the most frequently involved regions are the head and neck , hands , penis and arms . alhe typically manifests with single or multiple , red / brown dome - shaped papule or subcutaneous nodules . in some cases , histologically , it appears as reactive proliferation of a small blood vessel that surrounds a muscle artery together with inflammatory infiltrates . a 30-year - old male patient presented to the department of maxillofacial surgery with swelling in the right facial region . his anamnesis revealed that the patient had his right first molar tooth extracted owing to infection a year ago and that painless swelling in that region had been present ever since . clinical examination of the swelling demonstrated a painless , hard , mobile , localized elastic lesion on palpation in the subcutaneous tissues extending in line with mandibular border . the lesion was located approximately between the angle of the mandible and the anterior aspect of the sternocleidomastoid muscle ( 23 cm below the inferior border of the mandible ) [ figure 1a ] . ( d ) 12 month postoperative extraoral view there was no lymphadenopathy in the region . the lesion was explored at the level of the subplatismal plane via extraoral approach under local anesthesia through an incision made parallel to the mandibular border . the lesion , which appeared of vascular origin because of red - brown color , was capsulated and associated with a small artery on both the anterior and posterior borders [ figure 1b ] . after total enucleation , subcutaneous tissues were sutured with 3/0 polyglycolic acid and the skin was sutured with 4/0 polyprolene . the excised specimen measuring 1.5 cm was sent to the laboratory for histopathological examination [ figure 1c ] . there was a large blood vessel with patent lumen and thick wall in the middle of the lesion [ figure 2a ] . ( a ) histopathological image of the large blood vessel ( h&e stain , x40 ) . ( b ) photomicrograph showing lymphocyte and eosinophilic leukocyte infiltration along with blood capillaries ( h&e stain , x200 ) vascular configurations were lined by epithelioid endothelial cells . edematous connective tissue with lymphocyte and eosinophilic leukocyte infiltration were detected among vascular configurations [ figure 2b ] . under the light of these findings , the patient was diagnosed with epithelioid hemangioma . no esthetic problem or complaint or recurrence was encountered over the course of the 3-year follow - up period [ figure 1d ] . here , we report a case of alhe in the angle region of the mandible in a 30-year - old male patient . the etiology of alhe remains unknown , because it is not clear if it is primarily a vascular neoplasm , a lymphoproliferative process or a heterogeneous group of entities . trauma , infections and renin or hyperestrogenic conditions ( pregnancy or oral contraceptive agents ) are considered to be the likely causes . infection was considered as the etiological factor in the present case report , because it was learned from his anamnesis that swelling caused by an infected first molar tooth a year ago induced the pathology in that region . alhe usually appears in head and neck region , frequently in the auricular area and usually measures about 23 cm in size . however , other authors have reported that lips , oral mucosa and tongue may also be involved . in the present case , epithelioid the present case report might contribute to the literature of other cases of epithelioid hemangioma that might be presented in the future . in the literature , it is usually mentioned that alhe is an asymptomatic lesion , more prevalent among females and that lymphadenopathy is present in about 520% of patients . particularly , considering that alhe is a reactive lesion , frequent palpation of the lesion by the patients may be triggering the inflammatory process . alhe must be histologically and clinically differentiated from kimura disease , which is a chronic inflammatory condition characterized by large subcutaneous nodules in the head and neck region . it should be kept in mind that kimura disease is more prevalent among young males ; it is associated with increased immunoglobulin e levels and skeletal involvement may be encountered . the most significant distinctive criterion is the fact that whilst alhe is pathology of vascular origin , kimura disease is a chronic inflammatory process . in addition to kimura disease , differential diagnosis of alhe includes cutaneous lymphoma , cavernous hemangioma , pyogenic granuloma , kaposi sarcoma and bacillary angiomatosis . vascular proliferation in subcutaneous tissue , the presence of cobblestone - like endothelial cells lining the vessels , lymphocyte infiltration together with eosinophilia are important histopathological criteria for diagnosis . eosinophilic chemotactic factor released from mast cells is suggested as an extra agent contributing to eosinophilia , which adds to the inflammatory characteristics of such cases . alternative therapies include electrodessication , curettage , radiotherapy , cryotherapy , chemotherapy , corticosteroids , laser surgery and various agents , for example , interferon alpha 2b . spontaneous remission in such cases is possible within months , even years , but recurrences are frequent . treatment is necessary in symptomatic cases and in situations that alter the patient 's appearance . in the present case we believe that complete surgical resection is a successful therapeutic option for such cases , because of its feasibility and practicality .
angiolymphoid hyperplasia with eosinophilia ( alhe ) , also called epithelioid hemangioma , is a rare benign vascular lesion usually affecting the muscular arteries of the head and neck in female patients . here , we report a 30-year - old male patient who presented with painless swelling in the angle region of the mandible . 
 the diagnosis of the specimen , which was surgically removed under local anesthesia , was made as alhe . 
 the patient has remained uneventful for 3 years .