Cytologic features of Kimura's disease in fine-needle aspirates. A study of eight cases

Kimura's disease presenting with intraparotid and neck nodes: A case report and review of literature

Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown etiology. The purpose of this article is to increase the awareness of clinicians regarding KD presenting with intraparotid and neck nodes which can mimic various inflammatory and neoplastic conditions. A 22-year-old man presented with a slow-growing left parotid swelling for 3 years. Ultrasound and computed tomography showed multiple enlarged intraparotid and neck nodes. Fine needle aspiration results showed lymphoid tissue hyperplasia. A diagnosis of KD was based on characteristic histopathological findings after a superficial parotidectomy in conjunction with peripheral eosinophilia. KD should be included in the differential diagnosis especially in young Asian men with slow-growing lesions and peripheral eosinophilia. Cytology by fine needle aspiration is useful to exclude malignancy but the results may be inconclusive. Surgical excision is best for definitive histopathological diagnosis, and has been the mainstay of treatment of KD.

Kimura’s disease: A short study of cytomorphologic features with its differential diagnosis and review of literature

Kimura’s disease (KD) is a chronic inflammatory disorder of unknown etiology, endemic in Asia. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head-and-neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin (Ig) E levels. Many conditions including benign and malignant may mimic KD clinically. This study reports cytologic features of seven cases of KD which were studied and correlated with histology, Ig profile, and peripheral blood examination. KD shows a good response to medical treatment; hence, fine-needle aspiration cytology in conjunction with other laboratory findings lowers the need for additional biopsy procedures for early diagnosis as well as diagnosis of recurrent lesions.

Warthin-Finkeldey giant cells-A useful clue for the cytodiagnosis of Kimura disease: A report of three cases

Kimura disease (KD) is a rare, idiopathic chronic inflammatory disorder that usually presents as unilateral painless lymphadenopathy or soft tissue swelling of the head and neck region in young Asian males. The disease lacks pathognomonic clinical and cytomorphological features and can be mistaken for many reactive and malignant conditions. We report three cases of KD presenting as bilateral swelling of the head and neck region, and describe the cytomorphological features of each. In the correct clinical setting, a polymorphous lymphoid aspirate with eosinophils and Warthin-Finkeldey giant cells should raise a suspicion of KD and prompt further work up.

Kimura's disease mimicking thoracic spine dumbbell neurogenic tumor: a case report and literature review

Background

Kimura’s disease is a rare, benign chronic inflammatory disease of unknown etiology that mostly affects Asians. The disease typically presents as subcutaneous masses in the head or neck region that are predominantly found in the preauricular and submandibular areas.

Case presentation

A 7-year-old boy presenting with paralysis of both lower extremities and a thoracic spine dumbbell mass was initially diagnosed with a neurogenic tumor, but the pathological and laboratory examinations confirmed the diagnosis of Kimura’s disease. The paralysis symptom disappeared rapidly, but the patient had developed a recurrent mass in the cervical vertebral canal at the 9-month follow-up.

Conclusion

To our knowledge, no prior published literature has revealed Kimura’s disease cases that mimic dumbbell neurogenic tumors. Here, we report such a case of Kimura’s disease for the first time and provide a brief review of the literature.

KIMURA'S Disease - An E[X]clusive Condition

Kimura's disease is a rare autoimmune disease of unrecognized etiology. Due to its unspecific clinical presentation and laboratory studies, Kimura's is a diagnosis of exclusion . A systematic multidisciplinary approach is mandatory to rule out the other common causes of cervicofacial lymphadenopathy. A thorough Histopathological examination including immunohistochemical analysis along with the presence of specific biochemical markers, including raised Absolute eosinophilic count is necessary to conclude the diagnosis as Kimura's Disease. In this article we present a case of a middle aged Asian woman with cervicofacial lymphadenopathy with no associated illness. The above described protocol of clinical, radiological and histolopathological investigations was followed before establishing the final diagnosis of Kimura's. The review of literature on contemporary management and prognosis is discussed.

Angiolymphoid hyperplasia with eosinophilia and Kimura disease overlap, with evidence of diffuse visceral involvement

A relationship between Kimura disease (KD) and angiolymphoid hyperplasia with eosinophilia (ALHE) has been debated. Given substantial clinical and histological overlap, these entities were once considered to represent a disease spectrum; however, they are now widely considered to be nosologically distinct. A diagnosis of either condition is further complicated by resemblance to various malignancies, which must be carefully excluded. Coexistence of ALHE and KD in a patient is extremely rare, with only four cases reported in the English literature. We report what is to our knowledge the first case of ALHE and KD overlap with evidence of diffuse visceral involvement.

Kimura's disease: A diagnostic challenge experienced with cytology of postauricular swelling with histopathological relevance

Kimura's disease is a rare, chronic inflammatory disorder of unknown cause. It is endemic in Asia, affecting more number of males than females, with a ratio of 3:1. The typical clinical manifestations include a triad of painless unilateral cervical lymphadenopathy or subcutaneous masses predominantly in the head and neck region, blood and tissue eosinophilia, and an elevated serum immunoglobulin E (IgE) levels. Variable conditions both benign and malignant may mimic Kimura's disease both clinically and on fine needle aspirates. The confirmatory diagnosis is established only by histopathological examination. We report a case of Kimura's disease in a patient who underwent multiple investigations in view of her past history and family history of pulmonary Koch's. Fine needle aspiration cytology (FNAC) was performed thrice with consistently similar result of reactive lymphadenitis with numerous histiocytes and eosinophilia. The final diagnosis of Kimura's disease could finally be established only on histopathological examination.

Epithelioid hemangioma of brachial artery: report of a case and review of the literature

Epithelioid hemangioma (EH) is an uncommon benign vascular lesion, also known as angioblastic lymphoid (or angiolymphoid) hyperplasia with eosinophilia, characterized by an unclear etiopathogenesis.

It usually affects young to middle-aged adults and develops in the head and neck region, as painless cutaneous or subcutaneous reddish papules or nodules.

Large vessels involvement is extremely rare, and to date only two cases affecting the brachial artery have been cited in literature.

In this report we present a further case of EH of the brachial artery and review the pertinent literature.

Kimura's disease presenting with inguinal lymphadenopathy in an 11-year old girl: a case report

Kimura's disease (KD), mostly seen in young Asian boys, typically manifests with subcutaneous lesions and cervical lymphadenopathy. It has a good prognosis and has no risk of malignancy. Inguinal lymphadenopathy is rarely reported as a presenting feature of KD. Here we report such a case of KD in an 11-year old girl. The diagnosis of KD was confirmed in this case by characteristic histopathological findings of the excised lymph node.

Kimura's disease: clinical and imaging parameters for the prediction of disease recurrence

Kimura's disease is a rare chronic inflammatory disorder with a high rate of recurrence. The clinical and imaging features of Kimura's disease have been documented in the literature, but the relationship between these features and disease recurrence is still unclear. We conclude that disease duration of greater than 5 years, bilateral involvement, a lesion diameter of greater than 3 cm, a blood eosinophil count greater than 20%, and ill-defined lesions are predictive factors for the recurrence of Kimura's disease.

Kimura's Disease

Kimuras disease is a chronic inflammatory disorder of unknown etiology. It is rare in the West, but endemic in Asia. It typically presents as solitary or multiple subcutaneous nodules, that slowly increase in size. The lesions are variably painful and pruritic. It often accompanied by regional lymphadenopathy, raised serum eosinophil counts, and markedly elevated serum immunoglobulin E levels. Histologically, the lesions are characterized by reactive lymphoid follicles with eosinophilic infiltration and an increased amount of postcapillary venules. The optimal treatment for KD remains controversial. Although the condition seldom resolves spontaneously, malignant transformation has not been reported to date, and the prognosis is good. We describe a male patient with a 4-year pruritic progressive “bump” in front of his left ear. On physical examination, the patient had 2 discrete lesions on the left side of his face near his ear. Postauricularly, there was a 3 × 5 cm erythematous to violaceous, indurated nodule. Preauricularly, there was a similar, but smaller cyst-like nodule. Punch biopsy showed a superficial and deep nodular and interstitial infiltrate, reactive lymphoid follicles with a dense infiltration of eosinophils and areas of eosinophilic follicle lysis. The patient received intralesional triamcinolone acetonide injections 10 mg/cc behind left ear with a good improvement.

Kimura Disease

We have encountered 11 cases of Kimura disease, comprising 10 males and 1 female. The ages at presentation ranged from 16 to 48 years, with a mean of 31.5 years. The sites of the subcutaneous masses were bilateral posterior auricular regions in two cases, frontal region in two cases, temporal region in two cases, head region in one case, parotid region in two cases, parotid and temporal regions in one case, and left earlobe in one case. The interval from onset to surgery ranged from 1 to 10 years, with a mean of 4.7 years. For diagnostic imaging, a combination of magnetic resonance imaging (MRI) and ultrasonography had a high diagnostic value. MRI depicted abnormalities at sites in contact with bone, such as posterior auricular regions, and sites with abundant soft tissue, such as parotid and cheek regions. Diffuse atrophy of subcutaneous fat was observed at the sites of the masses. On ultrasonography, the interior of lymph nodes was homogeneous and hyperechoic, whereas the periphery was hyperechoic, and blood vessels entering lymph nodes were clearly depicted. Surgery was performed in all cases. Postoperative adjuvant radiotherapy was conducted in one patient and radiotherapy and steroid therapy in one other patient. There were two relapses, and both were excised by repeated surgery. Surgical excision of the subcutaneous mass in Kimura disease has the advantages that the treatment period is short and precise histopathologic diagnosis can be obtained.

Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two disease entities in the same patient: case report and review of the literature

BACKGROUND

Much controversy has existed with regard to the relationship between Kimura's disease and angiolymphoid hyperplasia with eosinophilia. They were initially thought to represent the same disease spectrum, but it has now been widely accepted that they are two separate disease entities. To our knowledge, there have been no reports to date describing a case of both Kimura's disease and angiolymphoid hyperplasia with eosinophilia coexisting in the same patient.

METHODS

We describe a patient presenting initially with a right postauricular subcutaneous swelling and subsequently developing multiple erythematous facial papules and nodules. The medical literature is reviewed.

RESULTS

Clinical features of the right postauricular subcutaneous swelling and multiple erythematous facial papules/nodules suggest Kimura's disease in the former and angiolymphoid hyperplasia with eosinophilia in the latter. Histopathological examinations of these lesions helped to confirm the diagnosis of Kimura's disease and angiolymphoid hyperplasia with eosinophilia, respectively.

CONCLUSIONS

Kimura's disease and angiolymphoid hyperplasia with eosinophilia can coexist in the same patient. Coexistence of the two types of lesions in one patient may also be considered evidence that Kimura's disease and angiolymphoid hyperplasia with eosinophilia form a spectrum in one disease.

Clinicopathologic study of parotid involvement in 21 cases of eosinophilic hyperplastic lymphogranuloma (Kimura's disease)

OBJECTIVE

To investigate the clinicopathologic features of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) in the parotid gland.

STUDY DESIGN

The hematoxylin and eosin sections and clinical data of 60 patients with eosinophilic hyperplastic lymphogranuloma (Kimura's disease), including with parotid involvement, were reviewed.

RESULTS

Of 60 cases of eosinophilic hyperplastic lymphogranuloma (average age, 42 years; average disease duration, 5.8 years), 35 cases (58%) were clinically seen to involve swelling of the parotid region. Parotid specimens were available in 21 cases and showed different microscopic changes. In mildly affected parotid samples, the histological features included infiltration of lymphocytes and eosinophils around the ducts of the interlobular connective tissues. In the moderately involved glands, the infiltrated area was enlarged and contained lymphoid follicles, resulting in adjacent acinar atrophy that was particularly obvious around the salivary ducts. In severe lesions, most acini were lost and only a few ducts remained. All cases with parotid involvement showed more severe pathological changes in the subcutaneous connective tissues and/or local lymph nodes. The parotid lesions often surrounded a central intraglandular lymph node with characteristic features of the disease; however, the salivary parenchyma was left alone. Nerve fibers affected by inflammatory lymphocytes and eosinophils were seen in 38/60 (63%) cases of eosinophilic hyperplastic lymphogranuloma (Kimura's disease) examined in this study.

CONCLUSIONS

Eosinophilic hyperplastic lymphogranuloma (Kimura's disease) does not show primary parotid involvement, but instead, pathological changes in the parotid gland are a result of disease spread from the intraparotid lymph nodes and adjacent soft tissues. In addition, our observations suggest that the pruritus often associated with the disease may be due to nerve infiltration by lymphocytes and eosinophils.

Kimura's disease: a case report and literature review

Kimura's disease, which occurs endemically in the Far East and sporadically in the West, has so far eluded efforts to determine its exact pathogenesis. It presents as solitary or multiple benign swellings of the skin, has a predilection for the periauricular and scalp regions, and often is associated with regional lymphadenopathy. Morphologically, the lesions are characterized by proliferating blood vessels with rich eosinophilic infiltrate. Peripheral blood eosinophilia and raised serum IgE levels are signature features of the condition. The overall prognosis is good. When surgery is not possible, conservative treatment with either corticosteroids or radiation often can produce a favorable response. Complete surgical excision whenever feasible is the preferred treatment despite a high recurrence rate. Based on a recent case of Kimura's disease in a 55-year-old black woman, we discuss the pitfalls in the diagnosis of this chronic inflammatory disorder.

Status of intraoperative cytology in the diagnosis of epithelioid hemangioma

Whereas evaluation of the frozen section of a subcutaneous retro-auricular mass was equivocal, the correct diagnosis of epithelioid hemangioma could be suggested on examination of intraoperative cytological smears. It is proposed that in the absence of cytological cues of malignancy and in the presence of the proper clinical setting, the constellation of vascular structures, eosinophils, lymphocytes, and clusters of cuboidal cells with vacuoles in their abundant acidophilic cytoplasm is indicative of epithelioid hemangioma.

Ultrasound of Kimura's disease

Kimura's disease is found almost exclusively in Orientals. It commonly affects the head and neck region and mainly involves the major salivary glands and regional lymph nodes. Its appearances can be mistaken for malignant disease. We present two patients with Kimura's disease. In one patient the disease involved the soft tissues and parotid gland, and in another the submandibular gland. Both patients demonstrated lymphadenopathy in the submandibular, submental areas and upper cervical region. Both patients had ultrasound examination of the salivary glands and neck. One of the patients also had contrast-enhanced CT and MRI. The clinical, pathological and imaging findings of Kimura's disease are discussed.