Answer to Image of the Month October 2015
Submitted by Subhra Dhar
Angiolymphoid hyperplasia with eosinophilia/Epithelioid hemangioma
Microscopic findings show proliferation of blood vessels in the dermis. The blood vessels are lined by plump endothelial cells, often occluding the lumen. The surrounding stroma shows a dense lymphocytic infiltrate with a good admixture of eosinophils. The overlying epidermis in this case showed variable acanthosis.
Differential diagnoses include capillary hemangioma which can show prominent endothelial cells but these are present focally. The accompanying stromal infiltrate of lymphocytes and eosinophils helps it to be distinguished from haemangiomas as well as other vascular neoplasms like retiform haemangioendothelioma and angiomas. Kimura's disease, another close differential diagnosis, looks like lymphoid tissue on scanner view but the endothelial cells are not as prominent as in angiolymphoid hyperplasia with eosinophilia. Eosinophils are numerous in Kimura's disease, in comparsion.