Multiple angiolymphoid hyperplasia with eosinophilia of the hand: report of a case and review of the literature.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare angioproliferative disorder with a predilection for the head and neck region. ALHE is very rare in the extremities and even more rare in the hand, with only single cases reported in this location. We describe the occurrence of multiple lesions of ALHE on the right hand of a 26-year-old woman. We report this unusual occurrence and convey a clinical differential diagnosis with other benign and malignant conditions of the hand. All the lesions of the palm were excised out as a unit, the subungual lesion removed completely, and the involved segment of the right common digital artery excised. The tissues were processed for routine histologic examination as well as for histochemical and immunohistochemical tests. Electron microscopic study was also performed. Recurrent lesions on the same hand were also excised. Histologic examination of all the lesions revealed classic morphologic features of ALHE. The results of special studies confirmed the endothelial nature of the proliferating cells. ALHE can present as multiple lesions in the hand, and can arise in a subungual location. The possibility of larger arteries being involved should be considered. Recurrent lesions may appear months after the original presentation.