Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) in the oral mucosa. A case report and review of the literature

Epithelioid Hemangioma of the Nasal Cavity: a Diagnostic Challenge

Epithelioid hemangioma also known as angio-lymphoid hyperplasia with eosinophilia is a rare benign vascular neoplasm of unknown etiology. It very rarely involves the nasal cavity. It always poses a diagnostic challenge for clinicians and is usually misdiagnosed as Kimura's, IgG4-related disease, or malignant vascular tumors. The present case report describes an extremely rare presentation of epithelioid hemangioma inside the left nasal cavity causing complete obstruction and nasal septal deviation towards the right side in a young male. Hematoxylin and eosin-stained sections depicted a lobular proliferation of small capillary-sized vessels lined by plump epithelioid endothelial cells surrounding central vessels and scattered around them. These cells had abundant eosinophilic to amphophilic cytoplasm and enlarged nuclei with fine chromatin and central nucleoli. On immunohistochemistry, CD34 and CD31 highlighted the vascular proliferation and epithelioid endothelial cells. Erythroblast transformation-specific (ETS)-related gene (ERG) showed strong nuclear positivity in neoplastic plump epithelioid endothelial cells. EH is a benign vascular proliferation, but a high chance of recurrence is seen if complete resection is not done. As a result, the treatment of choice is complete surgical excision with clear margins. The case highlights a non-conventional presentation of epithelioid hemangioma and the importance of histomorphological features in diagnosing this entity.

Epithelioid hemangioma of lingual alveolar mucosa: an immunohistochemical case report

Epithelioid hemangioma is a rare benign vascular lesion that presents as a nodular lesion in the skin of head and neck region. It is a superficial vascular entity which can either be due to tumor or reactive lesion, but the exact etiology is still unknown. We hereby present a rare case which has been reported with the history of small nodular-like growth on mandibular buccal and lingual area. The excisional biopsy was performed and tissue was submitted for histopathological diagnosis. The immunohistochemistry was performed to check the expression of CD31 marker which proved that origin of epithelioid cells was vascular.

Unilateral Intraparotid Swelling: A Case Report of Kimura's Disease and Review of Differential Diagnosis

An interesting case of Kimura's disease was described in the 42-year-old patient manifesting itself as a unilateral parotid swelling, albeit the disease usually affects both parotid glands. Furthermore, first pathohistological finding was not suggestive of the disease, revealing only fatty tissue, but on the repeated biopsy together with CT the correct diagnosis was established. It should be emphasized that Kimura's disease has to be taken into account while making differential diagnosis in parotid gland swellings, especially in people of Oriental origin.

Recurrent gingival swelling in pregnant women

The aim of this case report is to present a rare case which has been reported with the history of small nodule like growth on mandibular buccal and lingual area. Thirty year old pregnant women reported a nodule on left mandibular buccal and lingual region. The lesion was surgically excised and sent for biopsy to differentiate from kimura's disease, pyogenic granuloma, epithelioid angiosarcoma (EH). Histologically lesion shows proliferation of endothelial cells along blood vessels suggesting epithelioid hemangioma. The purpose of this report is to discuss and differentiate EH and other vascular rare entities occurring in the oral cavity.

Angiolymphoid hyperplasia with eosinophilia masquerading as Kimura disease

Angiolymphoid hyperplasia with eosinophilia is a rare benign vasoproliferative disease of unknown cause, which can present as tumour-like nodules in the head and neck. We treated a patient who showed some of the features of Kimura disease (KD), which is an important differential diagnosis, because of the latter's association with renal disease.

Gingival swelling in a 13-year-old girl with multiple recurrences

We present a challenging case of gingival swelling that recurred several times in 3.5 years in a 13-year-old girl. Histologic evaluation of the initial biopsy revealed groups of epithelioid cells surrounded by lymphocytes in the submucosal fibrous connective tissue, and it was diagnosed as noncaseating granulomatous inflammation. With the tissue specimens from subsequent multiple excisions and several immunohistochemical studies, the diagnoses evolved to benign cellular infiltrate of undetermined origin, epithelioid hemangioma, proliferating endothelial cell neoplasm of uncertain biologic potential, atypical vascular tumor, epithelioid hemangioendothelioma, and kaposiform hemangioendothelioma. We discuss the list of differential diagnoses from various pathologists and propose our diagnosis of epithelioid hemangioendothelioma based on its clinical behavior, histologic features, and immunohistochemical findings.

Epithelioid hemangioma in the oral mucosa: A clinicopathological study of seven cases and review of the literature

To investigate the clinicopathological characteristics and biologic behavior of epithelioid hemangioma in oral mucosa, the clinical features and pathological findings of seven cases of epithelioid hemangioma were reviewed, and all sections were examined by immunohistochemistry. There were 4 males and 3 females ranged from 8 to 65 years (mean 39.7 years). Sites of origin included the tongue (n = 4), lips (n = 2), and palates (n = 1). Five lesions presented as a solitary mass. Three patients had history of minimal trauma. Histopathologically, well-formed but often immature vessels lined by plump epitholid endothelial cells with prominent inflammatory components were observed. Immunohistochemical staining revealed that tumour cells were positive for Vimentin, FVIIIRAg and CD34. All the cases were negative to S-100 protein and EMA. One case recurred after surgical excision, while none of them metastasized. Epithelioid hemangioma is a benign vascular anomaly, and has close relationship with local trauma. The differential diagnosis is usually based upon histopathological findings.

A case of angiolymphoid hyperplasia with eosinophilia (ALHE) of the upper lip

Angiolymphoid hyperplasia with eosinophilia (ALHE) is clinically characterized by intradermal or subcutaneous papules and/or nodules usually occurring in young adults. Lesions in the oral mucosa are extremely rare. We report a case and review the literature of ALHE cases involving the oral mucosa. A 40-year-old man presented with a painless, 20 x 20 mm, submucosal nodule on the upper lip. Histological examination of lip biopsy specimens revealed an increase in many small vessels. The vascular walls consisted of prominent endothelial cells with a histiocytoid appearance, which protruded into the lumen. Many eosinophils and lymphocytes were also seen around the vessels. The diagnosis of ALHE was made from the above findings.

Fine needle aspiration biopsy of epithelioid hemangioendothelioma of the oral cavity: Report of one case and review of literature

Epithelioid hemangioendothelioma (EHE) is an uncommon vascular tumor with biological behavior intermediate between hemangioma and angiosarcoma. It rarely occurs in the oral cavity. We report a case of an 81-yr-old woman with a 2-mo history of a 2 x 2 cm2 submucosal buccal mass. Fine needle aspiration (FNA) smears were paucicellular and showed mainly single atypical large epithelioid cells in a bloody background. The atypical cells had abundant dense cytoplasm, some with fine vacuoles. Occasionally, cells with large cytoplasmic lumina were seen. Cytology preparations from fresh tissue received for frozen section revealed numerous neoplastic cells with large intracytoplasmic lumina, some of which contained red blood cells. In addition, cells with distinct intranuclear inclusions were present. Histologic sections and immunohistochemical stains confirmed the diagnosis of EHE. Although the histologic features of EHE are well recognized, reports of FNA cytology findings are sparsely existent in the literature as several case reports. The characteristic cytological features of EHE are reviewed in this report. We believe that the diagnosis of this rare tumor can be suggested when an adequate FNA specimen is obtained.

Intraoral papillary endothelial hyperplasia: case discussion with supportive histochemistry and immunohistochemistry

An intraoral mass of eight months duration in a six year-old girl was diagnosed as papillary endothelial hyperplasia. Histologically, the tissue was characterized by the unusual endothelial cell proliferation, which is significant, as papillary endothelial hyperplasia resembles angiosarcoma and possible over-treatment thereafter. Clarification of this unusual lesion based on histological findings with supportive histochemical staining and immunohistochemistry in the light of clinico-pathological correlation is discussed. This lesion warrants better documentation of the clinical behavior with regular monitoring.

[Kimura's disease on the hard palate in a patient from Martinique]

INTRODUCTION

We report an observation of Kimura's disease (angiolymphoid hyperplasia with eosinophilia) in a Black patient from West Indies, in a rare localisation on hard palate.

EXEGESIS

A 46-year-old male patient from French West Indies (Martinique) presented with a tumor of hard palate evolving from 2 years with locoregional lymph nodes. He had a history of chronic urticaria, prurigo, rhinitis and alopecia areata. Pathological examination of the tumor was consistent with the diagnosis of Kimura's disease. Blood tests showed hypereosinophilia, elevation of IgG and IgE. The serology of Toxocara canis with Western blott was positive. Corticosteroid therapy (0.7 mg/kg/d) and albendazole (800 mg/d) allowed regression of the tumor, lymph nodes, and urticaria. The remaining tumor was surgically excised.

CONCLUSION

Kimura's disease was first described in Japanese young men, between 20 and 40 years old, with subcutaneous nodules on head and neck area. Involvement of oral mucosa is rare, and the occurence in West Indian patients has been rarely reported.

Endothelial lesions of soft tissues: a review of reactive and neoplastic entities with emphasis on low-grade malignant ("borderline") vascular tumors

Soft tissue proliferations composed of endothelial cells are a heterogeneous group of lesions that can cause diagnostic difficulty. Further complicating the issue is the constantly changing nomenclature of some entities, as well as reclassification of some vascular tumors from the high-grade malignant category to the low-grade malignant or borderline category. Modern ancillary techniques such as immunohistochemistry and cytogenetics have done little to advance our knowledge of these lesions. This review article outlines the most recent classification of endothelial lesions of the skin and soft tissues, with emphasis on the low-grade malignant (borderline) category. In addition, many tumor-like lesions containing an endothelial component are also discussed.

Angiolymphoid hyperplasia with eosinophilia of the tongue: report of a case and review of the literature

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon disorder manifested as solitary or multiple nodules in dermis and subcutaneous tissue of head and neck region. ALHE affecting tongue is very rare. We report a 56-year-old man with ALHE of the tongue and review the previously reported cases of ALHE of the tongue.