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Vascular Tumours

Pathology of Angiolymphoid Hyperplasia with Eosinophilia [Epithelioid Hemangioma]

Dr Sampurna Roy MD           


Path Quiz Case 8 - Pathology case history and images

Diagnosis: Angiolymphoid Hyperplasia with Eosinophilia [Epithelioid Hemangioma]




Angiolymphoid  hyperplasia with eosinophilia also known as epithelioid hemangioma is a distinctive vascular lesion which usually occurs during early and mid adult life (20 - 40 years).

Clinically, this lesion presents as single or multiple pink to red-brown papules and nodules on the face, scalp and ear.


It is still uncertain whether this lesion is a  true neoplasm or a reactive process.
Some cases  appear to be associated with trauma, HIV infection, pregnancy and oral contraceptives.

Microscopically, these are well circumscribed lesions usually located in the dermis and subcutis. Angiolymphoid hyperplasia with eosinophilia consists of vascular and inflammatory cellular components.



The vascular component  displays thick and thin walled vessels lined by plump endothelial cells.

The epithelioid endothelial cells have rounded nuclei abundant eosinophilic cytoplasm containing occasional vacuoles that represent primitive vascular lumen formation.

These endothelial cell protrude into the vessels in a 'tombstone'  pattern. Within some thicker vessels there is intravascular proliferations of the endothelial cells.

The inflammatory component consists of lymphocytes scattered eosinophils and mast cells within the stroma. Lymphoid follicle may be present.
In areas the stroma may  be myxoid or fibrous in character.



Differential diagnosis:  Kimura's  disease ; epithelioid hemangioendothelioma; epithelioid angiosarcoma ; injection site granuloma (epithelioid cells are not present).            

Kimura's  disease is a separate entity which usually affects young Asian men and is commonly associated with lymphadenopathy.

Kimura's disease is a deeper lesion and reactive lymphoid follicles and are present together with a dense infiltration of eosinophils sometimes forming eosinophilic abscesses.
Blood vessels are also increased in number but these are lined by flat endothelial cells.

Epithelioid hemangioendothelioma
the tumour cells are arranged in nests and cords surrounded by hyaline and myxoid stroma. Well formed blood vessels are usualy not present.  Path Quiz Image 1  ; Image2  ;  Image3  ; Image4

Visit: Cutaneous Epithelioid Angiomatous Nodule


Further reading:

Angiolymphoid hyperplasia with eosinophilia associated with pregnancy: a case report and review of the literature.

Angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) of the lung: a clinicopathologic and immunohistochemical study of two cases.

Cutaneous epithelioid angiomatous nodule: a distinct lesion in the morphologic spectrum of epithelioid vascular tumors.

Human herpesvirus-8 is not associated with angiolymphoid hyperplasia with eosinophilia.

Angiolymphoid hyperplasia with eosinophilia: evidence for a T-cell lympho-proliferative origin.

Angiolymphoid hyperplasia with eosinophilia: a classic clinical presentation with histologic features of angiosarcoma.

Angiolymphoid hyperplasia with eosinophilia with bilateral involvement of the lacrimal glands.

Differential diagnosis of tumorous space-occupying lesions of the parotid gland: angiolymphoid hyperplasia with eosinophilia and Kimura disease.





Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


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