Trivedi Apoorva, Norris Ivy, DeWitt Corey M, Goldman Glenn D
The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT.
Dermatol Online J. 2019 Dec 15;25(12):13030/qt1t75v80t.
A 60-year-old healthy man presented with several enlarging, tender, spontaneously bleeding, and episodically pruritic nodules on his ear. Five agminated pink-red papulonodules of the superior postauricular sulcus were noted on examination. Pathological examination revealed a lobular dermal vascular proliferation with plump endothelial cells protruding into the lumen in a hobnail pattern, along with a dense perivascular inflammatory infiltrate composed of plasma cells, lymphocytes, and numerous eosinophils. The diagnosis of angiolymphoid hyperplasia with eosinophilia was confirmed. After discussing treatment modalities, the patient opted for Mohs micrographic surgery (MMS). Three stages of MMS were able to remove all large vessel involvement and clear the peripheral margins, but the tumor had a complex branching pattern of growth in the deep bed of the wound with numerous tiny foci remaining. Owing to risk of disfigurement, no further excision was undertaken. The area was reconstructed with a temporalis fascia flap and a full-thickness skin graft. Despite remaining microscopic disease, the patient remained without recurrence or symptoms at one year of follow up.
一名60岁健康男性，耳部出现多个不断增大、触痛、自发出血且间歇性瘙痒的结节。检查发现耳后上沟有5个聚集的粉红红色丘疹结节。病理检查显示小叶性真皮血管增生，内皮细胞丰满，呈鞋钉样突入管腔，伴有由浆细胞、淋巴细胞和大量嗜酸性粒细胞组成的密集血管周围炎性浸润。嗜酸性粒细胞增多性血管淋巴样增生的诊断得以证实。在讨论治疗方式后，患者选择了莫氏显微外科手术（MMS）。MMS的三个阶段能够切除所有大血管受累部分并清除周边切缘，但肿瘤在伤口深层床呈复杂的分支生长模式，仍有许多微小病灶残留。由于有毁容风险，未进行进一步切除。该区域用颞肌筋膜瓣和全厚皮片进行了重建。尽管仍有微小病灶残留，但患者在随访一年时未出现复发或症状。
