Answer: Angiolymphoid hyperplasia with eosinophils

Histology: Within the dermis there are lobular collections of an inflammatory process. This process is characterized by a proliferation of vessels, which contain prominent endothelial cells. In areas the endothelial cells have a hob-nail appearance. The inflammatory infiltrate surrounding these vessels consists of lymphocytes, plasma cells and eosinophils.

Discussion: These findings are classic for angiolymphoid hyperplasia with eosinophils, also known as epithelioid hemangioma. These lesions may occur superficially in the dermis characteristically in young to middle age women where there are multiple lesions that can persist over several years. Deeper lesions within the subcutaneous tissue tend to occur without gender predilection as a solitary lesion. The lesions may also persist for several years. The characteristic finding in this lesion is the presence of endothelial-lined channels with prominent endothelial cells. These distinctive epithelioid endothelial cells differentiate this lesions from other inflammatory processes such as reaction to an arthropod. Kimura’s disease was initially thought to represent part of the disease spectrum of angiolymphoid hyperplasia with eosinophils. However, currently these are thought to represent distinct entities. Kimura’s disease tends to have a male predominance, lacks epithelioid changes within the vessels, and has the predilection for involvement of individuals from the far East. Furthermore, Kimura’s disease often has more extensive involvement of salivary tissue and lymph nodes and may occur at sites distant from the head and neck region.