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Year : 2013  |  Volume : 58  |  Issue : 6  |  Page : 493
Asymptomatic swelling on ear lobule of 1 year duration


1 Department of Skin and STD, Mysore Medical College and Research Institute, Mysore, India
2 Department of Pathology, JSS Medical College, Mysore, India

Date of Web Publication17-Oct-2013

Correspondence Address:
H Bangaru
Department of Skin and STD, Mysore Medical College and Research Institute, Mysore, #14, OPD Block, K.R. Hospital, Mysore - 570 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.119975

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How to cite this article:
Bangaru H, Nanjundaswamy B L, Surendran K, Vijaya B. Asymptomatic swelling on ear lobule of 1 year duration. Indian J Dermatol 2013;58:493

How to cite this URL:
Bangaru H, Nanjundaswamy B L, Surendran K, Vijaya B. Asymptomatic swelling on ear lobule of 1 year duration. Indian J Dermatol [serial online] 2013 [cited 2019 Aug 25];58:493. Available from: http://www.e-ijd.org/text.asp?2013/58/6/493/119975


A 50-year-old lady presented with asymptomatic skin lesions over left ear lobe and retroauricular area since 1 year. It was gradual in onset; the initial lesion appeared over the left retroauricular area which progressed to involve the entire ear lobule. There was no history of trauma or any ear symptoms. On examination, there were multiple dull-red soft, papulo-nodular lesions of 5-30 mm in size closely grouped in and around left ear involving retroauricular area, back of earlobe, helix and external auditory canal [Figure 1]. Some of the lesions are dome shaped with smooth surface, and feware flat with dry surface [Figure 2]. No regional lymphadenopathy and there were no systemic symptoms.
Figure 1: Multiple smooth dull-red nodulesaround left ear

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Figure 2: Multiple dome shaped nodules present closely in retroauricular area and back of earlobe

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Routine blood tests, urine analysis, and other biochemical parameters were within normal limits. Peripheral smear showed no eosinophilia.

The histopathology showed proliferation of blood vessels in the dermis [Figure 3]. The vessels were lined by plump epithelioid endothelial cells, protruding into the lumen of blood vessels [Figure 4]. There was diffuse infiltration of lymphocytes and eosinophils. There was no nuclear atypia [Figure 5].
Figure 3: Proliferation of blood vessels with diffuse inflammatory infiltrate in the dermis (H and E, ×100)

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Figure 4: Proliferation of dilated blood vessels lined with plump epithelioid, endothelial cells and lymphocytic, and eosinophilic infiltration (H and E, ×400)

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Figure 5: Blood vessels lined with plump epithelioid, endothelial cells occluding the lumen with lymphocytic and eosinophilic infiltration (H and E, ×400)

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   Questions Top


  1. What is your diagnosis?
  2. Which are the proposed etiopathogenesis?
  3. What are the clinical and histopathological differential diagnosis?
  4. How to manage this case?




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   References Top

1.Wells GC, Whimster IW. Subcutaneous angiolymphoid hyperplasia with eosinophilia. Br J Dermatol 1969;81:1-14.  Back to cited text no. 1
    
2.Googe PB, Harris NL, Mihm MC Jr. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: Two distinct histopathological entities. J Cutan Pathol 1987;14:263-71.  Back to cited text no. 2
    
3.Olsen TG, Helwig EB. Angiolymphoid hyperplasia with eosinophilia. A clinicopathologic study of 116 patients. J Am Acad Dermatol 1985;12:781-96.  Back to cited text no. 3
    
4.Requena L, Sangueza OP. Cutaneous vascular proliferations. Part III. Malignant neoplasms, other cutaneous neoplasms with significant vascular component, and disorders erroneously considered as vascular neoplasms. J Am Acad Dermatol 1998;38:143-75.  Back to cited text no. 4
    
5.Leiferman KM, Peters MS. Eosinophils in cutaneous diseases. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick's dermatology in general medicine. 7 th ed. New York: McGraw-Hill Medical; 2008. p. 307-17.  Back to cited text no. 5
    
6.Jang KA, Ahn SJ, Choi JH, Sung KJ, Moon KC, Koh JK, et al. Polymerase chain reaction (PCR) for human herpesvirus 8 and heteroduplex PCR for clonality assessment in angiolymphoid hyperplasia with eosinophilia and Kimura's disease. J Cutan Pathol 2001;28:363-7.  Back to cited text no. 6
    
7.Andreae J, Galle C, Magdorf K, Staab D, Meyer L, Goldman M, et al. Severe atherosclerosis of the aorta and development of peripheral T-cell lymphoma in an adolescent with angiolymphoid hyperplasia with eosinophilia. Br J Dermatol 2005;152:1033-8.  Back to cited text no. 7
    
8.Santiago F, Reis JP. Case for diagnosis. Angiolymphoid hyperplasia with eosinophilia. An Bras Dermatol 2011;86:815-24.  Back to cited text no. 8
    
9.Calonje E, Wilson-Jones E. Vascular tumours: Tumour and tumour-like conditions of blood vessels and lymphatics. In: Elder D, Elenitsas R, Jaworsky C, Johnson Jr B, editors. Lever's Hitopathology of Skin. 8 th ed. Philadelphia: Lipponcott Williams and Wilkins; 1997. p. 891-5.  Back to cited text no. 9
    
10.Calonje E, Fletcher CD, Wilson-Jones E, Rosai J. Retiformhemangioendothelioma. A distinctive form of low-grade angiosarcoma delineated in a series of 15 cases. Am J Surg Pathol 1994;18:115-25.  Back to cited text no. 10
    
11.Redondo P, Del Olmo J, Idoate M. Angiolymphoid hyperplasia with eosinophilia successfully treated with imiquimod. Br J Dermatol 2004;151:1110-1.  Back to cited text no. 11
    
12.Koizumi H, Okuyama R, Tagami H, Aiba S. Spontaneous regression of generalized angiolymphoid hyperplasia with eosinophilia in a 2-year-old boy. Acta Derm Venereol 2008;88:395-6.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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