Hematoxylin-eosin staining of the biopsy specimen revealed granulomatous inflammation with perilymphatic distribution. The granulomas, which were noncaseating, were located around and sometimes within dilated blood vessels and lymphatic channels, consistent with a true granulomatous lymphangitis. There was dermal edema with a lymphohistiocytic perivascular infiltrate. Special stains for fungi, acid-fast bacilli, spirochetes, and parasites were negative, and there was no evidence of an atypical lymphoid infiltrate or implanted foreign material.
Chronic Periorbital Swelling in an Elderly Man—Diagnosis. Arch Dermatol. 2003;139(8):1075-1080. doi:10.1001/archderm.139.8.1075-a