Angiolymphoid Hyperplasia With Temporal Artery Eosinophilia: A Case Report

Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is a benign vascular proliferative disorder with uncertain etiology and pathogenesis. The aim of this paper is to report a case of ALHE in the temporal artery and discuss the general aspects of this pathology. A 29-year-old female black patient sought the Vascular Surgery Outpatient Service, complaining of bulging in the right temporal region, associated with pain and local discomfort. Physical examination revealed pulsatile bulging in the right temporal region measuring approximately 2.5 × 1.5 cm. Nuclear Magnetic Resonance showed an expansive fusiform lesion in the superficial soft parts of the right temporal region, measuring 2.9 cm in the longest longitudinal axis. Surgical excision proved to be the best therapeutic option for the patient in this case. Histopathological sections showed the proliferation of vessels of different sizes, covered by swollen endothelium, prominent inflammatory infiltrate composed of lymphocytes, plasma cells, eosinophils, and scarce histiocytes. Immunohistochemical analysis of the lesion showed positivity for CD31, corroborating the diagnosis of ALHE.

Kimura's disease as a mimicker of cavernous hemangioma: A case report and literature review

Kimura's disease (KD) is an immune-mediated disorder which mainly affects Asian men. It appears as head and neck subcutaneous masses, with inflammatory infiltrate and elevated serum immunoglobulin E levels. The clinical presentation of KD resembles that of various diseases. Here, we report the case of a 30-year-old Filipino man with KD mimicking cavernous hemangioma who was treated by surgery. Careful survey for possible KD cases is crucial. Misdiagnoses are prone to futile interventions and unwanted effects. Surgery with adjuvant therapy is superior to other forms of KD treatment.

Angiolymphoid Hyperplasia of the External Auditory Canal; Reconstruction of a Complex Defect

Angiolymphoid hyperplasia (AH) was first described by Wells and Whimster in 1969 as a benign vasoproliferative pathology with a varied infiltrate of eosinophils, lymphocytes, and plasmatic cells. Clinical presentation has been described in the literature as small red-bluish nodules, less than 3 cm in diameter that can bleed in 25% of the cases and be pruritic and painful in 37% and 20% of the cases, respectively. Particularly, AH can appear in the ear; nevertheless, other regions have been affected, including the scalp, lips, tongue, orbit, muscle, and bone. Most of these cases have occurred in adults with an unknown etiology; however, an inflammatory process has been associated in approximately 20% with eosinophilia. No malignancy has been reported.

[Kimura's disease mimicking primary neoplasm of the parotid gland: A case report]

BACKGROUND

Kimura's disease is an infrequent inflammatory disorder, of unknown etiology, with few reports outside of Asia. It presents as a nodule or tumor predominantly in the postauricular region, neck and parotid gland. It is histologically characterized by follicular hyperplasia with wellformed mantle zones, preservation of nodal architecture, prominent eosinophilic infiltrate in the germinal centers and interfollicular areas; and associated with elevated levels of IgE and peripheral eosinophilia.

CLINICAL CASE

We present a case of a 23-year-old man from Mexico, he presented with a recurrent tumor in the right parotid gland, previously treated with surgical resection. Imaging studies were performed and a primary neoplasm of the salivary gland was suspected, he was treated with surgical resection. The histological diagnosis was Kimura's disease.

CONCLUSIONS

Communication and divulgation of this rare inflammatory disorder expans the knowledge for the differential diagnosis of tumors of the head and neck, and salivary glands, mainly in men with peripheral eosinophilia and elevated IgE; it can sometimes simulate malignant neoplasms, leads to inadequate diagnostic and therapeutic approaches.

[Kimura's disease. (Clinical case study)]

The author presents his own observation of a patient with Kimura's disease (CD), which is a rather rare chronic inflammatory disease of soft tissues. The results of clinical examination and surgical treatment of this disease are presented. It is emphasized that for the diagnosis of CD, first of all, an excision biopsy of the lesion is necessary, as well as the presence of eosinophilia in the patient, an increased level of immunoglobulin E (IgE) in peripheral blood, an increase in regional lymph nodes.

Recurrent angiolymphoid hyperplasia with eosinophilia during several pregnancies

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign vascular tumor. Although its etiology is not clearly known, infection, hormonal factors, and trauma are the suspected reasons. There are few cases considered to be related to pregnancy described in the literature. Granulomas are rarely seen in the histopathology and only four patients with granulomas have been described. Herein, we will present a 28-year-old woman who has been pregnant three times; in every pregnancy, she developed pink nodular lesions on the back of her ear. In the first two pregnancies, the lesions had appeared during the pregnancy and regressed completely in the postpartum period. In her third pregnancy, the condition emerged again and lasted 1.5 years after birth of her child. Histopathology exhibited ALHE with granulomas. Although the relationship between ALHE and pregnancy is already known, there are few cutaneous ALHE cases associated with pregnancy reported in the literature. This association is further supported by this case having recurrent ALHE during each pregnancy period. Also, the presence of naked granuloma in histopathology, unlike most of the cases, contributes to the current histopathological data.

Angiolymphoid hyperplasia with eosinophilia treated with Mohs micrographic surgery

A 60-year-old healthy man presented with several enlarging, tender, spontaneously bleeding, and episodically pruritic nodules on his ear. Five agminated pink-red papulonodules of the superior postauricular sulcus were noted on examination. Pathological examination revealed a lobular dermal vascular proliferation with plump endothelial cells protruding into the lumen in a hobnail pattern, along with a dense perivascular inflammatory infiltrate composed of plasma cells, lymphocytes, and numerous eosinophils. The diagnosis of angiolymphoid hyperplasia with eosinophilia was confirmed. After discussing treatment modalities, the patient opted for Mohs micrographic surgery (MMS). Three stages of MMS were able to remove all large vessel involvement and clear the peripheral margins, but the tumor had a complex branching pattern of growth in the deep bed of the wound with numerous tiny foci remaining. Owing to risk of disfigurement, no further excision was undertaken. The area was reconstructed with a temporalis fascia flap and a full-thickness skin graft. Despite remaining microscopic disease, the patient remained without recurrence or symptoms at one year of follow up.

A fleshy papule on the eyelid

Angiolymphoid hyperplasia with eosinophilia is an uncommon tumor affecting the head and neck region. It usually presents as solitary or multiple erythematous or brownish papules and nodules. It is considered a reactive angioproliferative disorder by some, whereas others believe it to be a neoplastic growth. Involvement of the eyelid is a rare occurrence. We report an instance of angiolymphoid hyperplasia with eosinophilia involving the eyelid in a 19-year-old woman with review of literature.

Kimura disease of buccal region in a pediatric patient with nephrotic syndrome: A case report

RATIONALE

Kimura disease is a rare benign, chronic inflammatory disorder that typically presents with slowly enlarging, nontender, subcutaneous swellings in the head and neck region. The occurrence of Kimura disease in the oral cavity is extremely rare.

PATIENT CONCERNS

A 16-year-old boy presented with a complaint of a right painless buccal mass of 3 years' duration.

DIAGNOSIS

The patient had been diagnosed with nephrotic syndrome and treated with corticosteroid at the age of 5 years.

OUTCOMES

We report an extremely rare case of Kimura disease of the buccal region in a 16-year-old boy with nephrotic syndrome.

LESSON

We controlled Kimura disease and nephrotic syndrome in this patient by using a combination of surgical resection of the buccal mass and systemic steroid therapy.

Uncommon clinical presentation of Kimura’s disease as bilateral retroauricular masses in a young Malian male: successful surgical approach

We present a case of a 27 year-old Malian male referred to our hospital for two large, painless retroauricolar masses that had appeared two years earlier. Bilateral cervical painless lymphadenopathy was present at physical examination, without any other systemic symptoms. His history was relevant for bilateral Kimura’s disease lesions resected 5 years earlier in the same locations. Lymphocytosis and a mild hypereosinophilia were found in routine blood tests, together with increased total IgE levels. After surgery, histology showed lymphoid infiltrates with reactive prominent germinal centres containing eosinophils, suggesting relapse of Kimura’s disease, in the context of nonencapsulated fibrous proliferation with discontinuous collagen fibers, consistent with keloid. Three months after removal of retroauricular masses, abnormal laboratory findings reverted to normal. To the best our knowledge, this is the first case in literature of bilateral keloid lesions developed after surgery for Kimura Disease and harbouring its histopathologic features. Clinicians should be aware of these unusual reactive phenomena and their possible simulators.

An unusual case of angiolymphoid hyperplasia with eosinophilia of the nose

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare benign vascular lesion that most commonly involves the ear and preauricular area. We report the case of a 38-year-old man who presented with a progressively enlarging mass of the left nasal vestibule. The lesion was diagnosed as a nasal ALHE and treated with surgical excision. There were no complications.

Clinical utility of fine needle aspiration cytology in pediatric parotid tumors

OBJECTIVE

The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric parotid tumors.

METHODS

From June 2002 to June 2012, 22 patients ≤18-years-of-age with parotid mass were treated at Chonnam National University Hospital. Included in the study were 21 cases with preoperative FNAC. A retrospective chart review analyzed the results of FNAC and compared them with the corresponding histopathological diagnosis.

RESULTS

Twenty-one of the 22 patients had undergone preoperative FNAC, which diagnosed pleomorphic adenoma in 13 patients. The remaining eight patients were diagnosed with benign tumor (n = 6), malignant tumor (n = 1) or Kimura disease (n = 1). All 21 patients underwent parotid tumor removal. FNAC had a diagnostic sensitivity of 92.3%, positive-predictive value of 92.3% and accuracy of 90.5% for diagnosing pleomorphic adenoma of pediatric parotid tumor. FNAC had a diagnostic sensitivity of 100%, a positive-predictive value of 85% and accuracy of 85.7% for diagnosing benign parotid tumor.

CONCLUSIONS

Preoperative FNAC is a useful and accurate adjunct for preoperative evaluation of pediatric parotid tumors. We recommend that preoperative FNAC should be part of the initial evaluation of pediatric patients with parotid masses.

Angiolymphoid hyperplasia with eosinophilia on penile skin in a 7-year-old child

We report a case of a 7-year-old child who presented with a painless mass on his penis. He underwent removal of the mass, which was found to be an angiolymphoid hyperplasia with eosinophilia. Angiolymphoid hyperplasia with eosinophilia is an extremely rare tumor, especially in children's penis. In this situation, treatment of this tumor should be considered carefully, and there is a chance of spontaneous regression after volume reduction surgery.

Kimura disease: An unusual cause of head and neck masses. Report of 2 cases

Kimura disease is an uncommon chronic, benign, inflammatory condition of unknown etiology. It occurs endemically in Asia and sporadically in the West. Because it often imitates neoplastic or inflammatory processes of the head and neck, otolaryngologists and head and neck surgeons should be aware of its clinical presentations. In this article, the author reports 2 cases of Kimura disease-1 that was characterized by an unusual bilateral presentation and 1 that was managed conservatively-and he briefly reviews the literature on this entity.

Treatment of angiolymphoid hyperplasia with eosinophilia with the carbon dioxide laser

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, idiopathic condition that presents with isolated or grouped plaques or nodules in the periauricular region, forehead, or scalp. ALHE is marked by a proliferation of blood vessels with distinctive large endothelial cells accompanied by a characteristic inflammatory infiltrate that includes eosinophils. The lesion is benign but may be persistent and difficult to eradicate. Various therapeutic modalities that have been tried for its treatment include intralesional and oral corticosteroids, cryotherapy, oral retinoids, vinblastine, surgical excision, laser therapy, and INFalpha2a. We report two cases with this rare condition: one patient, treated with cryotherapy, did not improve, while the second patient was successfully treated with the CO(2) laser.

Epithelioid hemangioma of the colon: a case report

CONTEXT

Epithelioid hemangioma or angiolymphoid hyperplasia with eosinophilia is an uncommon benign vascular neoplasm that is usually located on the face or neck. Exceptionally, it has been described affecting the colon, with only two such cases described in the worldwide literature. The aim here was to present a case of primary epithelioid hemangioma of the sigmoid colon with confirmation by immunohistochemical examination.

CASE REPORT

A 37-year-old woman had had a complaint of intermittent abdominal pain for six months. Two months after the condition started, she began to present changes in her intestinal habit, with evacuations containing blood and mucus and a weight loss of 4 kg over this period. At physical examination, a palpable mass was noted in the lower left quadrant of the abdomen. Neoplasia of the colon was clinically suspected and she underwent colonoscopy. This demonstrated the presence of a vegetating sessile lesion of approximately 5 cm in diameter, at a distance of 36 cm from the anal margin. It occupied 80% of the intestinal lumen. A biopsy collected during the examination suggested a diagnosis of neoplasia of vascular origin. After surgical resection, histopathological examination of the resected specimen confirmed the diagnosis of epithelioid hemangioma of the colon, which was backed up by the immunohistochemical panel (factor VIII, Ki-67, CD-34). At present, three years after the surgery, the patient is asymptomatic, she has recovered her normal weight and she has normal findings from control colonoscopy. Despite the rarity of neoplasia of vascular origin, this possibility should be considered in the differential diagnosis for colorectal tumors.

Sonographic appearance of angiolymphoid hyperplasia with eosinophilia in the upper arm

Angiolymphoid hyperplasia with eosinophilia is an uncommon benign condition characterized by cutaneous nodules involving primarily the head and neck regions of young adults. We report thecase of a 49-year-old woman with such a lesion in the arm. Sonographically, the lesion exhibited a hypoechoic rim and an echogenic central portion. On color Doppler imaging, the central portion was markedly vascular.

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.

[Angiolymphoid hyperplasia of the lip with eosinophilia. Report of one case]

We report a 33 year-old female presenting with a 2 cm tumor of the upper lip lasting one year. The tumor was excised and the pathological examination showed multiple blood vessels with thickened walls, prominent endothelial cells, lymphoid follicles and an increased number of eosinophils. The final diagnosis was an angiolymphoid hyperplasia with eosinophilia. Six months after surgery, the patient was free of disease. This is a rare condition that must be distinguished from Kimura disease.

Radiotherapy in Kimura's disease: a report of eight cases

Kimura's disease is a rare condition of chronic inflammatory disorder affecting the skin and subcutaneous tissue. It is predominantly in the head and neck region. The lesion is benign but may be persistent/ recurrent and difficult to eradicate. Several forms of treatment have been used, including surgical excision, intralesional and oral corticosteroid, cryotherapy and radiotherapy. The authors report eight cases with histopathology consistent with Kimura s disease who received radiation therapy as a primary treatment or secondary treatment for recurrence after surgical excision in the Division of Therapeutic Radiology and Oncology, Chiang Mai University. The prescribed radiation doses varied from 30-40 Gy. With the mean follow-up time of 21 months, all eight patients were still free from disease at the time of analysis.

Radiotherapy for Kimura's disease: case report and review of the literature

Kimura's disease is a chronic inflammatory disease of uncertain etiology which involves subcutaneous tissue, presents as a tumor-like lesion and predominantly occurs in the head and neck region. Radiotherapy has been used for treating unresectable or recurrent lesions. We report a 32-year-old male who presented with a mass on the right side of the neck. The mass measured 52 x 40 mm. Peripheral eosinophilia and 5-fold increase in serum IgE level were found. Pathological evaluation following subtotal excision of the mass confirmed Kimura's disease and the patient was given prednisolone p.o. Local recurrence was observed one month later for which the patient received local radiotherapy. No recurrence has been observed up to 30 months in the post-radiotherapy period. Effective radiotherapy given in a favorable schedule and dosage could be a highly effective alternative when other treatment modalities are unsuccessful.

Angiolymphoid hyperplasia with eosinophilia affecting the nail bed and underlying bone

A 69-year-old Japanese woman had a dark red, 1-cm nodule located in the nail bed of the middle toe of her right foot. An X-ray examination revealed an osteolytic lesion of the distal phalanx of the right middle toe. Histopathology showed a proliferation of blood vessels surrounded by epithelioid cells and an infiltration of many eosinophils and some inflammatory cells. There has been no recurrence after surgical excision of the skin lesion and the distal phalanx of the right middle toe.

A case of angiolymphoid hyperplasia with eosinophilia (ALHE) of the upper lip

Angiolymphoid hyperplasia with eosinophilia (ALHE) is clinically characterized by intradermal or subcutaneous papules and/or nodules usually occurring in young adults. Lesions in the oral mucosa are extremely rare. We report a case and review the literature of ALHE cases involving the oral mucosa. A 40-year-old man presented with a painless, 20 x 20 mm, submucosal nodule on the upper lip. Histological examination of lip biopsy specimens revealed an increase in many small vessels. The vascular walls consisted of prominent endothelial cells with a histiocytoid appearance, which protruded into the lumen. Many eosinophils and lymphocytes were also seen around the vessels. The diagnosis of ALHE was made from the above findings.

[Kimura's disease of the parotid gland: a case report]

Kimura's disease (KD) is a rare, chronic inflammatory condition of unknown origin that is more commonly seen in Asia. Lymphadenopathy in head and neck region and subcutaneous swelling are accompanied with increased serum IgE levels. In some cases renal involvement is seen. A 46-year-old male patient was operated on for a painless mass in the superficial lobe of the right parotid gland. Histopathologic examination of the specimen yielded the diagnosis of KD. Kimura's disease, even though rarely encountered, must be kept in mind in the differential diagnosis of salivary gland tumors, and KD patients should be carefully followed-up for renal involvement and recurrence in the postoperative period.

Kimura disease in an African patient

We operated on a 23-year-old black Nigerian man with a 4-year history of a tumour on the left cheek associated with IgE hypergammaglobulinaemia and peripheral eosinophilia. The lesion recurred.

Angiolymphoid Hyperplasia With Eosinophilia Associated With Pregnancy: A Case Report and Review of the Literature

A case of angiolymphoid hyperplasia with eosinophilia (ALH) is reported in a 33-year-old woman who developed an auricular nodule during the second trimester of her pregnancy. Angiolymphoid hyperplasia with eosinophilia usually occurs on the head and neck of young adults and is more common in women than in men. Characteristic histologic features of ALH present in this case included proliferation of thick-walled blood vessels lined by prominent endothelial cells, infiltration of the interstitium by chronic inflammatory cells (mainly eosinophils), and presence of lymphoid follicles with germinal centers. The auricular tumor was completely excised. Thirteen months after excision, the patient remains tumor free. Although there are not many case reports on ALH during pregnancy or involving use of oral contraceptive pills, sex hormones may play a role in the pathogenesis of ALH. This hypothesis, in the context of cases previously described in the literature, and the differential diagnosis of ALH are discussed.

[Considerations about angiolymphoid hyperplasia with eosinophilia (ALHE) with regard to a case localized in the penis]

We report the case of a 27 year old man who presented a nodule in the ventral face of the penis, which increased in volume and turned painful during erection so a vascular lesion was suspected, later confirmed with a Doppler study. A complete excision of the lesion was carried out with local anaesthesia. The pathological specimen was informed as "angiolimphoid hyperplasia with eosinophilia" in its intravascular form. This is the third communication of this kind of lesion in the penis but no other adopted the intravascular variant like the present case. We discuss about this exceptional entity and make review of the most relevant literature.

Angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) of the lung: a clinicopathologic and immunohistochemical study of two cases

Two cases of primary angiolymphoid hyperplasia with eosinophilia (epithelioid hemangioma) (ALHE/EH) of the lung are described. Both patients are white, a 60-year-old man and a 27-year-old woman. One patient had a long-standing history of asthma, and the other had symptomatology related to the pulmonary mass. Wedge resections were performed in both cases, and both lesions shared similar histopathologic changes, mainly the presence of a tumor mass with a marked presence of eosinophils in the background, lymphoid hyperplasia, and marked proliferations of small-caliber vessels. Immunohistochemical studies using leukocyte common antigen, L-26, and UCHL-1 nicely stained the lymphoid component of the lesion, and CD31 clearly outlined the vascular component of the process. Clinical follow-up demonstrated that the woman died of status asthmaticus, and the man was alive and well 1 year after surgical resection of the lesion. Both cases highlight the ubiquitous distribution of ALHE/EH and underscore the importance of keeping these lesions in the differential diagnosis of vascular and lymphoid lesions of the lung.

Kimura's disease: a diagnostic and therapeutic challenge

INTRODUCTION

Kimura's disease (KD) is a rare, benign, chronic inflammatory disease with unknown aetiology. Its manifestation is protean. KD has a predilection for the head and neck area, and typically presents as tumour-like lesions that could be easily misdiagnosed. We review our experience with four recent cases.

METHODS

Over a four-year period, all patients admitted to Singapore General Hospital with KD of the head and neck region were retrospectively reviewed. Biodata, presenting symptoms and clinical parameters, especially serum eosinophil levels, preoperative investigations, type of surgical procedures and outcome were documented.

RESULTS

Four patients presented with KD of the head and neck and displayed varied manifestations of the disease. All the patients had raised serum eosinophil levels. None of them had renal involvement. Preoperative computed tomography were performed in two of the patients and showed features suggestive of KD. Fine-needle aspiration cytology that was performed in two patients was not useful in the diagnosis. All the patients underwent surgical excision of the lesions. Only one patient had multiple recurrence, both at the original and remote sites in the head and neck.

CONCLUSION

The clinical presentation and behaviour of KD is very variable. Preoperative imaging is useful in the diagnosis of the disease but the final diagnosis is histological. Surgical excision is the current treatment of choice but recurrence is common. A high index of suspicion and awareness is vital in the early diagnosis and management of KD.

Angiolymphoid Hyperplasia with Eosinophilia Associated to a Squamous Cell Carcinoma of the Ear

BACKGROUND

Angiolymphoid hyperplasia with eosinophilia is a benign vascular proliferation that usually affects the head and neck region.

METHOD

An 89-year-old man who had a squamous cell carcinoma on the posterior aspect of one ear developed lesions of angiolymphoid hyperplasia with eosinophilia on the anterior aspect of the same ear.

RESULTS

After surgical treatment of the malignant neoplasm, the lesions of angiolymphoid hyperplasia with eosinophilia disappeared spontaneously.

CONCLUSIONS

Damage to the vasculature of the ear by the malignant neoplasm or the release of angiogenic factors by the same neoplasm is a plausible explanation for the development and eventual resolution of the vascular proliferation.

Mohs Micrographic Surgery for Angiolymphoid Hyperplasia with Eosinophilia

BACKGROUND

Angiolymphoid hyperplasia with eosinophilia is a benign vascular proliferation that typically presents on the head and neck. Multiple treatment modalities have been proposed for angiolymphoid hyperplasia with eosinophilia, each with limited success or undesirable side effects. At this time, standard surgical excision is considered the treatment of choice but carries recurrence rates of 33% to 50%.

OBJECTIVE

The objective was to present a case of angiolymphoid hyperplasia with eosinophilia successfully extirpated using Mohs micrographic surgery.

METHODS

A 52-year-old woman presented with an ill-defined solitary plaque of angiolymphoid hyperplasia with eosinophilia within her left conchal bowl that enlarged despite conservative therapy with intralesional and topical corticosteroids. Mohs micrographic surgery using the fresh tissue technique and standard hematoxylin and eosin staining was performed. The characteristic histologic features of angiolymphoid hyperplasia with eosinophilia were readily identifiable on frozen sections and complete extirpation required two stages of micrographically controlled resection.

RESULTS

Resection of angiolymphoid hyperplasia with eosinophilia of the conchal bowl with complete resolution of symptoms and no evidence of clinical recurrence 8 months after surgery.

CONCLUSION

Given the high recurrence rates reported for standard excision, Mohs micrographic surgery with complete margin examination should be considered as a treatment option for angiolymphoid hyperplasia with eosinophilia, particularly for lesions with ill-defined margins or in locations where tissue sparing is desirable.

Kimura?s disease presenting as bilateral parotid masses

Kimura's disease, a unique angiolymphoid proliferative disorder with unknown cause, is apparently more prevalent in a young Oriental males, but also occurs rarely in Western people. It has occasionally been misdiagnosed as malignant tumor or other serious diseases, leading to unnecessary radical surgery. Hence, clinicians should be made aware of this disease. The most common presentation is a unilateral soft-tissue mass in the head and neck region. Kimura's disease of bilateral parotid involvement has been reported rarely. We encountered a rare case of Kimura's disease presenting as bilateral parotid region masses and treated it successfully with surgery.

Kimura's disease: two case reports with a review of the literature

Kimura's disease is an uncommon, chronic inflammatory disorder of unknown etiology. The disease usually presents as a massive subcutaneous swelling with predilection for the head and neck region in young men. Morphologically, the lesions are characterized with lymphoid follicles, intensive aggregations of eosinophils, vascular proliferation and fibrosis. Laboratory analyses detect hypereosinophilia and elevated total IgE in the blood. We present two cases of Kimura's disease in which lymphadenopathy and cutaneous nodules were the main findings. We reviewed the literature on Kimura's disease.

Kimura's disease in the parotid and submandibular regions: two case reports

Two male patients (aged 13 and 50 years) who presented with a complaint of painless mass in the parotid and submandibular regions, respectively, were found to have eosinophilia and increased blood immunoglobulin E (IgE) levels. Following ultrasonographic examination of the masses, surgical excision was performed. Histopathologic evaluation revealed massive lymphocytic and eosinophilic infiltration. Histopathologic findings and the presence of peripheral eosinophilia and high IgE levels led to a diagnosis of Kimura's disease. Postoperatively, no recurrences were detected within a year follow-up.

Kimura's disease of parotid gland presenting as solitary parotid swelling

BACKGROUND

Kimura's disease is a chronic inflammatory disorder of unknown etiology commonly seen among orientals and characterized histologically by lymphatic follicles, vascular proliferation, and marked eosinophilic infiltration. It has a predilection for the head and neck region. The lesion is benign but can be mistaken to be a malignant lesion.

METHODS

Between January 1987 and December 1999, eight cases of Kimura's disease were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur. All the patients underwent surgical excision followed by initial high-dose steroid therapy and low-dose maintenance.

RESULTS

All the patients are men, seven belong to the Malay race and one is Chinese. The patients' ages at diagnosis are 18 to 46 years. All were initially seen with swelling in the parotid gland, ranging from 1 year to 20 years' duration. Pruritus of the overlying skin was seen in seven patients. Treatment by surgical excision and steroid therapy has led to no recurrences.

CONCLUSION

Kimura's disease of parotid gland is rare. It is a chronic inflammatory condition also called eosinophilic hyperplastic lymphogranuloma. Treatment by surgical excision and steroid therapy has led to no recurrences.

Angiolymphoid hyperplasia with eosinophilia arising from the facial artery

We report on a rare case of angiolymphoid hyperplasia with eosinophilia (ALHE) arising from the facial artery, which was pre-operatively diagnosed as an aneurysm. ALHE is a rare lesion, the precise nature of which remains controversial: it is still unclear whether ALHE is a tumour or an inflammatory disease or whether it can be separated from Kimura's disease based on its pathological characteristics. ALHE rarely occurs in muscular arteries, and this is the first description of ALHE arising from the facial artery. Angiography vividly revealed the pathological structure of the lesion in this case, which prompted us to advocate angiography for diagnosing ALHE arising from muscular arteries. Complete dissection and cryotherapy proved to be effective treatment, although complete management of any therapeutic protocol should avoid recurrence of the lesion, whatever specific treatments are selected.