Cutaneous angiolymphoid hyperplasia with high endothelial venules is characterized by endothelial expression of cutaneous lymphocyte antigen

Two cases in which the presence of cutaneous lesions with a characteristic admixture of lymphoid hyperplasia and vascular proliferation lead to the di agnosis of so-called acral pseudolymphomatous angiokeratoma (APA) of childr en are reported. Owing to the prominence of its blood vessels, so striking as to be reminiscent of high endothelial venules (HEVs), APA was initially interpreted as a vascular lesion rather than a pseudolymphoma. This resembl ance is further compounded by our finding that cutaneous lymphocyte antigen (CW), an HEV marker, is also expressed in APA epithelioid blood vessels. C onsequently, we believe that "cutaneous angiolymphoid hyperplasia with high endothelial venules" (ALH-HEV), which alludes to the dual nature of prolif erating elements and the HEV-like phenotype of the vascular component, woul d be a better denomination for this entity. Additionally, we speculate that ALH-HEV lymphoid hyperplasia self-perpetuates through the transformation o f dermal capillaries into HEVs, which would bind non-skin homing lymphocyte s expressing L-selectin and promote their local recruitment and recirculati on. HUM PATHOL 32:227-229. Copyright (C) 2001 by W.B. Saunders Company.