eMedicine Specialties > Dermatology > Lymphoma and Related Processes

Kimura Disease: Differential Diagnoses & Workup

Author: Sena J Lee, MD, PhD, Staff Physician, Department of Dermatology, Hospital of University of Pennsylvania
Coauthor(s): Alaina J James, MD, PhD, Staff Physician, Department of Dermatology, University of Pennsylvania Medical Center; William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System; Laura M Tamburin, MD, Affiliated Dermatology, PC; Patricia Mercado, MD, Chief, Dermatology Division at Birmingham Veterans Administration Medica, Associate Professor of Dermatology, Department of Dermatology, University of Alabama at Birmingham
Contributor Information and Disclosures

Updated: May 25, 2007

Differential Diagnoses

Angiolymphoid Hyperplasia with Eosinophilia
Cylindroma
Dermatofibrosarcoma Protuberans
Kaposi Sarcoma
Pyogenic Granuloma (Lobular Capillary Hemangioma)

Other Problems to Be Considered

Eccrine cylindroma
Eosinophilic granuloma
Lymphoma
Mikulicz disease
Nodal metastasis
Reactive lymphadenopathy
Salivary gland tumor

Workup

Laboratory Studies

  • CBC count with differential almost always reveals peripheral eosinophilia in KD (98%).
  • Serum immunoglobulin E levels are often elevated in persons with KD.
  • Blood urea nitrogen, creatinine, and urinary protein levels should be obtained to exclude concomitant renal dysfunction and/or nephrotic syndrome.
  • Serum eosinophil cationic protein levels parallel the course of the disease.

Imaging Studies

  • CT scan or MRI can help determine the extent of the disease.

Procedures

  • Incisional biopsy is recommended to obtain the diagnosis.

Histologic Findings

Lymphoid nodules with discrete germinal centers can occupy an area extending from the reticular dermis to the fascia and muscle. A marked eosinophilic infiltrate and eosinophilic abscesses are present. Capillary proliferation is not characteristic, but when present, manifests as masses of canalized vessels with flat endothelial cells. Fibrosis usually surrounds and may extend into lesions.

More on Kimura Disease

Overview: Kimura Disease
Differential Diagnoses & Workup: Kimura Disease
Treatment & Medication: Kimura Disease
Follow-up: Kimura Disease
References
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References

  1. Kimm HT, Szeto C. Eosinophilic hyperplastic lymphogranuloma, comparison with Mikulicz's disease. Proc Chin Med Soc. 1937;329.

  2. Kimura T, Yoshimura S, Ishikawa E. On the unusual granulation combined with hyperplastic changes of lymphatic tissues. Trans Soc Pathol Jpn. 1948;37:179-80.

  3. Kung IT, Gibson JB, Bannatyne PM. Kimura's disease: a clinico-pathological study of 21 cases and its distinction from angiolymphoid hyperplasia with eosinophilia. Pathology. Jan 1984;16(1):39-44. [Medline].

  4. Kaneko K, Aoki M, Hattori S, Sato M, Kawana S. Successful treatment of Kimura's disease with cyclosporine. J Am Acad Dermatol. Nov 1999;41(5 Pt 2):893-4. [Medline].

  5. Hongcharu W, Baldassano M, Taylor CR. Kimura's disease with oral ulcers: response to pentoxifylline. J Am Acad Dermatol. Nov 2000;43(5 Pt 2):905-7. [Medline].

  6. Boulanger E, Gachot B, Verkarre V, Valensi F, Brousse N, Hermine O. all-trans-Retinoic acid in the treatment of Kimura's disease. Am J Hematol. Sep 2002;71(1):66. [Medline].

  7. Hareyama M, Oouchi A, Nagakura H, Asakura K, Saito A, Satoh M, et al. Radiotherapy for Kimura's disease: the optimum dosage. Int J Radiat Oncol Biol Phys. Feb 1 1998;40(3):647-51. [Medline].

  8. Armstrong WB, Allison G, Pena F, Kim JK. Kimura's disease: two case reports and a literature review. Ann Otol Rhinol Laryngol. Dec 1998;107(12):1066-71. [Medline].

  9. Birol A, Bozdogan O, Keles H, Kazkayasi M, Bagci Y, Kara S, et al. Kimura's disease in a Caucasian male treated with cyclosporine. Int J Dermatol. Dec 2005;44(12):1059-60. [Medline].

  10. Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol. Apr 2004;28(4):505-13. [Medline].

  11. Day TA, Abreo F, Hoajsoe DK, Aarstad RF, Stucker FJ. Treatment of Kimura's disease: a therapeutic enigma. Otolaryngol Head Neck Surg. Feb 1995;112(2):333-7. [Medline].

  12. Googe PB, Harris NL, Mihm MC Jr. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: two distinct histopathological entities. J Cutan Pathol. Oct 1987;14(5):263-71. [Medline].

  13. Gumbs MA, Pai NB, Saraiya RJ, Rubinstein J, Vythilingam L, Choi YJ. Kimura's disease: a case report and literature review. J Surg Oncol. Mar 1999;70(3):190-3. [Medline].

  14. Helander SD, Peters MS, Kuo TT, Su WP. Kimura's disease and angiolymphoid hyperplasia with eosinophilia: new observations from immunohistochemical studies of lymphocyte markers, endothelial antigens, and granulocyte proteins. J Cutan Pathol. Aug 1995;22(4):319-26. [Medline].

  15. Katagiri K, Itami S, Hatano Y, Yamaguchi T, Takayasu S. In vivo expression of IL-4, IL-5, IL-13 and IFN-gamma mRNAs in peripheral blood mononuclear cells and effect of cyclosporin A in a patient with Kimura's disease. Br J Dermatol. Dec 1997;137(6):972-7. [Medline].

  16. Kuo TT, Shih LY, Chan HL. Kimura's disease. Involvement of regional lymph nodes and distinction from angiolymphoid hyperplasia with eosinophilia. Am J Surg Pathol. Nov 1988;12(11):843-54. [Medline].

  17. Matsuda O, Makiguchi K, Ishibashi K, Chida Y, Ida T, Matsuda K, et al. Long-term effects of steroid treatment on nephrotic syndrome associated with Kimura's disease and a review of the literature. Clin Nephrol. Mar 1992;37(3):119-23. [Medline].

  18. Ohta N, Okazaki S, Fukase S, Akatsuka N, Aoyagi M, Yamakawa M. Serum concentrations of eosinophil cationic protein and eosinophils of patients with Kimura's disease. Allergol Int. Mar 2007;56(1):45-9. [Medline].

  19. Senel MF, Van Buren CT, Etheridge WB, Barcenas C, Jammal C, Kahan BD. Effects of cyclosporine, azathioprine and prednisone on Kimura's disease and focal segmental glomerulosclerosis in renal transplant patients. Clin Nephrol. Jan 1996;45(1):18-21. [Medline].

  20. Som PM, Biller HF. Kimura disease involving parotid gland and cervical nodes: CT and MR findings. J Comput Assist Tomogr. Mar-Apr 1992;16(2):320-2. [Medline].

  21. Wang YS, Tay YK, Tan E, Poh WT. Treatment of Kimura's disease with cyclosporine. J Dermatolog Treat. 2005;16(4):242-4. [Medline].

  22. Yoganathan P, Meyer DR, Farber MG. Bilateral lacrimal gland involvement with Kimura disease in an African American male. Arch Ophthalmol. Jun 2004;122(6):917-9. [Medline].

  23. Yuen HW, Goh YH, Low WK, Lim-Tan SK. Kimura's disease: a diagnostic and therapeutic challenge. Singapore Med J. Apr 2005;46(4):179-83. [Medline].

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Further Reading

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Keywords

eosinophilic granuloma of soft tissue, eosinophilic hyperplastic lymphogranuloma, eosinophilic lymphofolliculosis, eosinophilic lymphofollicular granuloma, eosinophilic lymphoid granuloma

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Contributor Information and Disclosures

Author

Sena J Lee, MD, PhD, Staff Physician, Department of Dermatology, Hospital of University of Pennsylvania
Sena J Lee, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Alaina J James, MD, PhD, Staff Physician, Department of Dermatology, University of Pennsylvania Medical Center
Disclosure: Nothing to disclose.

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other

Laura M Tamburin, MD, Affiliated Dermatology, PC
Laura M Tamburin, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Patricia Mercado, MD, Chief, Dermatology Division at Birmingham Veterans Administration Medica, Associate Professor of Dermatology, Department of Dermatology, University of Alabama at Birmingham
Patricia Mercado, MD is a member of the following medical societies: American Academy of Dermatology and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Takeji Nishikawa, MD, Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Daniel S Loo, MD, Associate Professor, Residency Program Director, Department of Dermatology, Boston University School of Medicine
Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology and Association of Professors of Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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