Indian Journal of Dermatology
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


Yi-Liang Lin1, Gong-Yau Chu2,  
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

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




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;66:405-407


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 2023 Feb 7 ];66:405-407
Available from: https://www.e-ijd.org/text.asp?2021/66/4/405/326128


Full Text



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}

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}{Figure 3}{Figure 4}

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}

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.

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