Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 1542  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
CORRESPONDENCE
Year : 2021  |  Volume : 66  |  Issue : 4  |  Page : 405-407
Time from Injury to Tumor Onset in Patients with Angiolymphoid Hyperplasia with Eosinophilia: A Case Report and Literature Review


1 Department of Dermatology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
2 Department of Dermatology, Shin-Kong Wu Ho-Su Memorial Hospital; Department of Dermatology, Kang-Ning General Hospital, Taipei, Taiwan

Date of Web Publication17-Sep-2021

Correspondence Address:
Gong-Yau Chu
Department of Dermatology, Shin-Kong Wu Ho-Su Memorial Hospital; Department of Dermatology, Kang-Ning General Hospital, Taipei
Taiwan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_54_20

Rights and Permissions



How to cite this article:
Lin YL, Chu GY. Time from Injury to Tumor Onset in Patients with Angiolymphoid Hyperplasia with Eosinophilia: A Case Report and Literature Review. Indian J Dermatol 2021;66:405-7

How to cite this URL:
Lin YL, Chu GY. Time from Injury to Tumor Onset in Patients with Angiolymphoid Hyperplasia with Eosinophilia: A Case Report and Literature Review. Indian J Dermatol [serial online] 2021 [cited 2021 Dec 6];66:405-7. Available from: https://www.e-ijd.org/text.asp?2021/66/4/405/326128




Angiolymphoid hyperplasia with eosinophilia (ALHE), also known as epithelioid hemangioma, is a rare benign vascular proliferative condition mostly located in the head and neck.[1] Recently, we found an interesting case of large ALHE with a ganglion cyst-like appearance on the wrist after venous catheterization. To the best of our knowledge, this unique manifestation and the rapid onset time (1 month) of large ALHE have never been reported in the literature.

A 69-year-old woman presented with a nontender subcutaneous nodule on the dorsum of the left wrist for 2 months [Figure 1]. She was hospitalized 3 months ago. During the hospitalization, she received peripheral venous catheterization and was infused with normal saline. One month after discharge, the nodule developed at the previous insertion site of the venous catheter and enlarged gradually. Physical examination revealed a 3 cm × 3 cm, asymptomatic light pink-colored compressible nodule. Her personal and family histories were unremarkable. Laboratory data including hemogram and biochemistry data were within normal limits. The tentative impression was a ganglion cyst.
Figure 1: Light pink-colored subcutaneous nodule on the dorsum of the left wrist

Click here to view


She then underwent surgical removal [Figure 2]. Histopathology revealed perivascular infiltrate of the lymphocytes, histiocytes, marked eosinophils [Figure 3], and proliferation of capillary-sized vessels lined by prominent endothelial cells [Figure 4]. The clinical history and pathological findings led to the diagnosis of ALHE, probably caused by injury after venous catheterization.
Figure 2: Specimen from the patient

Click here to view
Figure 3: Pathological examination revealing perivascular infiltrate of lymphocytes, histiocytes, and marked eosinophils (hematoxylin and eosin stain, ×200 magnification)

Click here to view
Figure 4: Proliferation of capillary-sized vessels lined by prominent endothelial cells (hematoxylin and eosin stain, ×400 magnification)

Click here to view


ALHE was first described in 1969 and presents as single or multiple nodules in the head and neck.[1] Histopathologically, ALHE is characterized by small-vessel proliferation lined by enlarged endothelial cells protruding into the lumen of the vessels. Around the blood vessels, there is an inflammatory infiltrate with lymphocytes and varying numbers of eosinophils.[2] The etiology of ALHE is unclear. A variety of insults that resulted in vascular damage have been proposed, including trauma, infection, hyperestrogenic states, and immunologic dysregulatory mechanisms.[1]

According to our literature review [Table 1],[1],[3],[4],[5],[6],[7],[8] we found the interval between injury and ALHE formation ranged from immediateness to 24 years. ALHE may develop immediately to several months after a penetrating injury.[4],[5],[6],[7] In contrast, it may form more than 1 year after a blunt trauma.[1],[3],[8] We thought that a penetrating injury damages blood vessels directly, soon resulting in traumatic arteriovenous fistula and inducing a local inflammatory reaction. This inflammatory process generates proliferative stimuli to endothelial cells, and ALHE develops quickly. In comparison with blunt trauma, which may cause contusion and hematoma of an arterial wall, the lesion takes a longer period to form ALHE. The relationship between the type of an injury and ALHE remains unclear and we hope to keep investigating it.
Table 1: Case reports of ALHE after injury: a summary

Click here to view


Although ALHE can spontaneously regress,[9] symptomatic and deforming lesions may require treatment. Surgical excision is considered as the most effective treatment, but local recurrences occur in 33%–50%.[9] Despite a high recurrence rate, our patient had a successful recovery at her 6-month follow-up visit.

Based on our case report, ALHE should be a differential diagnosis when large subcutaneous tumors are noted after various injury with different interval, according to the type and degree of vascular insult.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Busquets AC, Sánchez JL. Angiolymphoid hyperplasia with eosinophilia induced by trauma. Int J Dermatol 2006;45:1211-4.  Back to cited text no. 1
    
2.
Guo R, Gavino AC. Angiolymphoid hyperplasia with eosinophilia. Arch Pathol Lab Med 2015;139:683-6.  Back to cited text no. 2
    
3.
Rohrer TE, Allan AE. Angiolymphoid hyperplasia with eosinophilia successfully treated with a long-pulsed tunable dye laser. Dermatol Surg 2000;26:211-4.  Back to cited text no. 3
    
4.
Tseng HW, Chien SH, Wu CS, Tseng HH, Tseng CE. Angiolymphoid hyperplasia with eosinophilia developing on an antecedent welding burn: A case report. Kaohsiung J Med Sci 2010;26:266-70.  Back to cited text no. 4
    
5.
Stewart N, Zagarella S, Mann S. Angiolyphoid hyperplasia with eosinophilia occurring after venipuncture trauma. J Dermatol 2013;40:393-5.  Back to cited text no. 5
    
6.
Okman JS, Bhatti TR, Jackson OA, Rubin AI. Angiolymphoid hyperplasia with eosinophilia: A previously unreported complication of ear piercing. Pediatr Dermatol 2014;31:738-41.  Back to cited text no. 6
    
7.
Ozkan BT, Eroglu CN, Cigerim L, Gunhan O. Angiolymphoid hyperplasia with eosinophilia in the angle region of the mandible. J Oral Maxillofac Pathol 2015;19:108.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Ciaramicolo N, Custódio M, de Sousa SC, Naclério-Homem MG. Rare lesion, unusual location, uncommon presentation: A case of angiolymphoid hyperplasia with eosinophilia. Br J Oral Maxillofac Surg 2019;57:479-80.  Back to cited text no. 8
    
9.
El Sayed F, Dhaybi R, Ammoury A, Chababi M. Angiolymphoid hyperplasia with eosinophilia: Efficacy of isotretinoin? Head Face Med 2006;2:32.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,543 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed379    
    Printed6    
    Emailed0    
    PDF Downloaded19    
    Comments [Add]    

Recommend this journal