Published: 2021-02-24

Dilemma in diagnosing a post-auricular mass-angiolymphoid hyperplasia with eosinophilia versus Kimura’s disease, an infrequent encounter

Sandeep Shetty, Shilpa Chandrashekar, Nivetha Devi Ganesan, Debayan Dey, Ramya Sathanur Bhaskarachar


Angiolymphoid hyperplasia with eosinophilia (ALHE) and Kimura’s disease are uncommon chronic benign lesions of the skin mainly involving the head and neck regions where ALHE involves vascular and lymphocytic proliferation and Kimura’s is of inflammatory type. Dermal involvement is more in ALHE but In Kimura’s disease the lymphnodes and subcutaneous tissues are involved more. ALHE is a rare vascular tumor and Kimura’s disease is a chronic inflammatory disease. Both not only have uncertainty in etiology and pathogenesis, but also there is therapeutic dilemma in management. In this article, we describe a case of ALHE which presented to our ENT outpatient department with swelling in the left postauricular region which appeared 1.5 years back and posed a riddle in coming to correct diagnosis. On examination, a single smooth spherical swelling in upper part of post-auricular region of size 3×3 cm with well-defined edges and normal skin. Blood investigations revealed elevated absolute eosinophil count. HRCT temporal bone showed a well-defined rounded hypo-dense lesion measuring 28×23 mm with no effect of adjacent bony erosion / calcifications/ cystic changes suggestive of benign etiology. FNAC showed scantly cellular and occasionally scattered fibroblasts, pinkish stromal collagen fragments with inflammatory cells in background of haemorrhage suggestive of soft tissue neoplasm.


Angiolymphoid hyperplasia with eosinophilia, ALHE, Kimura's disease, Post auricular swelling, AEC

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Bahloul E, Amouri M, Charfi S, Boudawara O, Mnif H, Boudawara T et al. Angiolymphoid hyperplasia with eosinophilia: report of nine cases. Int J Dermatol. 2017;56(12):1373-8.

Abhay H, Swapna S, Darshan T, Vishal J, Gautam P. Kimura’s disease: A rare cause of local lymphadenopathy. Int J Sci Study. 2014;2:122‑5.

Wells GC, Whimster IW. Subcutaneous angiolymphoid hyperplasia with eosinophilia. Bri J Dermatol. 1969;81(1):1-5.

Weiss SW, Enzinger FM. Epithelioid hemangioendothelioma a vascular tumor often mistaken for a carcinoma. Cancer. 1982;50(5):970-81.

Kimura T, Yoshimura S, Ishikawa E. On the unusual granulation combined with hyperplastic changes of lymphatic tissue. Trans Soc Patho Jpn. 1948;37:179-80.

Chitrapu P, Patel M, Readinger A, Menter A. Angiolymphoid hyperplasia with eosinophilia. Proc (Bayl Univ Med Cent). 2014;27:336-7.

Esteves P, Barbalho M, Lima T. Angiolymphoid hyperplasia with eosinophilia: A case report. Case Rep Dermatol. 2015;7:113-16.

Adler BL, Krausz AE, Minuti A. Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): a systematic review. J Am Acad Dermatol. 2016;74:506-12.

Chen YM, Chen CH, Chen HH, Chen YH, Chen DY, Lan JL. Clinical manifestations, therapeutic response and disease outcome of Kimura’s disease in Taiwan. Formos J Rheumatol. 2009;23:33‑9.

Calleja LAJM, Iturriaga TM, Romero MP, de María Martínez G, Martín‑Moro JG, del Castillo JL. Kimura disease: Report of a case in a Caucasian male and revision of the literature. Rev Esp Cir Oral Maxilofac. 2006;28:353‑8.

Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: A clinicopathologic study of 21 cases. Am J Surg Pathol. 2004;28:505‑13.

Priyokumar OS, Niteshore MS, Ratan K. Bilateral Kimuras disease with sinusitis and parotid gland involvement: A case report and a brief review of literature. IOSR J Dent Med Sci. 2014;13:22‑5.

Hui PK, Chan JK, Ng CS, Kung IT, Gwi E. Lymphadenopathy of Kimura’s disease. Am J Surg Pathol. 1989;13:177-86.

Guo R, Gavino AC. Angiolymphoid hyperplasia with eosinophilia. Arch Pathol Lab Med. 2015;139(5):683-6.

Kempf W, Haeffner AC, Zepter K, Sander CA, Flaig MJ, Mueller B et al. Angiolymphoid hyperplasia witheosinophilia: evidence for a T-cell lymphoproliferative origin. Hum Pathol. 2002;33(10):1023-9.

Bastos JT, Rocha CR, Freitas BM, Cassia FD, Avelleira JC. Angiolymphoid hyperplasia with eosinophilia versus Kimura’s disease: a case report and a clinical and histopathological comparison. Anais Brasileiros de Dermatol. 2017;92(3):392-4.

Patel CS, Dave RV. Kimuras disease: A case report. Int J Dent Clin. 2011;3:115‑6.

Calleja LAJM, Iturriaga TM, Romero MP, de María Martínez G, Martín‑Moro JG, del Castillo JL. Kimura disease: Report of a case in a Caucasian male and revision of the literature. Rev Esp Cir Oral Maxilofac. 2006;28:353‑8.

Alshaiji JM. Angiolymphoid Hyperplasia with Eosinophilia. Harper's Textbook of Pediatrics Dermatology. 2019;1350-5.

Youssef A, Hasan AR, Youssef Y, Al-Soufi L, Elshimali Y, Alshehabi Z. Angiolymphoid hyperplasia with eosinophilia: a case report. Journal of medical case reports. 2018;12(1):1-6.

Ghimire A, Singh I, Bhattarai M. Angiolymphoid hyperplasia with eosinophilia: a rare entity for otolaryngologist. Nep Med Col J. 2006;8(3):208-10.