Angiolymphoid Hyperplasia With Eosinophilia

The findings are highly characteristic for angiolymphoid hyperplasia with eosinophilia. The unique constellation of thick-walled vessels lined by unusual proplastic endothelial cells with a background reactive lymphohistiocytic and eosinophilic infiltrate is very distinctive for this entity. There are really no other diagnostic considerations.

Angiolymphoid hyperplasia with eosinophilia has been documented in HIV patients and likely represents the sequela of a Th2 immune dysregulatory cytokine milieu that is operational in human immunodeficiency virus infection. Rather than the vascular proliferation being related to HHV8 it is due to the Th2 dominant milieu that can be seen as part of the polymorphous immune dysregulation of human immunodeficiency virus infection.

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Slide 1: 40 year-old woman with an eyebrow mass. There is polypoid distortion and expansion of the dermis .

Slide 2: The dermis is expanded by proliferating thick-walled vessels. There is a concomitant background of lymphocytic infiltration. A few small germinal centers are noted amidst the zones of lymphocytic infiltration. The inflammatory cell aspect of this infiltrate is accentuated around vessels as well as adnexal structures.

Slide 3: There are also many eosinophils that percolate through the dermis including in the zones of lymphoplasmacytic infiltration. There are also scattered plasma cells. The vessels are lined by hobnailed epithelioid appearing endothelium.