Eosinophilic Angiocentric Fibrosis and Granuloma Faciale: Analysis of Cellular Infiltrate and Review of Literature

Abstract

Eosinophilic angiocentric fibrosis (EAF) is a rare specific inflammatory condition that affects the nose and upper airways and is characterized by distinctive histopathologic features. We report the clinical, histopathologic, and radiologic features of EAF in an elderly woman who presented to us with complete stenosis of the left nostril, nasal swelling, and granuloma faciale (GF) of the overlying nasal skin. The histopathologic spectrum of the early, intermediate, and late stages of EAF in the deeper nasal tissues is illustrated along with the adjacent changes of GF in the overlying nasal skin. Quantification of immunohistochemically stained lymphocyte cell subsets in the perivascular inflammatory component was performed by using software to compare the proportions of lymphocyte subsets in the two conditions. The results showed similar proportions of perivascular CD4 T lymphocytes in EAF and GF. We believe that both EAF and GF may represent unusual tissue responses. Similar analysis in other cases will help confirm these findings. A review of the literature suggests that the condition, if localized, is amenable to surgical treatment. In progressive late stages, EAF causes fibrotic stenosis of the affected site with localized extension.