У пациента на ухе диагностирована доброкачественная ангиолимфоидная гиперплазия с эозинофилией

Slideshow - Figure 1 - Figure 2 - Figure 3 - You can skip this ad in 3 seconds. - Figure 4 A middle-aged man presents with a growth on his right ear that has been present for over a year. The patient reports that the lesion has been growing slowly and occasionally bleeds. Physical examination reveals a group of erythematous papules in the triangular fossa of the right ear (Figure 1). A shave biopsy of the ear lesion was performed. Histologic examination of the biopsy specimen reveals a polypoid vascular lesion with lymphocytes and numerous eosinophils (Figure 2). The endothelial cells appeared swollen and focally showed fenestration (Figure 3). Further immunohistochemistry studies were conducted. ERG and CD34 stains highlight the endothelial cells (Figure 4), while the HHV-8 stain was negative. The biopsy findings were most consistent with angiolymphoid hyperplasia with eosinophilia (ALHE). The lesion demonstrated a polypoid vascular proliferation composed of epithelioid (hobnail) endothelial cells, dense lymphocytic infiltrates, and numerous eosinophils, all of which represented classic histopathologic features of ALHE.... Submit your diagnosis to see full explanation. The biopsy findings were most consistent with angiolymphoid hyperplasia with eosinophilia (ALHE). The lesion demonstrated a polypoid vascular proliferation composed of epithelioid (hobnail) endothelial cells, dense lymphocytic infiltrates, and numerous eosinophils, all of which represented classic histopathologic features of ALHE. The endothelial cells appeared swollen and focally fenestrated, and immunohistochemistry showed ERG/CD34 positive vasculature with HHV-8 negativity, further supporting a benign vascular proliferation rather than a neoplastic or infectious process. These findings aligned closely with the established diagnostic criteria for ALHE.1 For the differential diagnosis, eosinophilic granuloma was excluded because it is characterized by Langerhans cells with reniform, grooved nuclei, often accompanied by eosinophils but requiring CD1a and Langerin (CD207) positivity, none of which were present in this case.2 Pyogenic granuloma was also unlikely because it usually manifests as a lobular capillary hemangioma with edematous stroma and neutrophilic inflammation, lacking the eosinophil-rich infiltrate and epithelioid endothelial cells seen in this case.3 Basal cell carcinoma was ruled out because it required basaloid tumor nests with peripheral palisading, stromal retraction, and mitotically active atypical cells, features absent in this vascular inflammatory lesion.4 The absence of epithelial tumor islands and the presence of a well-formed vascular proliferation with eosinophils made BCC incompatible with the histologic picture. Together, these distinctions supported ALHE as the correct diagnosis. After counseling the patient on the diagnosis of ALHE, including its benign, recurrent nature and potential for spontaneous regression, the decision was made to defer excision. He was advised to return to the clinic if conservative and supportive management proved insufficient. Riley Andrews, MD, is a recent graduate of the Baylor College of Medicine who is currently pursuing a career in diagnostic radiology. Soo Jung Kim, MD, PhD, MBA, is a board-certified dermatologist who currently practices at the University of Washington Dermatology in Seattle, WA. Promise Ufomadu, MD, is a recent graduate of the Baylor College of Medicine who is currently pursuing a career in dermatology. References 1. Olsen TG, Helwig EB. Angiolymphoid hyperplasia with eosinophilia. A clinicopathologic study of 116 patients. J Am Acad Dermatol. 1985;12(5 Pt 1):781-796. doi:10.1016/s0190-9622(85)70098-9 2. Rodriguez-Galindo C, Allen CE. Langerhans cell histiocytosis. Blood. 2020;135(16):1319-1331. doi:10.1182/blood.2019000934 3.Sarwal P, Lapumnuaypol K. Pyogenic Granuloma. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 10, 2024. 4. Crowson AN. Basal cell carcinoma: biology, morphology and clinical implications. Mod Pathol. 2006;19 Suppl 2:S127-S147. doi:10.1038/modpathol.3800512