Hyperplasia angiolymphoids with eosinophilia L98.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

Synonym(s)

angioplasia papulosa; Kimura disease; Papular angioplasia; subcutaneous angiolymphoid hyperplasia with eosinophilia (Wells und Whimster)

History
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Kim and Szeto 1937; Kimura, 1948; Wells and Whimster, 1969

Definition
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Multicentric, benign lymphoproliferative hyperplasia, clinically characterized by dermal nodules and nodules, but also by subcutaneous nodules with edema, lymphocytic and eosinophilic infiltrates, formation of germinal centres, fibrosis and hyperplasia of blood vessels. Some authors make a distinction between Kimura disease and angiolymphoid hyperplasia with eosinophilia based on clinical and histological criteria. Apparently, overlaps of both clinical pictures are observed.

Occurrence/Epidemiology
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Panethnic among men and women of all ages. Unlike M. Kimura no preference of the Asian population.

Etiopathogenesis
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Unknown.

Localization
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No predilection sites; in Kimura M. the scalp and neck region are preferentially affected.

Clinical features
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Single or multiple, 2-40 mm in size, hemispherical, red to reddish-brownish, more rarely purple or ulcerated nodules and nodes. Rarely disseminated occurrence or lymphadenopathy. Very severe pruritus (missing in Kimura disease!). In Kimura M. larger subcutaneous (also intramuscular) non-itching nodules are observed.

Histology
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Dermal and subcutaneous diffuse infiltrate of T and B lymphocytes and eosinophils. Moderate fibrosis, slight edema, sporadic formation of germinal centres. Normally structured vessels with numerous, partly solid vascular sprouts of little differentiated cell elements. Occasional mast cells.

Therapy
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Excision for longer periods of storage. Danger of bleeding! Possibly alsoCO2 laser. Recurrence treatment in patients > 65 years with X-rays (GD: 20-30 Gy). Combinations ofCO2 laser irradiation with intralesional glucocorticoid application such as triamcinolone acetonide crystal suspension (e.g. Volon A diluted 1:3 with a local anaesthetic, e.g. Scandicain) are also described as successful.

Progression/forecast
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Chronic progressive but benign course.

Literature
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  1. Asadi AK (2002) Angiolymphoid hyperplasia with eosinophilia. Dermatol Online J 8: 10
  2. Helander SD et al (1995) Kimura` disease and angiolymphoid hyperplasia: New observations from immunohistochemical studies of lymphocyte markers, endothelial antigens, and granulocyte proteins. J cutan pathol 22: 319-326
  3. Kempf W et al (2002) Angiolymphoid hyperplasia with eosinophilia: evidence for a T-cell lymphoproliferative origin. Hum Pathol 33: 1023-1029
  4. Kim HT, Szeto C (1937) Eosinophilic hyperplastic lymphogranuloma, comparison with Mikulicz`s disease. Chin Med J 23: 699
  5. Kimura T et al (1948) Unusual granulation combined with hyperplastic changes of lymphoid tissue. Trans Soc Pathol Jpn 37: 179
  6. Krapohl BD et al (2003) A rare vasoproliferative lesion: angiolymphoid hyperplasia with eosinophilia of the hand. Br J Plast Surgery 56: 168-170
  7. Metze D et al (1991) Angiolymphoid hyperplasia with eosinophilia (AHE). Dermatologist 42: 101-106
  8. Schirren CG et al (1991) Angiolymphoid hyperplasia with eosinophils. Dermatologist 42: 107-111

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Last updated on: 29.10.2020