Fig. 8.3. Epithelioid haemangioma showing "hobnailed" endothelium of the capillary on the left and lymphocytic infiltration

ally, only lymph nodes are involved. There is a peripheral blood eosinophilia and raised levels of IgE.

Microscopically, the subcutaneous masses are found to be composed of lymphoid follicles surrounded by oe-dematous connective tissue rich in eosinophils and containing numerous thin-walled blood vessels resembling high endothelial venules [6]. Infiltration of the germinal centres with eosinophils and follicle lysis is a frequent finding, as is the presence of multinucleated cells. There is deposition of IgE on the processes of the follicular dendritic cells and there are also numerous mast cells, the latter well shown by immunostaining with IgE mAb. Plasma cells may also be prominent.

Diagnostic confusion between angiolymphoid hyperplasia with eosinophilia and Kimura's disease is likely to occur if the characteristic vascular appearances in angiolymphoid hyperplasia with eosinophilia have not been recognised and if there is very prominent lym-phoid hyperplasia with follicle formation and marked tissue eosinophilia in the latter. In Kimura's disease the endothelial cells in the proliferating vessels never show an epithelioid/histiocytoid appearance, nor is there an associated large vessel with intimal thickening. In angiolymphoid hyperplasia with eosinophilia there is never lymph node enlargement or tissue deposition of IgE.

Both epithelioid haemangioma and Kimura's disease are benign entities. Recurrence is rare in the former if it is completely excised. It is more frequent in the latter, but eventually it becomes stationary. A nephrotic syndrome may rarely occur in Kimura's disease.

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