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kimura 's disease was first described in 1937 by kim and szeto in the chinese literature and later by kimura et al . in 1948 .
angiolymphoid hyperplasia with eosinophilia ( alhe ) is a rare vasoproliferative disease with a benign nature .
a 32-year - old female presented with a history of multiple itchy nodules in the axillae for 2 years .
there was a history of recurrence of lesions after trichloroacetic acid applications ( 100% ) and radiofrequency ablations on various occasions ( done outside our institution , treated with a provisional diagnosis of pyogenic granuloma ) .
the patient had recurrent episodes of raynaud 's phenomenon . on examination , there were multiple , nontender , hyperpigmented papules and nodules in the left axilla and supraclavicular area [ figure 1 ] .
a differential diagnosis of pyogenic granuloma , eccrine poroma , lymphocytoma cutis , cutaneous secondaries , and apocrine tumors were considered .
the results of renal function tests , liver function tests , and urine routine were within the normal limits .
dermis showed groups of lymphoid follicles with prominent germinal center [ figure 2 ] with numerous proliferating blood vessels lined by plump epithelioid endothelial cells with a 
hob - nail  or  cobblestone  appearance [ figure 3 ] and the intervening tissue shows a mixture of eosinophils and lymphocytes [ figure 4 ] .
immunohistochemistry with special markers for cd 31 [ figure 5a ] , cd 34 [ figure 5b ] , and fviii was positive only in vascular components .
a chest ct scan revealed left axillary lymphadenopathy , the largest measuring 15  23 mm [ figure 6 ] .
finally , a diagnosis of an overlap of ahle and kimura 's disease was made .
hyperpigmented papules and nodules in left axillae dermis showing groups of lymphoid follicles with germinal centers h and e , 45 numerous vascular channels lined by plump endothelial cells ( arrow marks ) ( h and e , 200 ) intervening tissue showing eosinophils ( red cells ) and lymphocytes h and e 45 ( a and b ) cd 31 and cd34 positive in vascular channels ( h and e , 45 ) ct chest revealing left axillary lymphadenopathy skin lesions were treated with cryotherapy .
two to three freeze  thaw cycles with 10-s freezing and 2-min thawing per session were done at weekly intervals for 2 weeks .
there was complete regression of skin lesions [ figures 7 and 8 ] with no recurrence after 1 year of follow - up .
there were no episodes of raynaud 's phenomenon after 1 year of follow - up .
kimura 's disease , first described in china in 1937 by kim and szeto in 1937 , is characterized by a triad of subcutaneous masses in the head and neck region , peripheral eosinophilia , and elevated serum immunoglobulin e ( ige ) levels .
alhe was originally described by wells and whimster in 1969 is an entity which presents with proliferative vascular lesion of skin and mucous membraneswhich is benign in nature , with a chronic course . in the past ,
kimura 's disease was classified as a variant of alhe , but today it is considered as a different entity .
the unique features of kimura 's disease and angiolymphoid hyperplasia with eosinophilia are summarized in table 1 .
kimura 's disease versus alhe the patient presented in this study had the classic triad of kimura 's disease .
clinically , the presence of multiple papules and nodules with a history of occasional bleeding from the lesions simulates lesions of alhe , but the presence of lymphadenopathy suggests a pointer toward kimura 's disease .
histologically , there was keratinized squamous epithelium with underlying groups of lymphoid follicles with well - formed germinal centers , which is a feature of kimura 's disease , intervening tissue showed a mixture of eosinophils and lymphocytes . however , the presence of vascular channels with plump endothelial cells with a  hob - nail pattern  or
the coexistence of these two entities in the same patient has been described earlier , although the pathogenesis , clinical , and histopathological features of both appear separate .
this patient also had repeated episodes of raynaud 's phenomenon , which is a finding more commonly reported in kimura 's disease .
systemic agents such as corticosteroids , cytotoxic agents , and cyclosporine are tried . in alhe ,
other options tried are cryotherapy , laser therapy ( co2 laser , argon laser , and 585-nm - pulsed - dye laser ) , intralesional therapy with ( bleomycin , vinblastine , and fluorouracil ) have been tried .
cryotherapy causes necrosis of vascular lesions , which elicits an inflammatory response , and clearance of lesions .
there was no recurrence of skin lesions after 1 year of follow - up . in view of raynaud 's phenomenon ,
the patient had no recurrence of raynaud 's phenomenon on 1 year of follow - up .
there is a concept that alhe and kimura 's disease are two entities of the same spectrum , specific differences are observed .
we here - in report a case of an overlap , with features of kimura 's disease and alhe .
no reports of an overlap , presenting with lesions in the axillae are available to date , to the best of our knowledge .
angiolymphoid hyperplasia and kimura 's disease had been considered as separate entities . however , there are a few reports showing an overlap of these entities . herein , we present a case of a female patient who had features of clinical , serological , and histopathological overlap of both the entities .
the patient also had lesions in the axillae , with overlap features and a successful treatment of skin lesions with cryotherapy , for the skin lesions , with no relapse at 1 year of follow - up , which is not reported before .
kimura 's disease is characterized by a triad of painless subcutaneous masses , eosinophilia in the peripheral blood and in tissues with marked increase in serum ig e. angiolymphoid hyperplasia with eosinophilia ( alhe ) manifests with the presence of dermal papules and nodules . 
 unique clinical , histopathological , and biochemical findings are noted in these individual entities . 
 a 32-year - female presented with multiple nodules in the axillae for 2 years . 
 peripheral smear showed eosinophilia with aec of 6080 . 
 histopathological examination showed features of overlap . 
 antinuclear antibody immunoflorescence was was negative . 
 cd31 , cd34 , and fviii were positive in vascular component . 
 a ct chest revealed left axillary lymphadenopathy . 
 the patient was treated with cryotherapy and there was complete regression of skin lesions , with no recurrence after 1 year of follow - up . 
 alhe and kd are common in the head and neck region , but no reports of an overlap , presenting with lesions in the axillae are available to date , to the best of our knowledge . 
 response of skin lesions to cryotherapy is highlighted .