Angiolymphoid Hyperplasia with Eosinophilia
Key Facts
Terminology
Angiolymphoid hyperplasia with eosinophilia (ALHE)
Epithelioid hemangioma
Clinical Issues
Presentation
Cough
Dyspnea
Asthma
Treatment of choice: Complete surgical resection
Lobectomy
Wedge resection
Prognosis: Good
Microscopic Pathology
Lymphoid hyperplasia
Endothelial hyperplasia
Inflammatory reaction
Eosinophilia
Top Differential Diagnoses
Hodgkin lymphoma (HD)
Absence of Reed-Sternberg cells in ALHE
Negative staining for HD markers
Eosinophilic pneumonia
ALHE characteristically shows presence of vascular proliferation and lymphoid hyperplasia
Parasitic infection
ALHE does not show acute inflammation
Negative staining for infectious organisms
Diagnostic Checklist
Endothelial and lymphoid hyperplasia
Eosinophilia
 Low-power view shows angiolymphoid hyperplasia with eosinophilia presenting as a pulmonary mass. The lesion is fairly well circumscribed. |
 High-power view of ALHE shows the characteristic features of lymphoid aggregates, proliferation of small vessels, and prominent eosinophilic infiltrate. |
TERMINOLOGY
Abbreviations
Angiolymphoid hyperplasia with eosinophilia (ALHE)
Synonyms
Epithelioid hemangioma
Definitions
Benign vascular tumor characterized by vascular proliferation, lymphoid hyperplasia, and eosinophilia
CLINICAL ISSUES
Presentation
Cough
Dyspnea
Asthma
Treatment
Surgical approaches
Complete surgical resection
Lobectomy
Wedge resection
Prognosis
Good when lesions are limited to the lung
MACROSCOPIC FEATURES
General Features
Tumor nodule
Necrosis &/or hemorrhage are absent
Well circumscribed but not encapsulated
Size
2-3 cm in diameter
MICROSCOPIC PATHOLOGY
Histologic Features
Eosinophilia and proliferation of epithelioid endothelial cells
Predominant Cell/Compartment Type
Endothelial
Lymphocyte
DIFFERENTIAL DIAGNOSIS
Hodgkin Lymphoma (HD)
Absence of Reed-Sternberg cells in ALHE
Negative staining for HD markers
Often HD presents in lung with multiple pulmonary nodules
Eosinophilic Pneumonia
ALHE characteristically shows presence of vascular proliferation and lymphoid hyperplasia, which are not present in eosinophilic pneumonia
In eosinophilic pneumonia, alveoli are filled with eosinophils
Eosinophilic pneumonia does not show endothelial or lymphoid hyperplasia
Parasitic Infection
ALHE does not show acute inflammation
Negative staining for infectious organisms
No parasitic organisms are identified on conventional stains
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