Recurrent Angiolymphoid Hyperplasia with Eosinophilia of the Parotid

Abstract

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vasculoproliferative disorder. It usually affects young adults presenting as papules or nodules involving the skin of head and neck region and rarely involves extracutaneous sites. ALHE involving parotid is rare and can be a diagnostic dilemma as it mimics a parotid neoplasm. This is a case of a 23 year old male presenting with a recurrent swelling over the left parotid region post surgery. Ultrasonography revealed a vascular soft tissue lesion in the preauricular region suggestive of a benign lesion. Contrast enhanced magnetic resonance imaging showed a hyperintense lesion involving the superficial lobe of the left parotid gland. Patient underwent superficial parotidectomy and histopathologically was diagnosed to have ALHE. Very few cases have been reported and this case is highlighted as the facial nerve was enmeshed by the intraparotid lesion which was a surgical challenge.

Keywords: Angiolymphoid hyperplasia with eosinophilia; Facial nerve; Parotid gland; Recurrent parotid swelling.

Fig. 1

Swellings  noted in the left parotid and mastoid areas

Fig. 2

Contrast enhanced MRI showing lesion in the left parotid and postauricular regions

Fig. 3

Intraoperative picture of the parotid swelling

Fig. 4

Gross specimens of superficial parotidectomy and the growth over the mastoid

Fig. 5

Histopathological features of ALHE in parotid gland. a Vascular proliferation along with lymphoid aggregates. b Eosinophil aggregates