Angiolymphoid Hyperplasia with Eosinophilia



Angiolymphoid Hyperplasia with 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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Jul 9, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Angiolymphoid Hyperplasia with Eosinophilia

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