Serum concentrations of eosinophil cationic protein and eosinophils of patients with Kimura's disease

Comparative Imaging Analysis of Kimura's Disease Using 18F-FDG PET/CT and [18F]AlF-NOTA-FAPI-04 PET/CT

Kimura's disease is a rare, chronic inflammatory disorder characterized by subcutaneous nodules, eosinophilia, and elevated serum IgE levels. It commonly affects young Asian males and typically presents in the head and neck region. Diagnosis is confirmed via histopathological examination, while treatment options include corticosteroids, surgery, and radiotherapy. [18F]AlF-NOTA-FAPI-04 PET/CT demonstrated superior imaging, with clearer background and higher target-to-background ratio, highlighting lesions with higher SUV values and greater specificity for fibroblast activity. Compared to 18F-FDG PET/CT, which is limited by nonspecific uptake in inflammatory tissues, [18F]AlF-NOTA-FAPI-04 PET/CT offers superior sensitivity and specificity in visualizing fibroblast activation. These advantages not only improve diagnostic accuracy in Kimura's disease but may also have broader implications for other eosinophilic or inflammatory disorders sharing similar clinical features. This technique improves diagnostic accuracy, facilitates treatment planning, and may guide the development of future treatment.

Kimura's disease sequentially involving multiple sites in the head and neck: A case report with a 13-year follow-up and literature review

Kimura's disease is a rare, chronic inflammatory condition with a high recurrence rate, primarily affecting young to middle-aged Asian males. It typically manifests as masses in the head and neck, accompanied with regional lymphadenopathy. This report describes the case of a 50-year-old man initially diagnosed with Kimura's disease 13 years ago, following surgical removal of a left submandibular mass. Subsequent recurrences involved the parotid and contralateral submandibular regions, requiring radiotherapy and intermittent oral prednisone therapy. After 6 years, he developed progressive proptosis and visual impairment, revealing multiple orbital masses bilaterally. A puncture examination of the left submandibular mass was indicative of Kimura's disease. Throughout the follow-up period, the eosinophil levels correlated with prednisone use. This case highlights the disease's capacity for multisite recurrence within the head and neck over an extended duration. The extensive orbital involvement without renal manifestations is a rare presentation. Long-term follow-up is crucial in Kimura's disease management, and oral prednisone can effectively control disease progression.

Narrative Review of Genetic and Immunological Mechanisms Involved in the Pathogenesis of Kimura's Disease: New Therapeutic Targets

Kimura's disease (KD) is a rare, chronic inflammatory disorder that predominantly affects young men of East Asian descent. It is characterized by painless solid masses primarily localized to the deep subcutaneous tissues of the head and neck, eosinophilia, and elevated serum immunoglobulin E (IgE). While the exact cause remains unclear, the pathogenesis is thought to involve dysregulated immune responses, particularly those mediated by T-helper cells 2 (Th2), eosinophils, and IgE production. Advances in molecular biology have suggested that genetic factors play a significant role in the development and progression of this chronic inflammatory condition. Recent studies have implicated several genes and immune pathways in its development, and understanding these genetic components may provide insights into better diagnostic tools and therapeutic strategies for KD. In this regard, biological therapies, by targeting the immune mechanisms underlying KD, have been used to treat this challenging condition with promising results, contributing to a better understanding of the pathogenesis of this rare disorder. The aim of this study was to review the literature concerning the genetic factors and immune mechanisms that contribute to the pathogenesis of KD, with a special focus on the role of biological therapies.

Efficacy and safety of dupilumab in the treatment of Kimura's disease

BACKGROUND

Kimura's disease (KD) is a rare chronic inflammatory condition characterized by nodules and lymphadenopathy in the head and neck region, exhibiting type II inflammation. Dupilumab is commonly used against type II inflammation.

AIM

To evaluate the efficacy and safety of dupilumab in KD patients.

DESIGN

The real-world study was conducted in a hospital in China.

METHODS

Six male patients with a mean age of 24.50 ± 15.47 years were treated with dupilumab following the same protocol as that for atopic dermatitis (AD). Clinical and laboratory indicators, such as maximum nodule diameter, blood eosinophil count, eosinophil percentage, and total serum IgE levels were assessed at baseline, Week 12 and Week 24. Adverse events were documented. Paired t-tests and one-way ANOVA were used for statistical analysis.

RESULTS

The results showed significant reductions in the longest nodule diameter at Week 12 (P = 0.006) and Week 24 (P = 0.017) compared to baseline. Blood eosinophil count decreased by 57.95% (P = 0.024) at Week 12 and 90.59% (P = 0.030) at Week 24. Eosinophil percentage decreased by 58.44% (P = 0.026) at Week 12 and 89.37% (P = 0.013) at Week 24. Total serum IgE levels decreased by 78.02% (P = 0.040) at Week 12 and 89.55% (P = 0.031) at Week 24. The presence of AD did not affect the results. One patient experienced temporary facial erythema after 32 weeks of treatment, which resolved with topical treatment. No other adverse events were reported.

CONCLUSION

Dupilumab demonstrated effectiveness in treating KD without severe adverse events.

Rare angiolymphoid hyperplasia with eosinophilia examined through fine needle aspiration cytology, histopathology and immunophenotypic characterization: A case report

Angiolymphoid hyperplasia with eosinophilia (ALHE), a rare benign proliferative tumor, mainly occurs in several countries in Asia and it is characterized by true vascular branching hyperplasia with infiltration of a large number of lymphocytes and eosinophils in the stroma. The present case report analyzed the clinical symptoms and fine-needle aspiration cytology, histopathological and immunohistochemical results of a patient with ALHE, and summarized the clinicopathological diagnostic features of the disease. To the best of our knowledge, this was the first study to comprehensively report the cytological, histopathological and immunophenotypic characteristics of ALHE, which could help clinicians fully understand this rare type of proliferative tumor.

Current concepts of Kimura disease: pathophysiology and evolution of treatment

Kimura disease (KD) is a chronic inflammatory disorder that frequently involves the subcutaneous tissue of the head and neck regions. It often manifests as regional lymphadenopathy or salivary gland enlargement in the affected area. The histologic architecture of the lymph nodes in KD patients is preserved, while the affected tissues show follicular hyperplasia and eosinophilic infiltration. No single modality has been adopted as an optimal treatment for KD. This article concentrates on the fundamental features of KD and reviews current approaches to its treatment.

Kimura's disease successively affecting multiple body parts: a case-based literature review

Background

Kimura’s disease is a rare, benign, chronic inflammatory disease that presents as painless, solid masses mainly affecting the deep subcutaneous areas of the head and neck, especially the salivary glands, parotid glands and nearby lymph nodes. It is characterized by elevated peripheral blood eosinophil and Immunoglobulin E (IgE) levels.

Case presentation

A 31-year-old Asian male presented with an orbital space-occupying lesion lasting for 1.5 years. Ten years prior, surgical excision of bilateral fossa cubitalis and groin masses was performed, and the pathological examination showed "lymphoproliferative disease". One year later, masses reappeared near the surgical sites; they grew slowly and shrank after glucocorticoid treatment. At this point, admission examinations showed in the peripheral blood an eosinophil proportion of 13.4%, a total IgE level of 26,900.00 IU/mL, prurigo present on the whole body, and multiple palpable masses near the bilateral fossa cubitalis and groin. The left eyeball was exophthalmic. The left elbow mass was excised, and the pathological examination confirmed Kimura’s disease. Oral glucocorticoid therapy is taken and tapering regularly. The eosinophil count returned to normal, the IgE level gradually decreased, the orbital space-occupying lesion and elbow and groin masses shrank significantly, and the whole-body skin prurigo disappeared. Currently, the patient has been in a stable condition for eighteen months.

Conclusion

Our case provides a novel insight that Kimura’s disease should be involved in the differential diagnosis of inflammatory lesion mass of orbit and also supports systemic regular glucocorticoid as a valuable therapy of such condition, but close follow-up and long-term observation are crucial.

Eosinophilic hyperplastic lymphogranuloma: Clinical diagnosis and treatment experience of 41 cases

PURPOSE

The purpose of this study was to investigate the clinical features of eosinophilic hyperplastic lymphogranuloma (EHLG) in the head and neck.

MATERIALS AND METHODS

Collecting the patients who diagnose with EHLG by pathological examination. The EHLG patients with the masses involved regions, such as involved inguinal region, chest wall, abdominal wall, anterior superior iliac spine or clavicle, instead of head and neck were excluding. All of the participants will sign the informed consent form. The history data includes: clinical history, blood routine test, pathological examination, and recurrence will be collected.

RESULTS

A total of 41 patients of EHLG were included. These patients predominantly presented as an enlarging and painless single or multiple masses with a history of repeated swelling. There were the complaint of itchy skin and pigmentation. The routine blood test showed that the percentage value of eosinophil increased in almost patients including 26 cases had raised absolute eosinophil count. The serum level of lgE was increased in 29 cases remarkably. With the methods of treatments, 36 patients received surgical excision, 3 patients accepted hormonotherapy, and another 2 patients for radiotherapy. The recurrence of EHLG was in 9 patients.

CONCLUSIONS

EHLG is a rare disease. The clinical manifestation (itchy skin and pigmentation) and increased eosinophil play critical values to the diagnosis of EHLG. Confirmed diagnosis always depends on pathological examination. Surgery is a preferred treatment, while low dose of radiotherapy is necessary for preventing relapse after operation and hormonotherapy.

Expression of the interleukin-21 and phosphorylated extracellular signal regulated kinase 1/2 in Kimura disease

OBJECTIVE

To investigate the expressions of interleukin (IL)-21 and phosphorylated extracellular signal regulated kinase 1/2 (pERK1/2) in Kimura disease (KD) and to correlate the findings with clinical and prognostic variables.

METHODS

Immunohistochemical analysis of IL-21 and pERK1/2 was performed in 18 cases of KD and five gender- and age-matched control samples. Clinical data were extracted and patients followed up for a mean period of 32.1 months.

RESULTS

After a mean follow-up period of 32.1 months (range 1-102 months), recurrence was diagnosed as the end point for seven patients-that is, a 44% (7/16) cumulative recurrence rate. In comparison with gender- and age-matched controls, patients showed strong in situ expressions of IL-21 and pERK1/2, respectively (p<0.05). Patients with strong IL-21 staining intensity and overexpression of pERK1/2 had a lower recurrence rate than those with moderate staining intensity (p=0.049, p=0.019, respectively). However, differences were not statistically significant by gender, age, eosinophils, location, multiplicity, laterality, size, duration and primary outbreak. pERK1/2 was the independent prognostic factor (p=0.020), while age, gender, eosinophils, multiplicity, laterality, size, duration, primary outbreak and expression of IL-21 were not.

CONCLUSIONS

This study suggests that the IL-21/pERK1/2 pathway is activated in KD, and pERK1/2 might be considered as a potential prognostic indicator in KD.

[An indolent and fluctuating subcutaneous mass of the skull in a 5-year-old patient: Diagnostic approach and difficulties]

A subcutaneous mass of the skull in children can have many different causes (infectious, tumoral, and inflammatory). We report on the case of a 5-year-old patient with a subcutaneous mass of the skull evolving over several months. The first pathological analysis concluded in Kimura disease. The progression and scarcity of this entity in children led to a second pathological analysis that showed lymphoblastic lymphoma B (LLB). This case reminds us that when there are discrepancies between pathological conclusions and clinical progression of a tumoral process, repeated analysis and immunochemistry are necessary.

Pulmonary embolism as the initial clinical presentation of Kimura disease: case report and literature review

Pulmonary embolism is clinically critical in that if misdiagnosed or delayed, the mortality is very high. The recognition of its risk factor or underlying disease is important for prevention of recurrence. Kimura disease is a rare, chronic inflammatory disease, which is seldom associated with thrombosis. We reported a 47-year-old male case presenting with pleural pain and dyspnoea and was found to have pulmonary embolism. After successful management of pulmonary embolism, he was noticed to have eosinophilia and lymphadenopathy. Pathologic examination of a resected lymph node has confirmed the diagnosis of Kimura disease. The patient was treated with corticosteroid and cyclosporine A, with a significant improvement of the symptoms and signs of Kimura disease and no recurrence of any thromboembolism. Associated literatures were reviewed to explore the pathogenesis underlying the thrombotic event in Kimura disease cases. It is suggested that hypereosinophilia may play a key role in thrombosis formation. The control of hypereosinophilia may contribute to the prevention of thrombosis and its recurrence in patients with Kimura disease.

Kimura disease complicated with bowel infarction and multiple arterial thromboses in the extremities

Kimura disease (KD) is a chronic inflammatory disease characterized by slowly growing subcutaneous nodules in the face and the neck region. Although a concomitant hypercoagulable state can accompany KD, massive thromboses in patients with KD have rarely been reported. Here, we report a case of KD complicated with bowel infarction and multiple arterial thromboses in the upper and lower extremities. The patient underwent bowel resection and was successfully treated with corticosteroid and anticoagulation.

Increased CD45RO+ CD62L+ CD4+ T-cell subpopulation responsible for Th2 response in Kimura's disease

Kimura's disease is characterized by subcutaneous masses, eosinophilia, and markedly elevated serum immunoglobulin E, suggesting that T helper (Th)2 cells may play a role in the pathogenesis. We investigated Th2 cytokine synthesis by mononuclear cells and possible Th1/Th2 subpopulations in Kimura's disease. Peripheral blood samples were obtained from seven patients with Kimura's disease and CD4(+) T-cell subpopulations separated by CD45RO and CD62L were isolated. Purified cells were stimulated with PHA or anti-CD3 mAb, and the cytokine levels were measured by Cytometric Bead Array kit. Peripheral blood mononuclear cells in the majority of the patients produced Th2 cytokines such as interleukin (IL)-3, IL-4, IL-5, IL-13 or GM-CSF higher than those of controls. The ratio of CD45RO(+) CD62L(+) cells in CD4(+) T cells was increased in six out of seven patients compared to age-matched controls. Especially, patient 1 had remarkably increased levels of CD45RO(+) CD62L(+) population in CD4(+) T cells. In addition, IL-4 production levels by CD45RO(+) CD62L(+) CD4(+) T cells of patients 1 and 2 were higher than those of their CD45RO(+) CD62L(-) CD4(+) T cells, in the same manner as those by a normal control. Taken together, the synthesis of Th2 cytokines and CD62L-positive subpopulation in CD45RO(+) CD4(+) T cells, which may represent characteristics of Th2, are increased in patients with Kimura's disease, suggesting that deviation to Th2 may involve in pathogenesis of the disease.

Kimura disease: CT and MR imaging findings

BACKGROUND AND PURPOSE

KD is a rare chronic inflammatory disorder of unknown etiology. The purpose of this study was to evaluate the CT and MR imaging findings of KD in the head and neck.

MATERIALS AND METHODS

We retrospectively reviewed the CT (n = 21) and MR (n = 9) images obtained in 28 patients (24 males and 4 females; mean age, 32 years; age range, 10-62 years) with histologically proved KD in the head and neck.

RESULTS

In these 28 patients, CT and MR images demonstrated a total of 52 non-nodal lesions, 1-8 cm in greatest diameter, in the head and neck. The lesions were unilateral in 11 patients and bilateral in 17 patients. Eleven patients had a solitary lesion, and 17 patients had 2-4 lesions. The parotid and/or periparotid area was the most frequent location, with 36 lesions in 23 patients. The margin of the lesions was well-defined in 1 and ill-defined in 51 cases. Compared with the adjacent muscle, the MR signal intensity of all lesions was iso- to slightly hyperintense on T1-weighted images and hyperintense on T2-weighted images. Most of the lesions demonstrated mild or moderate enhancement on postcontrast CT scans and moderate or marked enhancement on postcontrast MR images. MR images also showed tubular signal-intensity voids in 7 of 13 lesions. Associated lymphadenopathy was demonstrated in 23 patients, usually bilaterally.

CONCLUSIONS

Multiple ill-defined enhancing masses within and around the parotid gland with associated regional lymphadenopathy are characteristic CT and MR imaging findings of KD in the head and neck.

Kimura disease: diagnostic challenges and clinical management

Kimura disease is a rare inflammatory lesion of the head and neck region, usually seen in young Asian men. Patients usually present with a painless mass involving a major salivary gland with lymphadenopathy. Current studies suggest an immunologic mechanism for the pathogenesis of this disease entity. Histopathologically, this tumor is composed of vascular proliferation and lymphoid infiltrate rich in eosinophils. The immunohistochemical findings are usually nonspecific but might help in eliminating malignancies. The role of fine needle aspiration (FNA) and biopsy procedure appears to be limited in making the histologic diagnosis of Kimura disease. The natural history of the disease, however, appears to be indolent, without any malignant transformation reported, although recurrence can be frequent. Here, we describe 2 cases of Kimura disease with differing presentations, diagnostic difficulties, and their clinical management. The difficulties encountered in establishing an accurate preoperative diagnosis and the complexity of surgical management highlight the need for an index of suspicion for this clinical entity while mandating appropriate surgical management to minimize operative morbidity and reduce the risk of recurrence.

Kimura's Disease: A Case Report in a Child

Kimura's disease is chronic inflammatory disorder of unknown etiology that most commonly present as painless, unilateral cervical lymphadenopathy, males are more commonly effected than females with 3.5:1-9:1 ratio. Kimura's disease commonly seen in young adults median age being 28-32 years. Here we are presenting a case of Kimura's disease in a 6 year old male child, with a bilateral presentation. The goals of pharmacotherapy for Kimura's disease are to reduce morbidity and to prevent complications. The prognosis for Kimura's disease is good with no potential for malignant transformation.

Selected topics on lymphoid lesions in the head and neck regions

Lymphoid tissue located in the head and neck region include multiple regional lymph node chains as well as mucosa associated lymphoid tissue of the conjunctiva, buccal and nasopharyngeal cavities (Waldeyer's ring), and thyroid and salivary glands. This region is a rich source of antigenic stimuli including infectious agents coming from the outside environment. Many reactive conditions that affect lymphoid tissue in this region may mimic neoplasia. In fact, distinguishing between benign and malignant lymphoid proliferations in the head and neck region is a relatively frequent diagnostic challenge and in many instances, this distinction is not straightforward. It therefore behooves the practicing pathologist to be able to recognize the benign lymphoproliferative disorders that affect this region so as to effectively guide the appropriate clinical management of such patients. Kimura disease, Epstein Barr lymphadenitis, HIV associated salivary gland disease and chronic sialadenitis are benign conditions that not infrequently affect lymphoid tissue in the head and neck region and that share certain overlapping features with malignant lymphoma. In this brief review, we discuss these conditions and highlight clinicopathological features that may help distinguish them from neoplastic lymphoproliferations that may share similar features.

In situ expression of CD23 in lymph nodes of patients with Kimura's disease

OBJECTIVE

The aim of this study was to investigate the expression of CD23 (Fcɛ RII) in the lymph nodes (LNs) of patients with Kimura's disease (KD).

METHODS

Expression of CD23 was examined immunohistochemically. The concentrations of soluble CD23 and titers of IgE in sera from patients with KD were studied by enzyme-linked immunosorbent assay (ELISA).

RESULTS

In the germinal centers (GCs) of LNs from patients with KD, overexpression of CD23 on well-developed follicular dendritic cells (FDCs) was observed. GC lymphocytes in the LNs of KD patients were intensely positive for CD23, and positive cells were also observed in both the light and dark zones. In contrast, in the LNs of normal patients, CD23-positive cells were restricted to the light zone of the GCs. Although serum IgE titers were raised in all KD patients, serum concentrations of soluble CD23 were not elevated.

CONCLUSION

These results suggest that CD23 and FDCs play important roles in the pathogenesis of KD.

Increase of Th2 and Tc1 cells in patients with Kimura's disease

OBJECTIVE

A Th1/Th2 cytokine imbalance with a predominance of Th2 cytokines has been suggested to be of pathogenic importance in Kimura's disease.

METHODS

To evaluate the role of Th1/Th2 cytokines in Kimura's disease, the subsets of Th1, Th2, Tc1 and Tc2 cells from patients with Kimura's disease were examined by intracellular cytokine flow cytometry. The expressions of IL-5, eotaxin and RANTES in the lesions were investigated by RT-PCR.

RESULTS

The population of Th2 and Tc1 cells in Kimura's disease was significantly increased compared with these cells in control (p<0.05). Th1 and Tc2 cells in Kimura's disease were not significantly increased compared with control subjects. The titers of IgE and the number of Th2 cells were correlated. The expression of IL-5 and RANES was observed in the lesions of patients with Kimura's disease.

CONCLUSION

These results indicate that the predominance of Th2 and Tc1 cells might contribute to the mechanism in pathogenesis of Kimura's disease.

The (1)H, (13)C, (15)N resonance assignment, solution structure, and residue level stability of eosinophil cationic protein/RNase 3 determined by NMR spectroscopy

Eosinophil cationic protein (ECP)/human RNase 3, a member of the RNase A family, is a remarkably cytotoxic protein implicated in asthma and allergies. These activities are probably due to ECP's ability to interact with and disrupt membranes and depend on two Trp, 19 Arg, and possibly an extremely high conformational stability. Here, we have used NMR spectroscopy to assign essentially all (1)H, (15)N, and backbone (13)C resonances, to solve the 3D structure in aqueous solution and to quantify its residue-level stability. The NMR solution structure was determined on the basis of 2316 distance constraints and is well-defined (backbone RMSD = 0.81 A). The N-terminus and the loop composed of residues 114-123 are relatively well-ordered; in contrast, conformational diversity is observed for the loop segments 17-22, 65-68, and 92-95 and most exposed sidechains. The side chain NH groups of the two Trp and 19 Arg showed no significant protection against hydrogen/deuterium exchange. The most protected NH groups belong to the first and last two beta-strands, and curiously, the first alpha-helix. Analysis of their exchange rates reveals a strikingly high global stability of 11.8 kcal/mol. This value and other stability measurements are used to better quantify ECP's unfolding thermodynamics.

Kimura disease: review of the literature

Kimura disease (KD) is a rare, chronic inflammatory disease of unknown cause and is characterized by painless s.c. swellings and lymphadenopathy commonly affecting the head and neck region. Much therapeutics has been used to treat KD, but is not satisfactory because of frequent relapse. Imatinib has been reported previously to be useful for treatment of hypereosinophilic syndrome and may work by selectively blocking protein-tyrosine kinases, such as platelet-derived growth factor receptor, and c-Kit. We carried out immunohistochemical examination of platelet-derived growth factor receptor-alpha and c-Kit in tissues from patients with KD. The results were positive and suggested that Imatinib might be an effective drug for the treatment of the disease. We have also briefly reviewed the epidemiology, aetiology, clinical manifestations, laboratory and pathological examinations, differential diagnoses, treatment and prognosis of KD in this manuscript.

Molecular cloning and characterization of the human RNase kappa, an ortholog of Cc RNase

A novel protein family, designated hereafter as RNase κ (kappa) family, has been recently introduced with the characterization of the specific Cc RNase, isolated from the insect Ceratitis capitata. The human ortholog of this family consists of 98 amino acids and shares > 98% identity with its mammalian counterparts. This RNase is encoded by a single-copy gene found to be expressed in a wide spectrum of normal and cancer tissues. The cDNA of the human ribonuclease has been isolated and subcloned into a variety of prokaryotic expression vectors, but most efforts to express it caused a severe toxic effect. On the other hand, the expression of the human RNase by the use of the methylotrophic yeast Pichia pastoris system resulted in the production of a highly active recombinant enzyme. Using a 30-mer 5′-end-labeled RNA probe as substrate, the purified enzyme seems to preferentially cleave ApU and ApG phosphodiester bonds, while it hydrolyzes UpU bonds at a lower rate. Based on amino acid sequence alignment and substrate specificity data, as well as the complete resistance of the recombinant protein to the placental ribonuclease inhibitor, we concluded that the human RNase κ is a novel endoribonuclease distinct from other known ribonucleases.