A vascular proliferation with plump epithelioid cells lining the lumina are clearly visible.
The mixed inflammatory infiltrate consists of lymphocytes and lots of eosinophils.
A closer look at the endothelial cells reveal their epithelioid morphology; some have a hobnail appearance with their nuclei protruding into the vascular lumina.
This different case shows a more solid growth of the endothelial cells. The lumina are less open and more slit-like.
The heavy eosinophilic infiltrate is still quite obvious and typical of this lesion.
The endothelial cells have quite vesicular nuclei and plentiful cytoplasm.
The vascular proliferation is nodular and centered in the superficial and sometimes deep dermis.
Again, features of plump epithelioid endothelial cells in a stroma filled with lymphocytes and eosinophils characterize the histologic picture.
Epithelioid hemangioma (a.k.a angiolymphoid hyperplasia with eosinophilia) are uncommon and presents as reddish nodules on the scalp. Histologically, it is characterized by a nodular proliferation of "hobnail" or epithelioid endothelial cells that protrude into the vascular lumina. There is an accompanying inflammatory infiltrate with numerous eosinophils and lymphocytes. The overlying epidermis is usually normal.
The differential diagnosis include epithelioid hemangioendothelioma (which has a cordlike arrangement of cells in myxohyaline stroma) and epithelioid angiosarcoma (which exhibits much more cytologic atypia)(Busam). If the inflammatory infiltrate is extremely robust and obscures the vascular component, the differential diagnosis would further include CD30+ lymphoproliferative disorders such as lymphomatoid papulosis as the lymphocytes in EH include large CD30+ activated lymphocytes (Cham).
Occurs in adults with a predilection for the head and neck, especially ear. Multiple nodules or erythematous subcutaneous papules may be seen, with a predilection for young women (Busam).
Busam KJ. Dermatopathology: Foundations in Diagnostic Pathology 1st Ed. Philadelphia, PA: Elsevier; 2010: 548.
Cham E, et al. Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) arising on the extremities. J Cutan Pathol. 2010 Oct;37(10):1045-52. Epub 2009 Aug 21.
Rapini RP. Practical Dermatopathology. Philadelphia, PA: Elsevier; 2005: 325-6.