THE DIFFERENTIAL-DIAGNOSIS OF TUMOROUS MA SS LESIONS OF THE PAROTID-GLAND - ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA AND KIMURAS-DISEASE

Background: Subcutaneous mass lesions of the head and neck are common in angiolymphoid hyperplasia with eosinophilia (ALHE) as well as in Ki mura's disease, most often in a periauricular location in young and mi ddle aged adults. Often these benign angioproliferative lesions of unk nown etiology will be misdiagnosed as parotid tumors although the majo rity are paraglandular. Whereas ill-defined lesions involving the paro tid gland are frequently observed in Kimura's disease, only one case o f intraparotid ALHE is reported in the literature. Case report: To thi s we add one further case: a 24-year-old man with a solid and well dis placable tumor of the left preauricular region. At ultrasound and intr aoperatively we found a well demarcated tumor with high central vascul arization surrounded by multiple networks of veins. One larger artery entered the lesion directly, visible as vascular structure on the cut surface. This blood vessel may have represented a vascular pattern (3 mm in diameter) that was identified as an artery by flow velocity meas urement at duplex sonography. Histopathologically we saw the character istic features of ALHE: numerous capillary proliferations showing prom inent epithelioid endothel cells with typical ''hob nail'' appearance, focal lympho-plasmacellular infiltrations and many eosinophils. The m ost conspicuous microscopic feature was a large thick-walled artery wi th total occlusions of the lumen that partially corresponded to duplex sonographic and macroscopic findings. Conclusion: In our opinion, thi s may be indicative of a primary arterial disorder with secondary vasc ular proliferation and chronic inflammation. The treatment of choice i s local excision with a safe margin of healthy tissue, since insuffici ent removal can result in recurrence.