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Alexander Martinez A, Sathya Prakash G, Sanghvi M, Pradhan J, Girishkumar H. Epithelioid Hemangioma of the Popliteal Artery: A Case Report. Cureus 2024; 16:e56011. [PMID: 38606217 PMCID: PMC11007673 DOI: 10.7759/cureus.56011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
An epithelioid hemangioma (EH) is a rare benign vascular lesion that is usually seen in superficial small vessels within the dermis and subcutaneous tissue. Intravascular epithelioid hemangiomas of large and medium-sized vessels are rare, and only a handful of cases have been reported in the literature. Intravascular epithelioid hemangiomas are biologically benign and best treated by complete surgical excision. On occasion, lesions have been associated with aneurysmal changes in the affected vessel. Local recurrence may occur, and close clinical follow-up is advised. Herein, we report the second case in the literature of an EH originating from the popliteal artery. A 57-year-old male patient presented with a one-month history of knee pain without claudication. Imaging highlighted a right popliteal aneurysm, 5x5 cm, with partial distal thrombosis and inadequate outflow. The patient subsequently underwent popliteal artery ligation above and below the aneurysm, reconstructed with a superficial femoral artery (SFA) to distal anterior tibial artery (ATA) reverse saphenous vein bypass graft. Patient recovery was complicated by the development of a 5x5 cm right-sided mid-thigh hematoma, requiring evacuation under anesthesia. A post-one-year arterial duplex of the affected limb demonstrated a recurrent enlarging popliteal aneurysm measuring 5.7x4.8x9.1 cm. The aneurysm was reported to be mostly thrombosed with noted vascularity, but patency of the original bypass was noted. The patient underwent excision of the recurrent aneurysm with subsequent ligation of the feeding arteries. Pathology and histology confirmed the final diagnosis of EH of the popliteal artery. An 18-month follow-up after the excision procedure demonstrated no recurrence of vascular lesion and patency of the original bypass graft.
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Markidan J, Hardy N, Kallen M, Ma L. Epithelioid hemangioma involving large arteries in the skin. J Cutan Pathol 2021; 49:377-380. [PMID: 34755378 DOI: 10.1111/cup.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
Epithelioid hemangioma (EH) is a benign vascular lesion, typically consisting of small vascular channels lined by epithelioid endothelial cells and associated with a dense lymphocytic infiltrate with eosinophils. Here, we report a rare case of EH involving large arteries. The patient presented with a 9-month history of an asymptomatic nodule on the forehead, which was thought to be an epidermal inclusion cyst. Skin biopsy revealed large arteries with clusters of epithelioid cells in the vascular walls and lumen. Scattered eosinophils were noted in the walls. Adjacent areas showed groups of small-caliber vessels lined by prominent endothelial cells and associated with a dense lymphoid infiltrate with eosinophils. No significant cytologic atypia was noted. Given the presence of the classic small-vessel involvement, along with CD31 reactivity for the epithelioid cells in the large vessels, the findings are classified as EH involving large arteries, which is an uncommon subtype. There have only been a handful of such cases reported in the literature.
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Affiliation(s)
- Janina Markidan
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Naomi Hardy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Linglei Ma
- Weill Cornell Medicine, New York, New York, USA
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Al-Qattan MM, Arafah M, Al-Marshad F. Angiolymphoid hyperplasia with eosinophilia involving the common digital artery of the hand: A case report and classification of upper limb lesions. Int J Surg Case Rep 2017; 39:84-87. [PMID: 28822892 PMCID: PMC5565780 DOI: 10.1016/j.ijscr.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/08/2017] [Accepted: 08/08/2017] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign reactive inflammatory lesion. The usual presentation is a single or multiple skin nodules of the head and neck. Involvement of the hand is very rare and there have been no comprehensive reviews on ALHE of the upper limb. In this paper, we report on a case involving the common digital artery of the hand. We also review the literature and offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either single or multiple lesions. PRESENTATION OF CASE A 32-year old female presented with a slowly growing subcutaneous mass at the second web space of the left hand. The mass was neither tender or mobile. An MRI showed a tri-lobed soft tissue lesion. At the time of surgery, the lesion was found to be within the common digital artery of the second web space. Complete excision was done. Histopathology confirmed the diagnosis of ALHE There has been no recurrence or cold tolerance at final follow-up 1year later. DISCUSSION We offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either a single or multiple lesions. CONCLUSION A rare case of ALHE of the hand is presented. The literature is reviewed and two classification systems for upper limb lesions are offered and their implications are discussed.
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Affiliation(s)
| | - Maha Arafah
- Department of Pathology, King Saud University, Riyadh, Saudi Arabia
| | - Felwa Al-Marshad
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia
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Fite-Trepat L, Martos-Fernandez M, Alberola-Ferranti M, Pablo-Garcia-Cuenca AD, Bescosatin C. Angiolymphoid Hyperplasia with Eosinophilia Involving the Occipital Artery: Case Report and Review of Literature. J Clin Diagn Res 2017; 11:ZD21-ZD23. [PMID: 28511526 DOI: 10.7860/jcdr/2017/23323.9569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/17/2016] [Indexed: 11/24/2022]
Abstract
Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is an atypical vascular tumour occurring primarily in the head and neck area, which must be distinguished from Kimura's disease. The lesions can appear as single or multiple grouped intradermal papules or subcutaneous nodules. We report a rare case of ALHE in a 57-year-old female with a large lesion of three nodules involving the right occipital artery which had a long term evolution and we treated it by surgical excision. The definitive histopathological diagnosis was ALHE. Our case report is accompanied by a discussion of clinical, radiological and histological features. Surgical excision with free margins is the treatment of choice but, even though ALHE is considered a benign condition, recurrence is common.
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Affiliation(s)
- Laia Fite-Trepat
- Resident, Department of Oral and Maxillofacial Surgery, Vall Hebron Hospital, Barcelona, Spain
| | - Miriam Martos-Fernandez
- Resident, Department of Oral and Maxillofacial Department, Vall Hebron Hospital, Barcelona, Spain
| | | | | | - Coro Bescosatin
- Head, Department of Oral and Maxillofacial Surgery, Vall d'Hebrón Hospital. Barcelona, Spain
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Di Vitantonio H, De Paulis D, Ricci A, Raysi SD, Marzi S, Del Maestro M, Galzio RJ. Angiolymphoid hyperplasia with eosinophilia and entrapment of the ulnar nerve. Surg Neurol Int 2016; 7:S160-3. [PMID: 27069750 PMCID: PMC4802987 DOI: 10.4103/2152-7806.177896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background: The angiolymphoid hyperplasia with eosinophilia (ALHE) is a sporadic vasoproliferative lesion of uncertain etiology involving the skin and the subcutaneous tissue. Occasionally, it involves also the large arteries compressing the near nerves. ALHE is commonly confused with Kimura's disease because of their clinical and histological similarities. Case Description: We report a case of a 52-year-old female suffering from a 6-month pain and paresthesias in the fourth and fifth finger of the right hand. The angiography showed a pseudoaneurysm in the proximal third of the right ulnar artery. A complete surgical excision of the vascular lesion was undertaken. The lesion forced the right ulnar nerve. The histopathological diagnosis deposed for ALHE. Conclusion: Up to now, literature has described 8 cases of ALHE involving the arteries, and only one case originating from the ulnar nerve. The authors report a case of a female with ALHE involving the ulnar artery that compressed the ulnar nerve. Clinical aspects, radiological features, surgical treatment, and operative findings are discussed reviewing the pertinent literature.
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Affiliation(s)
- Hambra Di Vitantonio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Danilo De Paulis
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Soheila Dehcordi Raysi
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Sara Marzi
- Department of Neurosurgery, San Salvatore city Hospital, L'Aquila, Italy
| | - Mattia Del Maestro
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
| | - Renato Juan Galzio
- Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy
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Moira R, Giuseppe F, Riccardo V, Nicola R, Daniele B, Pierfrancesco C, Antonio DCG, Antonello A, Bruno A, Giovanni C, Guglielmo F. Epithelioid hemangioma of brachial artery: report of a case and review of the literature. Open Med (Wars) 2015; 10:502-507. [PMID: 28352744 PMCID: PMC5368872 DOI: 10.1515/med-2015-0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/04/2015] [Indexed: 11/18/2022] Open
Abstract
Epithelioid hemangioma (EH) is an uncommon benign vascular lesion, also known as angioblastic lymphoid (or angiolymphoid) hyperplasia with eosinophilia, characterized by an unclear etiopathogenesis. It usually affects young to middle-aged adults and develops in the head and neck region, as painless cutaneous or subcutaneous reddish papules or nodules. Large vessels involvement is extremely rare, and to date only two cases affecting the brachial artery have been cited in literature. In this report we present a further case of EH of the brachial artery and review the pertinent literature.
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Affiliation(s)
- Ragazzi Moira
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Falco Giuseppe
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Valli Riccardo
- Pathology Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Rocco Nicola
- Department of Clinical Medicine and Surgery. University of Naples "Federico II", Naples, Italy
| | - Bordoni Daniele
- Department of Senology, Asur Marche Area Vasta 1, Santa Maria della Misericordia, Via Comandino 70, Urbino, Italy
| | - Cadenelli Pierfrancesco
- Plastic and Reconstructive Surgery Unit, Istituto Nazionale dei Tumori, via Venezian, Milano, Italy
| | | | - Accurso Antonello
- Department of Gastroenterology, Endocrinology and Surgery, AO "Federico II", Naples, Italy
| | - Amato Bruno
- Department of Clinical Medicine and Surgery. University of Naples "Federico II", Naples, Italy
| | - Casali Giovanni
- Unit of Vascular Surgery, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
| | - Ferrari Guglielmo
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
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Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): A systematic review. J Am Acad Dermatol 2015; 74:506-12.e11. [PMID: 26685720 DOI: 10.1016/j.jaad.2015.10.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/18/2015] [Accepted: 10/12/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Current knowledge of angiolymphoid hyperplasia with eosinophilia (ALHE) derives from retrospective reports and case series, leading to a nonevidence-based treatment approach. OBJECTIVE We sought to systematically review the literature relating to cutaneous ALHE to estimate its epidemiology and treatment outcomes. METHODS A literature search of PubMed, EMBASE, Web of Science, and Google Scholar was conducted. Articles detailing cases of histologically confirmed cutaneous ALHE were included. RESULTS In all, 416 studies were included in the review, representing 908 patients. There was no sex predominance among patients with ALHE. Mean age at presentation was 37.6 years. There was a significant association between presence of multiple lesions and pruritus, along with bleeding. Surgical excision was the most commonly reported treatment for ALHE. Treatment failure was lowest for excision and pulsed dye laser. Mean disease-free survival after excision was 4.2 years. There were higher rates of recurrence postexcision with earlier age of onset, longer duration of disease, multiple lesions, bilateral lesions, pruritus, pain, and bleeding. LIMITATIONS Potential for publication bias is a limitation. CONCLUSIONS Surgical excision appears to be the most effective treatment for ALHE, albeit suboptimal. Pulsed dye and other lasers may be effective treatment options. More studies are needed to improve the treatment of ALHE.
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Epithelioid hemangioma of the internal carotid artery: a case report supporting the reactive pathogenesis hypothesis of this vascular tumor. Int J Pediatr Otorhinolaryngol 2014; 78:1186-9. [PMID: 24837865 DOI: 10.1016/j.ijporl.2014.04.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 11/20/2022]
Abstract
The pathogenesis of epithelioid hemangioma is intriguing and has remained a controversial topic in the medical literature. Whether its etiology follows a neoplastic or reactive process is unclear, but a history of traumatic insult to the involved region is common. We report a case of epithelioid hemangioma of the internal carotid artery in a child who had undergone cannulization of the internal jugular vein as an infant to receive extracorporeal membrane oxygenation.
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Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. Surgical treatment of aneurysms in the upper limbs. Ann Vasc Dis 2013; 6:637-41. [PMID: 24130621 DOI: 10.3400/avd.cr.13-00024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/25/2013] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this study was to review the experience of aneurysms in the upper limbs treated with surgery and assess the outcomes. MATERIALS AND METHODS This study retrospectively reviewed the medical records of five patients with upper extremity aneurysms treated with surgical resection at Tokyo Medical and Dental University Hospital between March 2000 and February 2012. These patients were treated with excision surgery either with or without reconstructive surgery. RESULTS Two of the five patients were males and three were females with a mean age of 52 years (age range: 25-72 years). We treated 2 brachial, 2 ulnar, and 1 radial aneurysms. All aneurysms were excised, and two patients had reconstructive surgery. Three patients had false aneurysms, which included an ulnar artery aneurysm diagnosed as angiolymphoid hyperplasia with eosinophilia. During follow-up period, all grafts were clinically patent, and no cases had recurrent lesions. No patients had ischemic symptoms or any other postoperative complications. CONCLUSION Arterial aneurysms of the upper extremities are uncommon, and were most commonly caused by non-traumatic etiology in this series. These aneurysms were excised with or without reconstructive surgery, because of the fear of rupture and embolization. Revascularization can be performed selectively.
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Affiliation(s)
- Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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Igari K, Kudo T, Toyofuku T, Jibiki M, Inoue Y. Surgical Treatment of Aneurysms in the Upper Limbs. Ann Vasc Dis 2013. [DOI: 10.3400/avd.oa.13-00024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Orthopaedic case of the month: pulsatile soft tissue mass. Clin Orthop Relat Res 2012; 470:3275-9. [PMID: 22879093 PMCID: PMC3462853 DOI: 10.1007/s11999-012-2518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/24/2012] [Indexed: 01/31/2023]
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Hsiao HT, Wu YH. Intra-arterial angiolymphoid hyperplasia with eosinophilia of the temporal artery: Report of two cases and review of the literature. DERMATOL SIN 2012. [DOI: 10.1016/j.dsi.2012.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bhat SP, Moorthy N, Ramalingam R, Jayapal M, Nanjappa MC. Angiolymphoid Hyperplasia with Eosinophilia Presenting as a Giant Axillary Artery Aneurysm. Vascular 2010; 18:49-52. [DOI: 10.2310/6670.2009.00041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Angiolymphoid hyperplasia with eosinophilia (ALHE) is an unusual vascular tumor most frequently located in the superficial head and neck. Noncutaneous localization of this pathology in large arteries presenting as a pulsatile mass is extremely rare. We describe an adult male with a giant left axillary artery tumor secondary to ALHE. ALHE should be considered in the differential diagnosis of localized peripheral arterial masses, especially in young patients.
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Affiliation(s)
- Seetharama P.S. Bhat
- Departments of *Cardiothoracic and Vascular Surgery, †Cardiology, and ‡Pathology, Sri Jayadeva Institute of Cardiology, Bangalore, India
| | - Nagaraja Moorthy
- Departments of *Cardiothoracic and Vascular Surgery, †Cardiology, and ‡Pathology, Sri Jayadeva Institute of Cardiology, Bangalore, India
| | - Rangaraj Ramalingam
- Departments of *Cardiothoracic and Vascular Surgery, †Cardiology, and ‡Pathology, Sri Jayadeva Institute of Cardiology, Bangalore, India
| | - Mithravrinda Jayapal
- Departments of *Cardiothoracic and Vascular Surgery, †Cardiology, and ‡Pathology, Sri Jayadeva Institute of Cardiology, Bangalore, India
| | - Manjunath Cholenahalli Nanjappa
- Departments of *Cardiothoracic and Vascular Surgery, †Cardiology, and ‡Pathology, Sri Jayadeva Institute of Cardiology, Bangalore, India
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