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Loganathan SK, Mondal S, Basu S, Thangaraj A, Vignesh P, Nada R, Suri D. Membranous nephropathy with Kimura's disease: A case report and review of literature. Int J Rheum Dis 2024; 27:e15265. [PMID: 39030988 DOI: 10.1111/1756-185x.15265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024]
Abstract
Kimura's disease (KD) is a chronic inflammatory disorder characterized by nontender lymphadenopathy involving the head and neck region. Renal involvement in KD is rare, especially in children. We report a 12-year-old boy who had been previously treated for classical KD and had presented with anasarca and oliguria after 4 years. There were no swellings or lymphadenopathy. The kidney biopsy revealed membranous nephropathy. Remission was achieved with oral prednisolone and tacrolimus therapy. This patient highlights the need to regularly monitor patients with KD for the evolution of renal diseases, even if lymphadenopathy regresses. Serial monitoring for eosinophilia, inflammatory markers, and urine examination is needed to help identify subclinical disease early and prompt initiation of specific therapy.
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Affiliation(s)
- Sathish Kumar Loganathan
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjib Mondal
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abarna Thangaraj
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Pediatric Allergy Immunology Unit, Department of Paediatrics, Advances Paediatrics Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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2
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Zhao F, Zhou M, Mao A, Zhang Y, Chen Y. Kimura Disease: A Detailed Analysis of Clinical and Radiological Manifestations in a Retrospective Case Series. J Inflamm Res 2024; 17:3371-3381. [PMID: 38803691 PMCID: PMC11129738 DOI: 10.2147/jir.s462098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Background Kimura disease (KD) is a rare chronic inflammatory disease that affects mainly young Asian men and is characterized by painless subcutaneous masses, lymphadenopathy, and elevated serum IgE levels. Despite its benign nature, KD poses a diagnostic and therapeutic challenge due to its rarity and clinical variability. Objective This study aimed to provide a comprehensive analysis of the clinical and radiological features of KD in a retrospective case series, to assess treatment outcomes, and to discuss the implications for diagnosis and management. Methods We retrospectively analyzed four histologically confirmed cases of KD admitted to Zhejiang Provincial People's Hospital from January 2018 to October 2023. Clinical and radiological data were retrospectively analyzed, and imaging findings were analyzed by two neuroradiologists to determine lesion characteristics and contrast enhancement patterns. Results Our findings showed that the patients were predominantly male, with a mean age of 43 years and an age range of 13-71 years. All patients presented with painless subcutaneous masses and three of them had peripheral blood eosinophilia and elevated serum IgE levels. Radiographically, the lesions were predominantly ill-defined with heterogeneous enhancement, accompanied by subcutaneous fat atrophy. Complete surgical excision and oral corticosteroids were effective treatments, and no recurrence was noted during follow-up. Conclusion KD should be considered in the differential diagnosis of painless subcutaneous masses in the head and neck region, especially in the presence of eosinophilia and elevated IgE levels. Our findings contribute to the understanding of KD's clinical and radiological spectrum and highlight the need for long-term follow-up due to the risk of recurrence.
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Affiliation(s)
- Fanfan Zhao
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Min Zhou
- Department of Radiology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - An Mao
- Department of Outpatient, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yingjiao Zhang
- Department of Gastroenterology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Yao Chen
- Department of Radiology, 903 Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army, Hangzhou, Zhejiang Province, People’s Republic of China
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3
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Xie W, Luo J, Tang R, Zhou X, Wang X, Wang G, Zhang Y. Kimura's Disease in Unusual Anatomical Locations: Clinical and Radiological Characteristics. J Inflamm Res 2024; 17:2801-2809. [PMID: 38737107 PMCID: PMC11088400 DOI: 10.2147/jir.s459978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/25/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose To explore the clinical and imaging features of rare site Kimura's disease (KD). Methods Retrospective analysis was conducted on the clinical manifestations, laboratory examinations, and imaging features of five patients with rare site KD. All imaging data, including the location, quantity, size, uniformity, boundary, and enhanced appearance of the lesion were evaluated by two independent radiologists. Results Of the five patients, four were asymptomatic, and one experienced localized skin itching. Four cases involved subcutaneous nodules in the upper arm, while one was in the inguinal region. The main manifestations were single (three cases) or multiple (two cases) subcutaneous nodules/masses, with three patients accompanied by local lymph node enlargement. Four patients exhibited elevated eosinophil counts in their peripheral blood. Four patients had lesions with vascular flow voids; in three of these, the lesions also showed prominent enhancement. Notably, the lesion in a 5-year-old did not show vascular flow voids but displayed significant enhancement. Additionally, two patients showed edema around the lesions. Conclusion The presence of solitary or multiple subcutaneous nodules/masses in the upper arm or inguinal area, accompanied by lymph node enlargement, elevated eosinophils in the peripheral blood, and the observation of internal vascular within the lesion, can aid in the diagnosis of KD occurring in uncommon anatomical locations.
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Affiliation(s)
- Weiwei Xie
- Department of Radiology, the Fifth Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People’s Republic of China
| | - Junqi Luo
- Department of Radiology, the Fifth Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People’s Republic of China
| | - Ruowei Tang
- Department of Radiology, Beijing Friendship Hospital, Beijing, People’s Republic of China
| | - Xuan Zhou
- Departments of Pathology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong Province, People’s Republic of China
| | - Xiaohong Wang
- Department of Radiology, the Third Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi Prefecture, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Guojie Wang
- Department of Radiology, the Fifth Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People’s Republic of China
- Department of Radiology, The First People’s Hospital of Kashi Prefecture, Kashi Prefecture, Xinjiang Uygur Autonomous Region, People’s Republic of China
| | - Yaqin Zhang
- Department of Radiology, the Fifth Hospital of Sun Yat-sen University, Zhuhai, Guangdong Province, People’s Republic of China
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Li Y, Zhao J, Ruan X, Li Z, Li Z, Tang Z. Kimura disease with optic nerve and intracranial involvement: a case description. Quant Imaging Med Surg 2024; 14:1180-1186. [PMID: 38223041 PMCID: PMC10784061 DOI: 10.21037/qims-23-852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/12/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Yuhan Li
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiamei Zhao
- Department of Radiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoling Ruan
- Department of Neurosurgery, Università degli Studi di Pavia, Pavia, Italy
| | - Zhigao Li
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zongfang Li
- Department of Radiology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiwei Tang
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Negre GCMP, Regala FG, Ang CY, Tumalad MA. Kimura Disease: A case report with bilateral upper lid masses and a right parotid mass. Orbit 2023; 42:624-629. [PMID: 35436175 DOI: 10.1080/01676830.2022.2058022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
Abstract
A 38-year-old male presented with bilateral upper eyelid masses and a right parotid mass. Nineteen years before the consultation, the patient experienced swelling at both upper eyelids. Formerly diagnosed by an ophthalmologist, corticosteroid, an anti-inflammatory medication, was prescribed for the patient, which resulted in partial resolution of the lid swelling. However, he was lost to follow-up, and progressive enlargement of the lids was observed with the development of a right parotid mass. The visual acuity of the patient was classified as counting fingers, three feet bilaterally. A detailed examination was difficult owing to the obstructive nature of the masses. However, ocular structures appeared intact. An excisional biopsy with a reconstruction of bilateral upper lids was performed. Histopathologic findings revealed a lymphoproliferative lesion suggestive of Kimura disease (KD). The patient was subsequently referred to rheumatology for management, where they started a regimen of oral steroids and antihistamines.
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Affiliation(s)
| | - Fatima G Regala
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
| | - Charmaine Y Ang
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
| | - Marco A Tumalad
- Department of Health Eye Center, East Avenue Medical Center, Quezon City, Metro Manila, Philippines
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Almohawes EA, Zakareia Y, Dumiati ZA, Zaki WA, Alfudhili KM. A rarely described Kimura's disease of the breast. BJR Case Rep 2023; 9:20220160. [PMID: 37780976 PMCID: PMC10513005 DOI: 10.1259/bjrcr.20220160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/19/2023] [Accepted: 08/13/2023] [Indexed: 10/03/2023] Open
Abstract
Kimura's disease is a rare chronic inflammatory disease of unknown aetiology. The majority of cases are reported in middle-aged Asian males and rarely seen in other ethnicities. Patients classically present with chronic single or multiple painless subcutaneous masses, lymphadenopathies, hypereosinophilia and elevated serum immunoglobulin E. The disease usually affects the head and neck area, however, rare involvement of other locations such as axilla, upper limbs, popliteal region and abdomen has been reported. Here, we report a rarely encountered Kimura's disease of the breast and axillary lymph nodes in a middle-aged female. In this report, we will describe the main clinical, radiological and pathological features to raise the awareness about this indolent disease.
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Affiliation(s)
- Eman A. Almohawes
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Yasser Zakareia
- Medical Imaging Department, Radiology Registrar, Prince Sultan Armed Forces Hospital, Al Madinah, Saudi Arabia
| | - Zainab A. Dumiati
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Wael A. Zaki
- General Surgery Department, Consultant Surgeon, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
| | - Khalid M. Alfudhili
- Medical Imaging Department, Security Forces Hospital-Dammam, Dammam, Saudi Arabia
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Ravi GC, Nitha T, Greeshma PG, Uthaiah S, Famida PA, Nair RR, Aniketh VR. Kimura Disease in an Adult Indian Female, A Rare Presentation: A Novel Treatment with a Review of Literature. Indian J Otolaryngol Head Neck Surg 2023; 75:2394-2399. [PMID: 37636677 PMCID: PMC10447749 DOI: 10.1007/s12070-023-03664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Kimura disease (KD) is a chronic inflammatory disorder, which is quite rare and has an unclear and much debated etiology. KD is characterized by painless, nodular, subcutaneous swellings along with lymphadenopathy, encountered in the head and neck region more often. It is also known to affect major salivary glands. It is also associated with elevated Immunoglobulins (IgE) and peripheral blood and tissue eosinophilia. Kimura disease generally affects young Asian males. There is considerable difficulty in arriving at clinical diagnosis and often it is frustrating to both patients and the treating physicians because of the difficulty in its management. We are presenting and reporting a case of Kimura disease in a young adult Indian female patient who presented with a swelling in the left parotid region. We have successfully managed this patient medically with a unique combination of drugs, most of which have already been tried and reported in literature by various authors.
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Affiliation(s)
- G. C. Ravi
- Department of Otorhinolaryngology, Sri Siddhartha Institute of Medical Sciences, T Begur, Nelamangala Taluk, Bangalore Rural District, 562123 India
- Bangalore, India
| | - T. Nitha
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - P. G. Greeshma
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | | | - P. A. Famida
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - Reshma Radhakrishnan Nair
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
| | - V. R. Aniketh
- Department of Otorhinolaryngology, Adichunchanagiri Institute of Medical Sciences, BG Nagara, Nagamangala Taluk, Mandya District, 571448 India
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Yorita K, Fujii T, Nagao T, Murakami I, Hashida Y, Higuchi T, Daibata M, Toi M, Ayada Y, Igawa T. Kimura disease forming a human polyomavirus 6–negative parotid gland nodule with prominent squamous metaplasia in a young female: A case report. Radiol Case Rep 2023; 18:1933-1938. [PMID: 36970233 PMCID: PMC10030818 DOI: 10.1016/j.radcr.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 03/18/2023] Open
Abstract
A case of an asymptomatic 19-year-old woman with Kimura disease presenting with a nodule in the right parotid gland is presented. She had a medical history of atopic dermatitis and noticed a mass on her right-side neck. Cervical lymphadenopathy was clinically diagnosed. The initial management plan was to observe the lesion, which had enlarged from 1 cm to 2 cm in diameter 6 months later. An excisional biopsy was performed, and the pathology confirmed an eosinophil-containing inflammatory parotid gland lesion with many squamous nests and cysts, mimicking a parotid gland tumor. High serum immunoglobulin E levels, peripheral blood eosinophilia, and pathological and genetic diagnoses confirmed Kimura disease. The lesion tested negative for human polyomavirus 6. No recurrence was observed 15 months after the biopsy. The prognosis of Kimura disease without human polyomavirus 6 infection may be favorable; however, further validation of this hypothesis is required as only 5 or 6 cases of Kimura disease have been evaluated for this viral infection. Proliferative squamous metaplasia occurring in parotid gland lesions of Kimura disease is rare and may complicate the diagnostic imaging and pathological diagnosis.
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Affiliation(s)
- Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, 1-4-63-11, Hadaminami-machi, Kochi-shi, Kochi, 780-8562, Japan
- Department of Diagnostic Pathology, Kochi University Hospital, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
- Corresponding author.
| | - Tatsuya Fujii
- Department of Otorhinolaryngology, JA Kochi Hospital, 526-1, Nakano, Aza, Myouken, Nankoku-shi, Kochi, 783-8509, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Ichiro Murakami
- Department of Diagnostic Pathology, Kochi University Hospital, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
- Department of Pathology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Masanori Daibata
- Department of Microbiology and Infection, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Makoto Toi
- Department of Diagnostic Pathology, Kochi University Hospital, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan
| | - Yoshiyuki Ayada
- Department of Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takuro Igawa
- Department of Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Mai Y, Wang Y, Sun P, Jing Z, Dong P, Liu J. Kimura disease in children: A report of 11 cases and review of the literature. Front Pediatr 2023; 11:1131963. [PMID: 36873634 PMCID: PMC9982731 DOI: 10.3389/fped.2023.1131963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
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.
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Affiliation(s)
- Yumiao Mai
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yingjie Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pan Sun
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaohe Jing
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengpeng Dong
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jian Liu
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Kim WJ, Kim HK. Current concepts of Kimura disease: pathophysiology and evolution of treatment. Arch Craniofac Surg 2022; 23:249-255. [PMID: 36596747 PMCID: PMC9816637 DOI: 10.7181/acfs.2022.01053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
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.
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Affiliation(s)
- Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong,
Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul,
Korea
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Hu X, Li X, Yang C, Li D, Cai J, Wang P. Kimura disease, a rare cause of inguinal lymphadenopathy: A case report. Front Med (Lausanne) 2022; 9:1023804. [PMID: 36213635 PMCID: PMC9537629 DOI: 10.3389/fmed.2022.1023804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xue Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Changwei Yang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dandan Li
- Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, China
- *Correspondence: Pan Wang,
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Jiong Cai,
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Dandan Li,
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Farooqui F, Rehman IU, Waseem S, Ullah I, Jehan M, Asghar MS. Kimura's disease and its masquerade with a malignancy: A case report. Ann Med Surg (Lond) 2022; 78:103864. [PMID: 35734712 PMCID: PMC9207072 DOI: 10.1016/j.amsu.2022.103864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022] Open
Abstract
Kimura's disease is an uncommon chronic condition that often masquerades as a malignancy. It is reported predominantly in males of South-East Asia in their second and third decade of life. Most of the patients present with increased eosinophilia, follicular hyperplasia and high levels of IgE circulating in their blood. In this case, we report a patient of 29 years age who presented with complaints of left parotid and left post-auricular swellings. It was painless and growing gradually in size over the period of 8 years. It was asymptomatic during the whole period of the disease. Patient was diagnosed on histology and subsequent immunohistochemistry reports. Treatment in this patient included parotidectomy and lymph node dissection. It was followed by local radiation to prevent recurrence. It can be concluded that Kimura's disease may vary in its presentation but a few features remain characteristic. No reports of malignant change have been reported as of yet making its prognosis quite favorable for the patient. Surgery remains the choice of treatment but for more effective approach, it should be followed by radiation. In a patient presenting with neck mass along with history of weight loss, Kimura's Disease should be suspected. Multidisciplinary approach is required for prompt diagnosis and treatment in such cases. More knowledge on Kimura's disease will help physicians in coming up with a better management plan in future.
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13
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Shaikh M, Garg P, Sharma P, Khera P. MRI evaluation of Kimura's disease with emphasis on diffusion weighted imaging and enhancement characteristics. Indian J Radiol Imaging 2021; 29:215-218. [PMID: 31367095 PMCID: PMC6639867 DOI: 10.4103/ijri.ijri_468_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Kimura's disease is a rare disease of the head and neck region affecting mainly the adult males in eastern countries. The parotid and periparotid subcutaneous regions are the most common sites in head and neck region. Coupled with peripheral eosinophilia and raised serum IgE levels as characteristic features on hemogram, a painless swelling in parotid and periparotid region is diagnostic of Kimura's disease. Magnetic resonance imaging (MRI) has been an important modality in evaluating lesions of the head and neck region. Recently, interest in the diffusion weighted imaging (DWI) and contrast enhanced MRI (CEMRI) imaging of lesions in Kimura's disease has been noted to characterize it and differentiate it from other pathologies. We describe a case a recurrent Kimura's disease of the periparotid region and its MRI features with special emphasis on its characteristics on DWI and contrast enhanced sequences.
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Affiliation(s)
- Minhaj Shaikh
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pawan Garg
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Parameshwar Sharma
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pushpinder Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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14
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Zhao H, Cao ZW, Gu ZW. Case Report: A Rare Case of Nasal Forehead Mass in Kimura's Disease. Front Surg 2021; 8:672291. [PMID: 34095210 PMCID: PMC8176203 DOI: 10.3389/fsurg.2021.672291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Kimura's disease is a rheumatic immune disease and head and neck lymph nodes are often involved. A mass occurring in the nasal forehead is rare. Good prognosis after surgical resection by glucocorticoid therapy is more rare. Case Summary: We report the rare case of a nasal forehead mass in a 45-year-old male patient with Kimura's disease. The patient underwent resection of the mass in October 2018 in a local hospital and the postoperative pathology was unclear. He then underwent a second resection in our department in December 2019 mainly because growth of the mass was affecting his appearance. Postoperative pathology confirmed that the patient had Kimura's disease, and he accepted systemic treatment with prednisone. We followed the patient for 10 months after surgery. He is now recovering well and continues to be closely monitored during follow-up. Conclusion: It is rare that the painless mass in the nasal forehead is diagnosed as a Kimura's disease.After completely resection of the mass and systemic treatment with prednisone, the patient had a good outcome. We provide experience for the treatment of Kimura's disease in nasal forehead.
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Affiliation(s)
| | | | - Zhao-wei Gu
- Department of Otolaryngology Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Kimura's Disease: A Rare Cause of Unilateral Tonsillar Enlargement. Case Rep Otolaryngol 2021; 2021:8815317. [PMID: 33505749 PMCID: PMC7808821 DOI: 10.1155/2021/8815317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Kimura's disease is a rare inflammatory disorder of unknown cause, commonly seen in young Asian males. Case Report. A 61-year-old male patient presented with a history of right tonsillar mass and cervical lymphadenopathy. The patient underwent hematological investigation and imaging followed by resection of tonsillar mass. Based on histopathological and subsequent immunohistochemistry reports, the case was diagnosed as Kimura's disease of the tonsil. Discussion. Kimura's disease commonly presents as painless subcutaneous masses in the head and neck region or cervical lymphadenopathy. Kimura's disease presenting as a tonsillar mass is a very rare condition. Patients usually have peripheral eosinophilia and elevated levels of serum IgE. The diagnosis is based on the clinical and histopathologic findings in a biopsy of the mass and/or lymph node along with elevated peripheral eosinophil and serum IgE level. Conclusion The clinical presentation of Kimura's disease is highly variable. Kimura's disease should be considered as a differential diagnosis in patients presenting with a tonsillar mass. A high index of suspicion along with histopathological examination helps in the early diagnosis and management. Surgical excision is the treatment of choice.
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16
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Ramachandran PV, Healy CM, Lambert EM, Guerra D, Curry CV, Vogel TP. Case Report: Hyper IgE, but Not the Usual Suspects-Kimura Disease in an Adolescent Female. Front Pediatr 2021; 9:674317. [PMID: 34354968 PMCID: PMC8329340 DOI: 10.3389/fped.2021.674317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/21/2021] [Indexed: 01/13/2023] Open
Abstract
Elevated immunoglobulin E (IgE) levels can be associated with infectious, allergic and inflammatory disorders, and rarely as a manifestation of an inborn error of immunity. Here we report the case of an adolescent female who presented with a gradually enlarging neck mass, lymphadenopathy, eosinophilia and highly elevated IgE levels. Laboratory and histopathologic evaluation revealed an unlikely diagnosis of Kimura Disease. We discuss the differential diagnosis of a neck mass with prominent eosinophils on histology, and review support for T-helper type 2 (Th2) cell activation and hyper-IgE in Kimura Disease.
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Affiliation(s)
- Prasanna Venkatesh Ramachandran
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.,Pediatrician-Scientist Program, Baylor College of Medicine, Houston, TX, United States.,Texas Children's Hospital, Houston, TX, United States
| | - C Mary Healy
- Texas Children's Hospital, Houston, TX, United States.,Division of Infectious Disease, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Elton M Lambert
- Texas Children's Hospital, Houston, TX, United States.,Division of Otolaryngology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | | | - Choladda V Curry
- Texas Children's Hospital, Houston, TX, United States.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, United States
| | - Tiphanie P Vogel
- Texas Children's Hospital, Houston, TX, United States.,Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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17
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Sousa CP, Fonseca E, Viamonte B, Lobo JC, Madureira A. Kimura's disease: a rare cause of facial mass in a caucasian male patient. BJR Case Rep 2020; 6:20200099. [PMID: 33299599 PMCID: PMC7709070 DOI: 10.1259/bjrcr.20200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/05/2022] Open
Abstract
Kimura's disease is an uncommon inflammatory disorder of unclear aetiology, mainly affecting young Asian descent males among their second and fourth decades of life. The disease typically emerges as a long-standing and painless subcutaneous mass lesion in the head and neck region, frequently associated with swelling of major salivary glands, particularly the parotid gland, and regional lymphadenopathy. Peripheral eosinophilia and high serum immunoglobulin E are also characteristic findings. We report a case and describe the imaging and pathological features of the disease in a 19-year-old Caucasian male, with review of the literature.
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Affiliation(s)
- Célia Peixoto Sousa
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Elsa Fonseca
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Bárbara Viamonte
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - João Calheiros Lobo
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - António Madureira
- Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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18
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Sangwan A, Goyal A, Bhalla AS, Kumar A, Sharma R, Arava S, Dawar R. Kimura Disease: A Case Series and Systematic Review of Clinico-radiological Features. Curr Probl Diagn Radiol 2020; 51:130-142. [PMID: 33250297 DOI: 10.1067/j.cpradiol.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
Kimura disease is a rare chronic inflammatory disorder mostly reported in males in second to third decades from south-east Asia. Head and neck is the most commonly involved region. The usual presentation is painless facial swelling with salivary gland involvement and regional lymphadenopathy. The diagnosis can be suspected on imaging but needs to be proven on histopathology. We describe three histopathology proven cases of Kimura disease and emphasize the specific clinic-radiological findings which can help in early identification of the condition and its differentiation from other diseases with similar presentation. Gray scale Ultrasound, contrast-enhanced ultrasound, and contrast-enhanced Magnetic Resonance Imaging (CE-MRI) were done in all patients and Computed Tomography (CT) was done in one. The salient imaging features were ill-defined solid mass in the subcutaneous location of the facial region which was heteroechoic on Gray scale Ultrasound, heterogeneously hyperintense on T2W MRI and without much diffusion restriction. There was involvement of salivary glands with ipsilateral cervical adenopathy. The lesion showed avid contrast enhancement on contrast-enhanced ultrasound and CE-MRI. We also present a systematic literature review of clinico-radiological features in Kimura disease in the head and neck. The articles with histopathologically proven cases and satisfactory description of imaging findings were included and we have compared the findings in our cases with published literature. In addition, we have included examples of radiological mimics of this disease. Certain imaging findings are highly suggestive and can aid in early diagnosis of Kimura disease which helps in early initiation of treatment with better patient prognosis.
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Affiliation(s)
- Ankit Sangwan
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Ashu S Bhalla
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Atin Kumar
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Rakesh Dawar
- Department of Plastic and Reconstructive Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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19
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Kakehi E, Kotani K, Yoshida T, Nakai T, Sakurai S, Hirotani A, Simizu K, Nozaki T, Shoji K, Adachi S, Matsumura M. Older-age onset of Kimura's disease. Ther Adv Hematol 2020; 11:2040620720962596. [PMID: 33117518 PMCID: PMC7570770 DOI: 10.1177/2040620720962596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
A 60-year-old man was admitted to our hospital with bilateral post auricular masses, first noticed 1 year earlier. Blood tests showed eosinophilia and high immunoglobulin E (IgE) levels, and cervical computed tomography showed 10-mm soft tissue masses with scattered lymphadenopathy. The tumors showed intermediate and high signal intensity on T1- and T2-weighted cervical magnetic resonance imaging, respectively. After mass resection, the tumors were diagnosed as Kimura’s disease (KD). Generally, KD affects young men; however, even in older patients, KD should be included as a differential diagnosis for head and neck tumors in patients with eosinophilia and high IgE.
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Affiliation(s)
- Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital 1-1 Matoba, Tottori-City, Tottori 680-8501, Japan
| | - Kazuhiko Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
| | - Tsubasa Yoshida
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Tsubasa Nakai
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Shigehisa Sakurai
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Akane Hirotani
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Kaduyo Simizu
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Takafumi Nozaki
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Keisuke Shoji
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Seiji Adachi
- Department of General Medicine, Tottori Municipal Hospital, Tottori-City, Tottori, Japan
| | - Masami Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke-City, Tochigi, Japan
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20
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Saravanam PK, Gajendran A, Dinakaran N, Jayaraman D. Oropharyngeal Kimura's disease: a diagnostic dilemma and therapeutic challenge. BMJ Case Rep 2020; 13:13/10/e236366. [PMID: 33127696 DOI: 10.1136/bcr-2020-236366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Kimura's disease is a chronic inflammatory disorder involving subcutaneous tissue and locoregional lymph nodes of head and neck region, characterised by angiolymphoid proliferation. It is typically associated with peripheral eosinophilia, increased serum IgE and lymphadenopathy. Diagnosis is usually based on histopathological examination. Though various treatment modalities have been put forward, surgical management remains the first line of treatment, followed by systemic steroids application. This case report discusses the diagnostic dilemma and therapeutic management of a rare clinical presentation and management of oropharyngeal Kimura's disease in a young immunocompetent woman.
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Affiliation(s)
| | - Aishwarya Gajendran
- ENT, Head and Neck Surgery, Sri Ramachandra University Medical College, Chennai, India
| | - Nethra Dinakaran
- Otorhinolaryngology, Sri Ramachandra Medical College and Research Institute, Chennai, India
| | - Dhaarani Jayaraman
- Pediatric Hemato Oncology, Sri Ramachandra Medical College and Research Institute, Chennai, India
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21
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Zhang Y, Yu S, Zhang L, Kang L. Radiomics Based on CECT in Differentiating Kimura Disease From Lymph Node Metastases in Head and Neck: A Non-Invasive and Reliable Method. Front Oncol 2020; 10:1121. [PMID: 32850321 PMCID: PMC7397819 DOI: 10.3389/fonc.2020.01121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Kimura disease may be easily misdiagnosed as malignant tumors such as lymph node metastases based on imaging and clinical symptoms. The aim of this article is to investigate whether the radiomic features and the model based on the features on venous-phase contrast-enhanced CT (CECT) images can distinguish Kimura disease from lymph node metastases in the head and neck. Methods: A retrospective analysis of 14 patients of head and neck Kimura disease (a total of 38 enlarged lymph nodes) and 39 patients with head and neck lymph node metastases (a total of 39 enlarged lymph nodes), confirmed by biopsy or surgery resection, was conducted. All patients accepted CECT within 10 days before biopsy or surgery resection. Radiomic features based on venous-phase CECT were generated automatically from Artificial-Intelligence Kit (AK) software. All lymph nodes were randomly divided into the training set (n = 54) and testing set (n = 23) in a ratio of 7:3. ANOVA + Mann–Whitney, Spearman correlation, least absolute shrinkage and selection operator, and Gradient Descent were introduced for the reduction of the highly redundant features. Binary logistic regression model was constructed based on the selected features. Receiver operating characteristic was used to evaluate the diagnostic performance of the features and the model. Finally, a nomogram was established for model application. Results: Seven features were screened out at the end. Significant difference was found between the two groups for all the features with area under the curves (AUCs) ranging from 0.759 to 0.915. The AUC of the model's identification performance was 0.970 in the training group and 0.977 in the testing group. The disease discrimination efficiency of the model was better than that of any single feature. Conclusions: The radiomic features and the model based on these features on venous-phase CECT images had very good performance for the discrimination between Kimura disease and lymph node metastases in the head and neck.
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Affiliation(s)
- Ying Zhang
- Graduate School, Tianjin Medical University, Tianjin, China.,Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, China
| | - Shujing Yu
- Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, China
| | - Li Zhang
- Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, China
| | - Liqing Kang
- Department of Magnetic Resonance Imaging, Cangzhou Central Hospital, Cangzhou, China
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22
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Eh Dam VSK, Mohamad S, Mohamad I. Kimura Disease with Parotid Swelling and Cervical Lymphadenopathy: A Case Report and Literature Review. Medeni Med J 2020; 35:170-174. [PMID: 32733768 PMCID: PMC7384504 DOI: 10.5222/mmj.2020.84594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 11/05/2022] Open
Abstract
Kimura disease (KD) is a rare chronic benign inflammatory disorder of unknown etiology that is prevalent in Asian males. The head and neck region, especially the parotid glands and cervical lymph nodes, are most commonly affected. Diagnosis is based on clinicopathological features, while radiology findings are nonspecific. Although various treatment strategies have been proposed, there is a high recurrence rate. Combination therapy has been found to produce better results than monotherapy. We present a case of KD with huge parotid and cervical lymph node involvement that was treated with a combination of surgery and corticosteroids administered perioperatively.
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Affiliation(s)
- V Sha Kri Eh Dam
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | - Sakinah Mohamad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
| | - Irfan Mohamad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head and Neck Surgery, Kelantan, Malaysia
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23
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Kakehi E, Kotani K, Otsuka Y, Fukuyasu Y, Hashimoto Y, Sakurai S, Hirotani A, Simizu K, Fujita R, Shoji K, Adachi S, Matsumura M. Kimura's disease: effects of age on clinical presentation. QJM 2020; 113:336-345. [PMID: 31800058 DOI: 10.1093/qjmed/hcz312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Kimura's disease (KD) is known to be dominant among young Asian men, but it can also occur in middle- and advanced-aged people. The clinical characteristics of KD, especially by age, are not well known. AIM This study was performed to investigate the effects of age on the clinical characteristics of KD. DESIGN We conducted a case series study. METHODS All case studies of patients diagnosed with KD were collected via a PubMed search of studies published until August 2018. The data were analyzed by age group. RESULTS In total, 215 studies were reviewed (238 patients; mean age of 36 years). The male:female ratio was 4:1 overall, 17:1 in patients aged <20 years, 4:1 in patients aged 20-39 years and 2:1 in patients aged ≥40 years (P = 0.01). The percentage of patients with pruritus was 15.4% overall, 3.8% in patients aged <20 years, 15.5% in patients aged 20-39 years and 21.7% in patients aged ≥40 years (P = 0.02). The time to diagnosis was 5.3 years overall, 3.2 years in patients aged <20 years, 4.7 years in patients aged 20-39 years and 7.1 years in patients aged ≥40 years (P < 0.01). CONCLUSIONS The proportion of female patients affected the incidence of pruritus, and the time to diagnosis increased as the patients' age increased. There were no significant age-related differences in region/race, complications, multiplicity, laterality, anatomical distribution, maximum size, eosinophil count, immunoglobulin E level, initial treatment, recurrence or outcomes. This may be useful information for the diagnosis of KD.
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Affiliation(s)
- E Kakehi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Kotani
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Y Otsuka
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Fukuyasu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - Y Hashimoto
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Sakurai
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - A Hirotani
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Simizu
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - R Fujita
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - K Shoji
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - S Adachi
- Department of General Medicine, Tottori Municipal Hospital, 1-1 Matoba, Tottori-City, Tottori, Japan
| | - M Matsumura
- Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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24
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Sayit AT, Elmali M, Yildirim U, Gun S, Koyuncu M. Asian woman with difficulty in swallowing. Ann Saudi Med 2020; 40:159-162. [PMID: 32241171 PMCID: PMC7118232 DOI: 10.5144/0256-4947.2020.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | | | - Seda Gun
- From the Department of Pathology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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25
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Zhang G, Li X, Sun G, Cao Y, Gao N, Qi W. Clinical analysis of Kimura's disease in 24 cases from China. BMC Surg 2020; 20:1. [PMID: 31898499 PMCID: PMC6941305 DOI: 10.1186/s12893-019-0673-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/26/2019] [Indexed: 11/23/2022] Open
Abstract
Background We reviewed details of Chinese Kimura’s disease (KD) cases. A full clinical analysis was subsequently performed to improve the accuracy of clinical diagnosis and treatment of KD. Methods A total of 24 patients with pathologically confirmed KD treated between March 2008 and March 2018 were reviewed retrospectively for clinical and histopathological analysis. Results In the 24 KD cases, 20 were male and 4 were female with the age of onset ranging from 5 to 65 years. Lesion diameter ranged from 0.6 cm to 7 cm with unilateral involvement being more popular (79%). Imaging examination had a high detection rate for KD involving the parotid gland and subcutaneous but had low specificity. Microscopic analysis indicated that KD mainly involved subcutaneous soft tissue and lymph nodes. The prominent feature of lymphoid tissue was germinal center hyperplasia surrounded by several lobules associated with hyperplastic vascular structures. Out of the 24 patients, 11 experienced recurrence of disease after treatment (surgical resection: 46.2%, surgical resection followed by oral corticosteroids: 71.4% and surgical resection combined with radiotherapy: 0%). Conclusions Our analysis revealed clinical, imaging, and histological characteristics of KD. A better understanding of the disease will help clinicians reduce misdiagnosis and improve the diagnostic rate upon patient first clinical visit.
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Affiliation(s)
- Guoliang Zhang
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xumao Li
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Guangbin Sun
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yitan Cao
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Nan Gao
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Weidong Qi
- Department of Otorhinolaryngology, Affiliated Huashan Hospital, Fudan University, Shanghai, 200040, China.
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26
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Itamura K, Swanson M. A Painless Retroauricular Mass. JAMA Otolaryngol Head Neck Surg 2020; 146:75-76. [PMID: 31670791 DOI: 10.1001/jamaoto.2019.3246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kyohei Itamura
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles
| | - Mark Swanson
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles
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27
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Yu B, Xu G, Liu X, Yin W, Chen H, Sun B. Kimura's disease affecting multiple body parts in a 57-year-old female patient: a case report. Allergy Asthma Clin Immunol 2019; 15:84. [PMID: 31892932 PMCID: PMC6937823 DOI: 10.1186/s13223-019-0400-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022] Open
Abstract
Background Kimura’s disease (KD) is a rare chronic inflammatory disease with unknown etiology. It usually manifests as a painless soft tissue mass or subcutaneous nodule on one side of the patient’s head and/or neck and rarely affects multiple parts of the body. The disease is more common among young Asian males. Case presentation A 57-year-old Chinese woman complained of multiple masses on her body surface. Ultrasonography was used to examine the retroperitoneal, bilateral neck, bilateral supraclavicular, bilateral axillary, and bilateral inguinal superficial lymph nodes. Enlargement of multiple lymph nodes was found in all areas. Many solid nodules were also found in the right parotid gland and right posterior neck area, respectively. Numerous solid nodules were seen on the left chest wall. Laboratory tests showed that the percentage of eosinophils in the whole blood was 39.40%, total immunoglobulin E (IgE) level was > 5000 kU/L, and serum special IgE to Phadiatop (inhaled allergens) and fx5 (food allergens) were 1.01 and 1.04 kUA/L, respectively. After a complete examination, the masses located in the right neck, retroauricular and left axillary regions, and left chest wall were resected directly. Postoperative pathological findings revealed KD. Conclusions The case discussed in this study is extremely rare and did not meet the common affected areas and age characteristics of KD. This presentation can be used to improve disease awareness among physicians.
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Affiliation(s)
- Bo Yu
- 1Department of Emergency, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430014 Hubei province China
| | - Guoxing Xu
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Xiaofan Liu
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Wen Yin
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China
| | - Hao Chen
- 2Department of Allergy, Tongji Medical College, Huazhong University of Science and Technology, The Central Hospital of Wuhan, 26 Shengli Street, Wuhan, 430010 Hubei Province China.,Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Medical University, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120 Guangdong Province China
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Medical University, First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510120 Guangdong Province China
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Gupta D, Sahu SA, Nalla R, Singhal M. Kimura’s Disease: Presenting as a Giant Head and Neck Mass. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1821-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Li X, Wang J, Li H, Zhang M. Misdiagnosed recurrent multiple Kimura's disease: A case report and review of the literature. Mol Clin Oncol 2018; 10:352-356. [PMID: 30847173 PMCID: PMC6388464 DOI: 10.3892/mco.2018.1793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/07/2018] [Indexed: 11/05/2022] Open
Abstract
Kimura's disease (KD) is a rare condition, with only a few cases reported to date, mainly in Asian patients. We herein present the case of a 48-year-old man with KD who presented with recurrent masses in the right parotid gland and neck region over a 15-year period. The masses were not accompanied by pain, or significant functional or neurosensory dysfunction. The results of the laboratory tests revealed an increased eosinophil count and markedly elevated serum IgE levels. On magnetic resonance imaging examination, a widespread abnormal signal was detected in the area of the lesions; the contrast-enhanced scan revealed inhomogeneous enhancement, with partial involvement of the sternocleidomastoid muscle and the parotid gland. The patient underwent surgical resection of the right parotid and neck masses, and the postoperative pathological examination revealed eosinophilic hyperplastic lymphogranuloma, also referred to as KD. This presented case and review of the relevant literature aim to improve our understanding of KD in order to increase the accuracy of diagnosis, reduce the misdiagnosis rate and ensure proper treatment of this rare disease.
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Affiliation(s)
- Xuesheng Li
- Department of Prosthodontics, Hainan Stomatological Hospital, Haikou, Hainan 570105, P.R. China
| | - Jing Wang
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Hongbo Li
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Ming Zhang
- Department of Stomatology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
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Magnetic resonance perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant lesions: six case reports. Oral Radiol 2018; 34:73-82. [PMID: 30484085 DOI: 10.1007/s11282-017-0271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022]
Abstract
The perfusion and diffusion properties of a tumor are important clues in evaluating its growth potential and predicting its histological type, such as benign or malignant. Tumor perfusion can be estimated by assessing time-dependent changes in the intratumoral levels of the contrast agent during dynamic contrast-enhanced magnetic resonance (MR) imaging, whereas tumor diffusion can be estimated by assessing intratumoral water diffusivity on diffusion-weighted MR imaging. Granulomatous diseases with different etiologies occur in various head and neck regions, including the mandible, maxillary sinus, salivary glands, and lymph nodes. However, the perfusion and diffusion properties of granulomatous diseases in the head and neck regions are not well documented. In this study, we assessed the time-signal intensity curves and apparent diffusion coefficients of six granulomatous diseases of various histological types that appeared in the soft tissues of the head and neck. Our data show that the perfusion and diffusion characteristics of granulomatous diseases mimic those of malignant diseases, highlighting the need for careful interpretation of MR perfusion and diffusion findings to distinguish between granulomatous diseases and cancers of the head and neck region. Clinicians should pay particular attention to blood examination and biopsy results when interpreting imaging findings.
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Zhang L, Yao L, Zhou WW, Ma JN, Zhang CQ. Computerized tomography features and clinicopathological analysis of Kimura disease in head and neck. Exp Ther Med 2018; 16:2087-2093. [PMID: 30186444 DOI: 10.3892/etm.2018.6431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/02/2018] [Indexed: 02/04/2023] Open
Abstract
The aim of the current study was to discuss and analyze computerized tomography (CT) features and clinicopathological characteristics of patients with Kimura disease in head and neck. CT and clinicopathological data of 12 patients with Kimura disease diagnosed between May 2011 and May 2015 were analyzed. The mean age was 43.9 years and the disease course varied from 1 week-20 years. The mean absolute value of eosinophil granulocytes was 1.95×109/l. Multiple nodules were detected in 4 patients with Kimura disease. Main symptoms included multiple enlarged lymph nodes in neck and submaxillary regions. CT imaging of nodular lesions revealed a clear boundary, with moderate to marked homogeneous enhancement. Diffuse mass lesions were observed in 6 patients with Kimura disease. Main symptoms included subcutaneous diffuse soft tissue mass in parotid gland and maxillofacial regions. CT imaging of diffuse mass revealed unclear boundaries, adjacent skin thickness and moderate heterogeneous enhancement. In some cases, the diffuse mass involved soft mass with unclear boundaries. Pathological symptoms of Kimura disease included infiltration of eosinophilia, lymphocytic proliferation, formation of lymphatic follicles and variable degrees of fibrosis and vascular proliferation. Diagnosis of Kimura disease in head and neck regions may be improved based on lesions with clear or unclear boundaries, homogeneous or heterogeneous enhancement, with or without lymphadenectasis and by the presence of peripheral blood eosinophilia. However, a final diagnosis relies on a pathological examination.
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Affiliation(s)
- Li Zhang
- Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Li Yao
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Wei-Wei Zhou
- Department of Pathology, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Jian-Nan Ma
- Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
| | - Chun-Qian Zhang
- Department of CT Diagnosis, Cangzhou Central Hospital, Cangzhou, Hebei 061001, P.R. China
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Kumar V, Mittal N, Huang Y, Balderracchi J, Zheng HX, Li Z, Xu Y. A case series of Kimura's disease: a diagnostic challenge. Ther Adv Hematol 2018; 9:207-211. [PMID: 30013767 DOI: 10.1177/2040620718780370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
Kimura's disease (KD) is a rare, benign disorder characterized by subcutaneous masses with regional lymph-node enlargement. It is considered to be due to chronic inflammation of unclear etiology. Most cases have been reported in young, 20-30-year-old men of Asian descent. The diagnosis of KD is based on pathological features and elevated immunoglobulin E levels. Characteristic pathological features include intact lymph-node architecture, florid germinal center hyperplasia, extensive eosinophilic infiltrates, and proliferation of postcapillary venules. However, these features can also be seen in Hodgkin's disease or T-cell lymphoma, therefore, cases presenting as KD pose a diagnostic challenge. We report a case series of two cases with suspected KD at initial presentation, with one patient eventually diagnosed with Hodgkin's disease after clinical progression. The first case was a 45-year-old Asian man who presented with bilateral thigh masses and significantly enlarged inguinal lymph nodes. The histopathology was characteristic and the patient had stable disease on treatment with cetirizine for 20 months. The second case was a 29-year-old African-American man who had progressive enlargement of the right neck lymph nodes extending into the mediastinum, with the original biopsy suggestive of KD. An initial search for Reed-Sternberg cells using immunohistochemical staining for CD15 and CD30 was negative. However, the patient developed neurological symptoms corresponding to tumor extension to the cervical and thoracic neural foramina. A repeat biopsy showed a lack of nodal structure and atypical large cells that were positive for CD30 staining. The patient was treated with chemotherapy with good response. We emphasize the importance of following the clinical course to render an accurate diagnosis. Both cases showed extensive eosinophilic infiltration and other KD-like pathological features. However, KD is rare; not missing a malignant diagnosis lies in high clinical suspicion and repeated exhaustive work up.
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Affiliation(s)
- Vivek Kumar
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Navneet Mittal
- Oncology San Antonio, 12705 Toepperwein Road, San Antonio 78233, USA
| | - Yiwu Huang
- Department of Hematology-Oncology, Maimonides Medical Center, NY, USA
| | | | - Huo Xiang Zheng
- Family Medicine Resident, Southside Hospital, Bay Shore, NY, USA
| | - Zujin Li
- Pathology Private Practice, Staten Island, NY, USA
| | - Yiqing Xu
- Department of Hematology-Oncology, Maimonides Cancer Center, 6300 8th avenue, Brooklyn, NY 11220, USA
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Ginat DT. Imaging of Benign Neoplastic and Nonneoplastic Salivary Gland Tumors. Neuroimaging Clin N Am 2018; 28:159-169. [DOI: 10.1016/j.nic.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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34
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Syed M, Bhattacharya D, Parida B, Sharma A. Detailed Imaging Findings in a Rare Case of Kimura Disease, with Special Mention on Diffusion Weighted Imaging. Pol J Radiol 2017; 82:607-611. [PMID: 29657623 PMCID: PMC5894045 DOI: 10.12659/pjr.903021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 01/22/2017] [Indexed: 11/09/2022] Open
Abstract
Background Kimura disease is an uncommon, benign, chronic, idiopathic disease that is seen mainly in the Asian population, particularly in females. It mainly affects the salivary glands and in particular parotid and cervical lymph nodes. So far, the diagnosis of Kimura disease has been based on histopathology. We hereby report of a confirmed case of Kimura disease and provide a detailed explanation of its imaging features with a special emphasis on diffusion-weighted imaging, as diffusion sequences may help distinguish Kimura disease from malignancy. Case Report A middle-aged female patient presenting with a history of multiple chronic neck swellings was thoroughly evaluated by ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The imaging findings included gross enlargement of the left parotid gland, a focal lesion in the right parotid gland, and cervical lymphadenopathy. These features correlated with histopathological findings, and the diagnosis of Kimura disease was made. Conclusions The imaging findings were found to be specific for Kimura disease.
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Affiliation(s)
- Moinullah Syed
- Department of Radiodiagnosis, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Poona, Maharashtra, India
| | - Divya Bhattacharya
- Department of Radiodiagnosis, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Poona, Maharashtra, India
| | - Bikash Parida
- Department of Radiodiagnosis, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Poona, Maharashtra, India
| | - Ashok Sharma
- Department of Radiodiagnosis, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Poona, Maharashtra, India
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A Rare Case of Kimura Disease with Bilateral Parotid Involvement. Arch Plast Surg 2017; 44:439-443. [PMID: 28946727 PMCID: PMC5621826 DOI: 10.5999/aps.2017.44.5.439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 11/08/2022] Open
Abstract
Kimura disease is a rare idiopathic chronic inflammatory disorder. It typically presents in the head and neck area, whereas bilateral involvement is unusual. Its diagnosis requires it to be differentiated from other inflammatory diseases and from head and neck tumors. Treatment methods include conservative management, steroid administration, radiotherapy, and surgery; however, no single treatment of choice has been established. Herein, we report an unusual presentation of Kimura disease with bilateral parotid involvement. This case was treated by surgical excision.
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Dokania V, Patil D, Agarwal K, Thakur P, Prajapati P. Kimura's Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature. J Clin Diagn Res 2017; 11:ME01-ME04. [PMID: 28764210 DOI: 10.7860/jcdr/2017/28603.10063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/16/2017] [Indexed: 11/24/2022]
Abstract
Kimura's Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient's presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/ or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level.
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Affiliation(s)
- Vivek Dokania
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Digvijay Patil
- Professor, Department of Oncosurgery, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Ketan Agarwal
- Resident, Department of Ear, Nose and Throat, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
| | - Prajakta Thakur
- Student, Department of Clinical Research and Data Management, James Lind Institute, Hyderabad, Telangana, India
| | - Piyush Prajapati
- Resident, Department of Medicine, Krishna Institute of Medical Sciences University, Karad, Maharashtra, India
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Karandikar A, Gummalla KM, Loke SC, Goh J, Tan TY. Approach to intensely enhancing neck nodes. Diagn Interv Radiol 2017; 22:168-72. [PMID: 26782154 DOI: 10.5152/dir.2015.14561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cervical node evaluation is one of the most common problems encountered by a radiologist. Here, we present a pictorial review of intensely enhancing neck nodes. While enhancement in a cervical node is a common radiologic finding on contrast-enhanced computed tomography scan, only few conditions cause intense enhancement in cervical nodes. We discuss the common causes of intensely enhancing neck nodes along with pertinent radiologic features and key differentiating points that aid radiologists in reaching a diagnosis. In addition, we discuss certain potential non-nodal mimics, which need to be excluded.
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Kimura Disease: A Rare Case Report From Himalayan Region. Indian J Otolaryngol Head Neck Surg 2017; 69:571-574. [PMID: 29238694 DOI: 10.1007/s12070-016-1045-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022] Open
Abstract
Kimura's disease is a rare disorder of uncertain aetiology seen in Asian population, and presents as painless lymphadenopathy or subcutaneous masses in head-neck region. Peripheral eosinophilia, elevated levels of serum IgE, lymphoid proliferation and eosinophilic infiltration are its characteristic pathological features. We report a case of 40 year old male patient who presented with swelling behind right ear after successful ear surgery. The diagnosis was confirmed by histopathology and was treated by oral steroids.
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39
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Rodrigues G, Ravi B. Synchronous Kimura lesions at two different sites-a diagnostic dilemma! Quant Imaging Med Surg 2016; 6:214-7. [PMID: 27190775 PMCID: PMC4858467 DOI: 10.21037/qims.2015.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/03/2015] [Indexed: 11/06/2022]
Abstract
Kimura disease (KD) is a rare, chronic, benign inflammatory disorder of unknown etiology mimicking neoplastic disease and is characterized by multiple subcutaneous nodules and masses, primarily in the cervical region, accompanied by peripheral eosinophilia and lymphadenopathy. A 35-year-old male presented with a 2-year history of swelling in the right preauricular region and right thigh. Investigations showed a peripheral eosinophilia. CT of cervical region revealed parotid neoplasm and a fine needle aspiration was inconclusive. The thigh swelling felt vascular and a CT angiogram was done which revealed a diffuse vascular lesion. A superficial parotidectomy and an excision of the right thigh swelling were done. Histopathologies of both specimens were reported to have features suggestive of KD. The patient was evaluated for systemic manifestations and found to have no abnormalities. The patient has been disease free on follow-up after 2 years. This case is being presented for the rarity of its incidence and the nature of its presentation.
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Affiliation(s)
- Gabriel Rodrigues
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal 576104, India
| | - Bharadwaj Ravi
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal 576104, India
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40
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Pulmonary embolism as the initial clinical presentation of Kimura disease: case report and literature review. Blood Coagul Fibrinolysis 2016; 26:414-8. [PMID: 25699606 DOI: 10.1097/mbc.0000000000000278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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41
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Baba A, Ojiri H, Dogru M, Tanaka Y, Takahashi S, Mogami T, Kobashi Y, Yamazoe S, Nozawa Y, Ogino N, Yamauchi H, Aoyagi Y. An Unusual Clinical Presentation of Kimura Disease Manifesting with a Typical Cephalocervical Lesion and an Atypical Subcutaneous Hip Mass Lesion. Intern Med 2016; 55:1017-20. [PMID: 27086824 DOI: 10.2169/internalmedicine.55.6236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Kimura's disease (KD) is a rare lymphoproliferative inflammatory disorder, typically presenting as firm, painless or pruritic single or multiple subcutaneous lesions in the head and neck, especially in the parotid and submandibular regions. We herein report a case of a 39-year-old Japanese man presenting with a typical cephalocervical KD lesion around the salivary glands with a rare association with a distant subcutaneous mass at the hip. We also emphasize the radiologically and clinically important features in the differential diagnosis and management. To the best of our knowledge, this case is the first report of KD manifesting with a typical cephalocervical lesion and an atypical subcutaneous hip mass lesion.
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Affiliation(s)
- Akira Baba
- Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Japan
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Preliminary study of diffusion-weighted imaging and magnetic resonance spectroscopy imaging in Kimura disease. J Craniofac Surg 2015; 25:2147-51. [PMID: 25377973 DOI: 10.1097/scs.0000000000001142] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In this study, we evaluated the value of diffusion-weighted imaging (DWI) and magnetic resonance (MR) spectroscopy imaging (MRSI) combined with computed tomography (CT) and conventional MR imaging (MRI) in the diagnosis of Kimura disease (KD). The clinical data and CT and MRI findings of 5 patients with KD proven by histopathologic examination were retrospectively reviewed. Diffusion-weighted imaging and MRSI were performed at 1.5 T in 3 patients with KD. Apparent diffusion coefficient (ADC) values and the choline/creatine ratio of the lesions were compared with those of the contralateral normal parotid glands. All imaging results were compared with histopathologic findings. The typical features of KD were subcutaneous lesions, continuously infiltrative parotid lesions with or without intraparotid lymphadenopathies, and reactive cervical lymphadenopathies on CT and conventional MRI. On DWI, the ADC values of all subcutaneous and infiltrative parotid lesions were higher compared to those of normal parotid glands, and the ADC values of reactive lymphadenopathies were lower compared to both. The choline/creatine levels of subcutaneous and infiltrative parotid lesions were slightly higher than those of normal parotid glands. In conclusion, DWI and MRSI offer valuable information that may be characteristic of KD, which can highly suggest the diagnosis of KD when combined with morphological imaging.
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43
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Bobinskas AM, Chandu A, Nastri AL. Kimura's disease: an uncommon cause of head and neck masses with potentially serious sequelae. J Surg Case Rep 2015; 2015:rjv131. [PMID: 26499315 PMCID: PMC4616046 DOI: 10.1093/jscr/rjv131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/02/2015] [Accepted: 10/07/2015] [Indexed: 11/19/2022] Open
Abstract
Kimura's disease (KD) typically presents as a mass in the head and neck region in association with eosinophilia and elevated serum IgE. Excisional biopsy is often required in order to obtain an adequate sample for histological diagnosis and exclude malignancy. If suspected, patients should also be investigated for renal involvement as this may complicate KD. Treatment options include surgical excision and medical therapies such as corticosteroids depending on the extent and severity of disease.
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Affiliation(s)
- Alexander M Bobinskas
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Australia
| | | | - Alf L Nastri
- Department of Oral and Maxillofacial Surgery, Royal Melbourne Hospital, Parkville, Australia
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Chokkappan K, Al-Riyami AM, Krishnan V, Min VLK. Unusual Cause of Swelling in the Upper Limb: Kimura Disease. Oman Med J 2015; 30:372-7. [PMID: 26421119 DOI: 10.5001/omj.2015.74] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Kimura disease is a rare chronic inflammatory disease of unknown etiology. The disease typically presents in young Asian males with single or multiple slowly progressing painless subcutaneous lumps in the head and neck region; regional lymphadenopathy is commonly accompanied. The disease is associated with peripheral blood eosinophilia and elevated serum immunoglobulin E levels. This gives an important clinical clue to the diagnosis and implies a possible immune-mediated pathophysiology. Although the disease commonly affects the head and neck region, it may also affect the extremities, axilla, groin, and abdomen. Upper limb involvement in Kimura's disease is rare and few cases have been reported in the literature. We describe the case of a man who presented with a history of progressive upper limb swelling. He was diagnosed with Kimura's disease based on concordant clinical, laboratory, radiological, and histopathological grounds. Although rare in the upper limb, the possibility of Kimura's disease has to be considered in young males presenting with painless swelling in the medial epitrochlear region with compatible imaging appearance, particularly if associated with lymph node enlargement and increased blood eosinophils. Characteristic imaging findings of Kimura's disease of the upper limb include specific location along the neuro-lymphovascular structures, the absence of necrosis or calcification, mutliple flow voids representing vascular structures, a varying amount of edema of subcutaneous fat plane overlying the lesion; displacement of adjacent muscles; and neurovascular structures without signs of direct invasion. Clinicians should be aware of this distinct entity in order to avoid misdiagnosis and to tailor appropriate management.
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Affiliation(s)
| | | | - Vijay Krishnan
- Department of Radiology, Khoo Teck Puat Hospital, Singapore
| | - Victor L K Min
- Department of Pathology, National University Hospital, Singapore
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Gong Y, Gu JY, Labh S, Shi YL. Kimura disease accompanied with nephrotic syndrome in a 45-year-old male. Diagn Pathol 2015; 10:43. [PMID: 25928198 PMCID: PMC4411654 DOI: 10.1186/s13000-015-0277-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 04/16/2015] [Indexed: 11/16/2022] Open
Abstract
Kimura disease (KD) is an uncommon chronic inflammatory disorder of unknown etiology, occurs mainly in Asian young males, presenting as subcutaneous growing masses, with a predilection for head and neck, with or without satellite lymphadenopathy. Herein, we report a case of an atypical manifestation of KD accompanied with NS in a middle-aged man, though the patient was clinically misdiagnosed previously. The diagnosis of KD can be difficult and misleading, so we must explore the main points of KD so as to prevent misdiagnosis.
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Affiliation(s)
- Yu Gong
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Rd, Shanghai, 200072, China.
| | - Jun-Ying Gu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Rd, Shanghai, 200072, China.
| | - Sony Labh
- Department of Dermatology, Tongji University School of Medicine, Shanghai, China.
| | - Yu-Ling Shi
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301, Middle Yanchang Rd, Shanghai, 200072, China.
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Abstract
A 7-year-old Korean boy was referred for a nontender mass in the left arm. He had a 5-year history of a poorly defined painless mass on the medial side of the left elbow. The ultrasonogram of the left arm indicated an ill-defined, lobulating solid mass involving the deep soft tissue layer. The fat-suppressed T2-weighted magnetic resonance image showed a poorly marginated, homogeneous high-signal intensity mass. On further follow-up of 1 year and 6 months, the mass showed no change in size and nature. At surgery, a poorly demarcated inflammatory mass was dissected from a branch of the superficial radial nerve and excised completely. There was no recurrence and any dysfunction, except temporary localized hypoesthesia of the medial aspect of the left arm at the 3.6-year follow-up.
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Yang TH, Chou YH, Kao WY, Cherng SC. Kimura Disease Simulating Hodgkin's Lymphoma on (18)F FDG PET-CT: Report of a Case. Nucl Med Mol Imaging 2014; 48:313-6. [PMID: 26396638 DOI: 10.1007/s13139-014-0285-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/26/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 16-year-old male patient presenting with several mass lesions on the left side of his neck that had been there for weeks. Whole-body (18)F-fluorodeoxyglucose positron emission tomography and computed tomography ((18)F FDG PET-CT) revealed multiple focal areas of increased uptake of fluorodeoxyglucose (FDG) on the left side of the neck, left supraclavicular fossa, left axilla, and mediastinum, simulating the imaging findings of Hodgkin's lymphoma. Subsequent incisional biopsy of lymph nodes in the left supraclavicular fossa with histologic examination confirmed the diagnosis of Kimura disease. The differential diagnoses should include Kimura disease when evaluating regional or generalized lymphadenopathy seen on (18)F FDG PET-CT because it also may show prominent uptake of FDG.
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Affiliation(s)
- Tsung-Han Yang
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China
| | - Yu-Hsiang Chou
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China
| | - Woei-Yau Kao
- Division of Hematology-Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China ; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Shiou-Chi Cherng
- Department of Nuclear Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No.289, Jianguo Rd., Xindian Dist., New Taipei City, 231 Taiwan Republic of China ; School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
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Abstract
Kimura disease is a chronic inflammatory disorder that occurs mainly in Asians. We present a patient with pulmonary Kimura disease assessed by whole-body 18F-FDG PET/CT examination and proved by pathologic findings. Chest x-ray detected left pulmonary hilum enlargement in a 49-year-old Chinese man. CT showed a soft tissue mass with punctate calcifications in the left pulmonary hilum, which obviously and homogeneously accumulated tracer on FDG PET. Histopathology findings showed characteristic of Kimura disease. Kimura disease should be included in the differential diagnosis of a pulmonary hilar tumor.
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Ukisu R, Kawahara Y, Hashizume N, Kushihashi T, Yamada Y, Kadokura Y. MR imaging of cheek lesions of Kimura’s disease: Focusing on the signal abnormalities and the relationship with superficial musculoaponeurotic systems. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/mri.2013.24009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Intraparotid Kimura disease. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 130:87-9. [PMID: 23021002 DOI: 10.1016/j.anorl.2012.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 05/14/2012] [Accepted: 05/31/2012] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Intraparotid locations are extremely rare in Kimura disease, especially in Europe. CASE REPORT A 31-year-old man presented with intraparotid Kimura disease, managed by parotidectomy. DISCUSSION/CONCLUSION The case was analyzed in the light of a review of the literature, focusing on the diagnostic and anatomopathologic problems encountered, and the physiopathology and treatment of this pathology. Any parotid mass found in a patient of Far-Eastern origin showing hypereosinophilia should suggest a diagnosis of intraparotid Kimura disease.
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