Rochester, MN, USA
| | - Engin Sezer
- Department of Dermatology Acibadem University School of Medicine, Istanbul, Turkey
| | | | - Umit Ince
- Department of Pathology Acibadem University School of Medicine, Istanbul, Turkey
| | - Emel Ozturk Durmaz
- Department of Dermatology Acibadem University School of Medicine, Istanbul, Turkey
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Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): A systematic review. J Am Acad Dermatol 2015; 74:506-12.e11. [PMID: 26685720 DOI: 10.1016/j.jaad.2015.10.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/18/2015] [Accepted: 10/12/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current knowledge of angiolymphoid hyperplasia with eosinophilia (ALHE) derives from retrospective reports and case series, leading to a nonevidence-based treatment approach. OBJECTIVE We sought to systematically review the literature relating to cutaneous ALHE to estimate its epidemiology and treatment outcomes. METHODS A literature search of PubMed, EMBASE, Web of Science, and Google Scholar was conducted. Articles detailing cases of histologically confirmed cutaneous ALHE were included. RESULTS In all, 416 studies were included in the review, representing 908 patients. There was no sex predominance among patients with ALHE. Mean age at presentation was 37.6 years. There was a significant association between presence of multiple lesions and pruritus, along with bleeding. Surgical excision was the most commonly reported treatment for ALHE. Treatment failure was lowest for excision and pulsed dye laser. Mean disease-free survival after excision was 4.2 years. There were higher rates of recurrence postexcision with earlier age of onset, longer duration of disease, multiple lesions, bilateral lesions, pruritus, pain, and bleeding. LIMITATIONS Potential for publication bias is a limitation. CONCLUSIONS Surgical excision appears to be the most effective treatment for ALHE, albeit suboptimal. Pulsed dye and other lasers may be effective treatment options. More studies are needed to improve the treatment of ALHE.
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Mutgi KAJ, Swick BL. Multifocal epithelioid hemangioma of the penis: a diagnostic and therapeutic challenge. J Cutan Pathol 2015; 42:303-7. [PMID: 26042800 DOI: 10.1111/cup.12526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Brian L Swick
- Department of Dermatology, University of Iowa, Iowa City, IA.,Department of Pathology, University of Iowa, Iowa City, IA.,Iowa City Veterans Affairs Medical Center, Iowa City, IA
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Esteves P, Barbalho M, Lima T, Quintella L, Niemeyer-Corbellini JP, Ramos-E-Silva M. Angiolymphoid Hyperplasia with Eosinophilia: A Case Report. Case Rep Dermatol 2015; 7:113-6. [PMID: 26120306 PMCID: PMC4478319 DOI: 10.1159/000381843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Angiolymphoid hyperplasia with eosinophilia is a rare disease considered as being a vascular malformation resulting from a subjacent arteriovenous shunt. It affects mostly the head of women between 20 and 40 years old and may present spontaneous involution.
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Affiliation(s)
- Paola Esteves
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcella Barbalho
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tiago Lima
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Quintella
- Sector of Pathology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Nouchi A, Hickman G, Battistella M, Estève E, Bagot M, Vignon-Pennamen D, Petit A. Traitement de l’hyperplasie angiolymphoïde avec éosinophilie (HALE) par le tacrolimus topique : deux observations. Ann Dermatol Venereol 2015; 142:360-6. [DOI: 10.1016/j.annder.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/21/2015] [Accepted: 02/04/2015] [Indexed: 11/30/2022]
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Angiolymphoid hyperplasia with eosinophilia of the external ear: case report and review of the literature. Eur Arch Otorhinolaryngol 2013; 270:2775-7. [DOI: 10.1007/s00405-013-2627-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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Isohisa T, Masuda K, Nakai N, Takenaka H, Katoh N. Angiolymphoid hyperplasia with eosinophilia treated successfully with imiquimod. Int J Dermatol 2012; 53:e43-4. [DOI: 10.1111/j.1365-4632.2011.05284.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nishi M, Matsumoto K, Fujita T, Satoh T, Iwabuchi K, Iwamura M, Baba S. Angiolymphoid hyperplasia with eosinophilia on penile skin in a 7-year-old child. J Pediatr Surg 2011; 46:559-61. [PMID: 21376210 DOI: 10.1016/j.jpedsurg.2010.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/06/2010] [Accepted: 12/07/2010] [Indexed: 11/17/2022]
Abstract
We report a case of a 7-year-old child who presented with a painless mass on his penis. He underwent removal of the mass, which was found to be an angiolymphoid hyperplasia with eosinophilia. Angiolymphoid hyperplasia with eosinophilia is an extremely rare tumor, especially in children's penis. In this situation, treatment of this tumor should be considered carefully, and there is a chance of spontaneous regression after volume reduction surgery.
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Affiliation(s)
- Morihiro Nishi
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan.
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Angiolymphoid hyperplasia with eosinophilia treated with vascular laser. Lasers Med Sci 2011; 26:285-90. [DOI: 10.1007/s10103-011-0892-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 01/18/2011] [Indexed: 11/26/2022]
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BITO T, KABASHIMA R, SUGITA K, TOKURA Y. Angiolymphoid hyperplasia with eosinophilia on the leg successfully treated with T-helper cell 2 cytokine inhibitor suplatast tosilate. J Dermatol 2010; 38:300-2. [DOI: 10.1111/j.1346-8138.2010.00990.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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