A Case of Angiolymphoid Hyperplasia with Eosinophilia of the Lower Eyelid: CASE REPORT
A 24-year-old man presented with an asymptomatic firm single erythematous papule on the lower eyelid. The lesion had started as a tiny papule 1 year earlier, and enlarged slowly. There was no history of trauma to the eyelid. He had been taking medication for nephrotic syndrome due to mesan- gioproliferative glomerulonephritis for 5 years. The family history was noncontributory. Laboratory tests including blood cell count and blood chemistry were within normal limits. On physical examination, a single shiny firm erythematous 5-mm sized, round papule was noted on the right lower eyelid (Fig. 1). There were no palpable lymph nodes. Clinically, our differential diagnosis included dermatofibroma, keloid scar, or granuloma pyogenicum. The histopathologic examination revealed dense multiple lobular infil-trations of inflammatory cells with central vessels throughout the dermis. Inflammatory cells included many eosinophils and lymphocytes (Fig. 2A).
Fig. 1. A single firm erythematous 5-mm sized, round papule on the right lower eyelid.
There was no lymphoid follicle formation. Vascular proliferation with prominent endothelial cells was characteristic. The endothelial cells had a hobnail appearance, protruding into the vascular lumen, and endothelial vacuoles were present (Fig. 2B, C). Immunohistochemistry revealed that the endothelial cells were positive for CD34 and well-developed pericytes were strongly positive for smooth muscle actin. Interstitial inflammatory cells were positive for vimentin and S100. The patient was diagnosed with ALHE, and treated with total excision. In the 6 months since the mass was excised, no recurrence has been observed. canadian pharmacy viagra
Fig. 2. Histopathologic examination reveals dense multiple lobular infiltrations of lymphocytes and eosinophils with central proliferation of vessels throughout the dermis (A: H&E, x200). The endothelial cells have a hobnail appearance, protruding into the vascular lumen (B) and some endothelial cells have vacuoles in the cytoplasm (C) (B and C: H&E, x400).
