Comparison between Kimura's disease and angiolymphoid hyperplasia with eosinophilia: case reports and literature review

Nodular Vulvar Lesions

A woman in her 30s presented with mildly itchy skin nodules in the vulvar region for 1 year, which occurred during pregnancy and increased gradually in size and number without any treatments. What is your diagnosis?

The clinical and pathological features of Kimura disease in pediatric patients

Background

Kimura disease is characterized by inflammation, with its underlying causes remaining uncertain. There is a lack of comprehensive and systematic research on the pathology of this condition in pediatric patients. Our objective is to study the clinical and pathological attributes of Kimura disease in pediatric patients and investigate the potential diagnostic significance of immunoglobulin E (IgE) in this context.

Methods

Clinical and laboratory information, pathological characteristics, and follow-up data were correlated to examine the distinctive features. Immunohistochemistry, acid-fast staining, and molecular assay were used to identify the presence of IgE and pathogens.

Results

We conducted an analysis of five cases of Kimura disease in pediatric patients at our hospital. The patients' ages ranged from 5 years and 7 months to 14 years and 2 months, with 4 (80%) being male. The most common site was the head and neck region, particularly the postauricular subcutaneous area. Eosinophilia was observed in four patients (80%), and two patients (40%) had elevated serum immunoglobulin E (IgE) levels. Histopathological changes included eosinophilic infiltrates, follicular hyperplasia, and the proliferation of postcapillary venules. Immunohistochemical results supported the reactive nature of the lymphoid process and IgE deposition in the follicle, while no specific pathogens were discovered by special staining. All patients underwent surgical excision, and none experienced recurrence in their original location.

Conclusion

Children with Kimura disease show distinct eosinophilic and IgE alterations in both laboratory findings and pathological features. The application of immunohistochemical staining of IgE could serve as a promising marker for diagnosing Kimura disease.

Angiolymphoid hyperplasia with eosinophilia and Kimura disease: A case report and literature review

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a benign vascular proliferative condition, typically presenting as subcutaneous nodules in the head and neck region of middle-aged women. Kimura disease (KD) is a benign condition that presents with subcutaneous nodules in a similar distribution with lymphadenopathy and eosinophilia, typically in Asian adult males. These diseases are often discussed together, including whether they exist on a spectrum or if they represent separate disease entities. Both are very rare in the pediatric population; in this report we highlight the case of a 10-year-old Caucasian male presenting with ALHE and KD.

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.

Challenging diagnosis of Kimura disease in a child with nephrotic syndrome: A case report

Kimura disease (KD) is a rare condition with a challenging diagnosis because it may be misdiagnosed and not differentiated from other disorders. We reported a 13-year-old patient who presented with growing neck masses and was hospitalized due to the nephrotic syndrome relapse but was eventually diagnosed with KD.

An Unusual Case of Systemic Lymphadenopathy - Kimura's Disease

Background

Kimura's disease (KD) is a rare, chronic inflammatory disease. Clinically, subcutaneous nodules of the head and neck are typical manifestations, often accompanied by local lymphadenopathy or salivary gland enlargement, but there is also systemic damage, such as kidney involvement. Due to the lack of specific markers and imaging examination is not specific, it is difficult to clinically diagnose accurately and can be easy to misdiagnose. The treatment of KD is still not standardized and overtreatment can affect the quality of life.

Case Presentation

The case of a 26-year-old man complaining of chest pain with self-conscious progressive lymphadenopathy after receiving Pfizer BioNTech COVID-19 vaccine for more than 1 month is presented. Eosinophil levels were normal and IgE elevated and the final diagnosis of KD was eventually confirmed by lymph node biopsy, which revealed lymphadenopathy with extensive eosinophilic infiltration in the right neck. Treatment was prednisone combined with methotrexate, resulting in satisfactory control.

Conclusion

This case demonstrates that that Kimura disease can involve systemic lymphadenopathy, not only in the head and face or regional lymphadenopathy, suggested that KD should be excluded in patients with systemic lymphadenopathy. The current patient's response to treatment suggested that corticosteroid combined with disease-modifying antirheumatic drugs (DENARDs) was a promising treatment for KD patients with systemic damage. It is worth noting that the mechanism of immunity in the pathogenesis of KD still needs to be further studied.

Kimura disease in children: A report of 11 cases and review of the literature

INTRODUCTION

Kimura disease (KD), also known as eosinophilic hyperplastic lymphoid granuloma, is a rare benign chronic inflammatory condition, which is featured with the painless progressive mass located in the subcutaneous area of the head and neck region, elevated peripheral blood eosinophils, and raised serum immunoglobulin E (IgE) levels. KD is uncommon in clinical practice, especially with low incidence in children, so it often leads to misdiagnosis or missed diagnosis in pediatric patients.

METHODS

The clinical data of 11 pediatric patients with KD in the authors' institution were retrospectively analyzed.

RESULTS

There were 11 pediatric patients with KD enrolled in total, including 9 male patients and 2 female patients (sex ratio 4.5:1). The median age at diagnosis stood at 14 years (range 5-18 years), the initial symptoms in all patients included painless subcutaneous masses and focal swelling, the duration of symptoms ranged from 1 month to 10 years, and the average duration was 24.45 months. Six patients had single lesions, and 5 had multiple lesions. The highest proportion of lesion regions were parotid gland (n = 5, 31.3%) and retroauricular (n = 5, 31.3%), followed by cervical lymph nodes (n = 4, 25%), and others (n = 2,12.5; elbow n = 1; back n = 1). The eosinophil absolute count elevated in all patients, ranging from 0.71×10⁹/L to 10.35 ×10⁹/L (normal range 0.02-0.52×10⁹/L). IgE levels were increased in all 7 patients who underwent serum immunoglobulin examination (normal range <100 IU/mL). Three patients received oral corticosteroid treatment while 2 relapsed. Three patients received surgical resection combined with oral corticosteroid treatment, and no patient relapsed. The other 3 patients received surgery and radiotherapy, surgery combined with corticosteroid and cyclosporin and corticosteroid combined with leflunomide respectively, and no patient relapsed.

CONCLUSION

Base on the study, it is found that Kimura disease is rare and may have the atypical symptoms in pediatric patients, combination therapy is recommended to reduce recurrence, and long-term follow-up should be performed.

Identifying erroneously used terms for vascular anomalies: A review of the English literature

Background

The classification of vascular anomalies includes terms of nomenclature that are not based on histogenesis resulting in confusion among health professionals of different specialties. Ongoing efforts to classify them properly have taken place. This literature review aimed to identify erroneous nomenclature of vascular anomalies and to investigate their continued use over the past four years after the last International Society for the Study of Vascular Anomalies (ISSVA) update.

Methods

Literature research was based on pertinent classifications (ISSVA, WHO) and books related to vascular anomalies and soft tissue pathology. After identifying twelve entities with confusing terminology, new research in the Pubmed database was conducted to verify their continued use in the last four years.

Results

The literature review highlighted terms referring to vascular malformations as neoplasms. In addition, terms used as equivalents represent entirely different entities. On the other hand, different terms to characterize the same entity were also recorded. Furthermore, regardless of the last ISSVA update in 2018, terms that are only descriptive or do not correspond to vascular anomaly histogenesis are consistently used.

Conclusion

Despite intensive efforts in the last decades for correct terminology and classification of vascular anomalies, modifications are still required. A common and broadly accepted scientific terminology should be applied, accurately representing histogenesis or pathogenesis, to obtain a common language among medical specialists, given that a multidisciplinary approach is crucial for managing vascular anomalies. HIPPOKRATIA 2022, 26 (4):126-130.

Kimura disease, a rare cause of inguinal lymphadenopathy: A case report

Kimura’s disease (KD) is a rare chronic granulomatous disease of unknown etiology that mainly involves damage to lymph nodes, soft tissues, and salivary glands. The clinical symptoms are mainly painless subcutaneous soft tissue masses, often involving head and neck lymph nodes and salivary glands, and are mainly characterized by diffuse eosinophilic infiltration, lymphocyte, and vascular proliferation. There are few reports in the literature that KD affects only inguinal lymph nodes. We report in this study a 41-year-old male patient who presented to the hospital for medical help with soft tissue masses in the groin. Magnetic resonance imaging (MRI) showed multiple abnormal soft tissue nodules around the iliac vessels in the left groin, and a contrast-enhanced scan showed obvious homogeneous enhancement. Diffusion-weighted imaging showed limited movement of water molecules and showed an obvious high signal. Fluoro18-labeled deoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) was recommended for further evaluation of the patient’s general condition, and the results showed that except for the radioactive uptake in the lesions in the left groin region, no obvious abnormality was found in the rest of the body. Based on these imaging findings, the patient was first suspected to have malignant lesions, and then the patient underwent histopathological examination, which was confirmed to be KD. Our case study suggests that KD affects only the inguinal lymph nodes is rare and should be considered as one of the imaging differential diagnoses for lymphadenopathy such as lymphoma, metastases, and Castleman’s disease.

Enlarged postauricular nodules in a young South Asian man

We report a 19-year-old South Asian man with progressively enlarging postauricular nodules over a 5-year period, which were eventually treated by surgical resection.