The epithelioid hemangioma, more commonly termed angiolymphoid hyperplasia with eosinophils, is a pathologic vascular proliferation characterized by a distinctive eosinophil-rich mixed inflammatory infiltrate. A nonspecific accompanying infiltrate has only rarely been reported, and may confound the diagnosis of this benign process with malignant mimics. We present such a case of angiolymphoid hyperplasia without eosinophils, and consider its diagnosis and pathogenesis within the spectrum of related entities.