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Kimura Disease Workup

  • Author: Evan W Piette, MD; Chief Editor: William D James, MD  more...
 
Updated: Mar 20, 2014
 

Laboratory Studies

Nearly all patients with Kimura disease demonstrate peripheral eosinophilia and elevated levels of serum IgE. In one series, the number of eosinophils was closely correlated to the sizes of the neck masses.[19]

Blood urea nitrogen, creatinine, and urinary protein levels should be obtained to exclude concomitant renal dysfunction (especially nephrotic syndrome).

Serum eosinophil cationic protein levels parallel the course of the disease.[20]

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Imaging Studies

The appearance of Kimura disease on imaging modalities, including CT scanning and MRI, is variable and is thought to be due, at least in part, to the variable degrees of vascular proliferation and fibrosis within individual lesions. One of the largest case series to date notes the characteristic findings to be multiple ill-defined, enhancing lesions around the parotid gland, with associated lymphadenopathy.[15]

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Procedures

Incisional biopsy is recommended to obtain the diagnosis of Kimura disease.

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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. Centrally, thick-walled vessels are present with hobnail endothelial cells. Immunohistochemical evaluation of the lymphoid nodules demonstrates a polymorphous infiltrate without clonality.[7, 15] Reports have also demonstrated the presence of plasmacytoid dendritic cells in a lesion of Kimura disease.[21]

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Contributor Information and Disclosures
Author

Evan W Piette, MD Resident Physician, Department of Dermatology, Hospital of the University of Pennsylvania

Evan W Piette, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Alaina J James, MD, PhD Assistant Professor, Department of Dermatology, The Hospital of the University of Pennsylvania

Alaina J James, MD, PhD is a member of the following medical societies: American Academy of Dermatology, National Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Daniel S Loo, MD Associate Professor of Dermatology, Residency Program Director, Department of Dermatology, Tufts Medical Center

Daniel S Loo, MD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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.

Acknowledgements

Sena J Lee, MD, PhD Resident Physician, Department of Dermatology, Hospital of University of Pennsylvania

Disclosure: Nothing to disclose.

Patricia Mercado, MD Associate Professor of Dermatology, University of Alabama at Birmingham School of Medicine

Disclosure: Nothing to disclose.

Laura M Tamburin, MD Affiliated Dermatology, PC

Disclosure: Nothing to disclose.

Karolyn A Wanat, MD Resident Physician, Department of Dermatology, University of Pennsylvania School of Medicine

Karolyn A Wanat, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and American Medical Women's Association

Disclosure: Nothing to disclose.

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. Ramchandani PL, Sabesan T, Hussein K. Angiolymphoid hyperplasia with eosinophilia masquerading as Kimura disease. Br J Oral Maxillofac Surg. 2005 Jun. 43(3):249-52. [Medline].

  4. Ohta N, Fukase S, Suzuki Y, Ito T, Yoshitake H, Aoyagi M. Increase of Th2 and Tc1 cells in patients with Kimura's disease. Auris Nasus Larynx. 2011 Feb. 38(1):77-82. [Medline].

  5. 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. 1997 Dec. 137(6):972-7. [Medline].

  6. Hosoki K, Hirayama M, Kephart GM, et al. Elevated numbers of cells producing interleukin-5 and interleukin-10 in a boy with Kimura disease. Int Arch Allergy Immunol. 2012. 158 Suppl 1:70-4. [Medline].

  7. Sun QF, Xu DZ, Pan SH, et al. Kimura disease: review of the literature. Intern Med J. 2008 Aug. 38(8):668-72. [Medline].

  8. 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. 1984 Jan. 16(1):39-44. [Medline].

  9. Wang DY, Mao JH, Zhang Y, et al. Kimura disease: a case report and review of the Chinese literature. Nephron Clin Pract. 2009. 111(1):c55-61. [Medline].

  10. Thomas J, Jayachandran NV, Chandrasekhara PK, Rajasekhar L, Narsimulu G. Kimura's disease--an unusual cause of lymphadenopathy in children. Clin Rheumatol. 2008 May. 27(5):675-7. [Medline].

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

  12. Rajpoot DK, Pahl M, Clark J. Nephrotic syndrome associated with Kimura disease. Pediatr Nephrol. 2000 Jun. 14(6):486-8. [Medline].

  13. Jennifer Lee and Yeon-Sik Hong. Kimura Disease complicated with bowel infarction and multiple arterial thromboses in the extremities. J Clin Rheumatol. Jan 2014. 20:38-41.

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

  15. Park SW, Kim HJ, Sung KJ, Lee JH, Park IS. Kimura disease: CT and MR imaging findings. AJNR Am J Neuroradiol. 2012 Apr. 33(4):784-8. [Medline].

  16. Bonfils P, Moya-Plana A, Badoual C, Nadéri S, Malinvaud D, Laccourreye O. Intraparotid Kimura disease. Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Apr. 130(2):87-9. [Medline].

  17. Yadla M, Sriramnaveen P, Sivakumar V, Sandeep Reddy Y, Sridhar AV, Krishna Kishore C. Epitrochlear mass in a patient on maintenance hemodialysis-Kimura disease. Hemodial Int. 2012 Jan 26. [Medline].

  18. Li D, Li YJ, Zhan FH, Dang CJ. The false-positive finding of left pulmonary Kimura disease on 18F-FDG PET/CT. Clin Nucl Med. 2013 Jul. 38(7):569-72. [Medline].

  19. Sakamoto M, Komura A, Nishimura S. Hematoserological analysis of Kimura's disease for optimal treatment. Otolaryngol Head Neck Surg. 2005 Jan. 132(1):159-60. [Medline].

  20. 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. 2007 Mar. 56(1):45-9. [Medline].

  21. Dargent JL, Vannuffel P, Saint-Remy JM, Fisogni S, Facchetti F. Plasmacytoid dendritic cells in Kimura disease. Am J Dermatopathol. 2009 Dec. 31(8):854-6. [Medline].

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

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

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

  25. Hernandez-Bautista V, Yamazaki-Nakashimada MA, Vazquez-Garcia R, Stamatelos-Albarran D, Carrasco-Daza D, Rodriguez-Lozano AL. Treatment of Kimura disease with intravenous immunoglobulin. Pediatrics. 2011 Dec. 128(6):e1633-5. [Medline].

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

  27. 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. 2002 Sep. 71(1):66. [Medline].

  28. Abbas S, Jerjes W, Upile T, Vincent A, Hopper C. Treatment of Kimura disease with photodynamic therapy: a case study. Photodiagnosis Photodyn Ther. 2012 Mar. 9(1):83-6. [Medline].

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

  30. Chang AR, Kim K, Kim HJ, Kim IH, Park CI, Jun YK. Outcomes of Kimura's disease after radiotherapy or nonradiotherapeutic treatment modalities. Int J Radiat Oncol Biol Phys. 2006 Jul 15. 65(4):1233-9. [Medline].

  31. Kapoor NS, O'Neill JP, Katabi N, Wong RJ, Shah JP. Kimura disease: diagnostic challenges and clinical management. Am J Otolaryngol. 2012 Mar. 33(2):259-62. [Medline].

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