This 45-year old woman presented with two pink to red nodules on her forehead that measured 0.6 and 1.4 centimeters. Angiolymphoid hyperplasia with eosinophilia (ALHE, also known as epithelioid hemangioma and histiocytoid hemangioma) is a distinct entity characterized by the proliferation of blood vessels lined by histiocytoid endothelial cells and surrounded by a prominent lymphocytic and eosinophilic infiltrate. This case has a classic clinical presentation in that ALHE most commonly arises in the head or neck of young to middle-aged women as single or multiple pink to red-brown plaques or papules. The etiology of ALHE is unknown with neoplastic, infectious, and reactive mechanisms proposed but not justified. ALHE must be distinguished from Kimura’s disease (a separate and distinct entity, contrary to old beliefs), angiosarcoma, and epithelioid hemangioendothelioma.
Closer inspection of the lesion reveals the blood vessels to be lined by plump, histiocytoid endothelial cells. Lymphocytes and eosinophils are interspersed between the vessels.