Angiolymphoid hyperplasia with eosinophilia involving the common digital artery of the hand: A case report and classification of upper limb lesions

INTRODUCTION: Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign reactive inflammatory lesion. The usual presentation is a single or multiple skin nodules of the head and neck. Involvement of the hand is very rare and there have been no comprehensive reviews on ALHE of the upper limb. In this paper, we report on a case involving the common digital artery of the hand. We also review the literature and offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either single or multiple lesions. PRESENTATION OF CASE: A 32-year old female presented with a slowly growing subcutaneous mass at the second web space of the left hand. The mass was neither tender or mobile. An MRI showed a tri-lobed soft tissue lesion. At the time of surgery, the lesion was found to be within the common digital artery of the second web space. Complete excision was done. Histopathology confirmed the diagnosis of ALHE There has been no recurrence or cold tolerance at final follow-up 1 year later. DISCUSSION: We offer two classification systems for upper limb lesions: One according to the primary structure involved, and the other according to the presentation with either a single or multiple lesions. CONCLUSION: A rare case of ALHE of the hand is presented. The literature is reviewed and two classification systems for upper limb lesions are offered and their implications are discussed.