Imaging Studies

The appearance of Kimura disease on imaging modalities, including computed tomography scanning and magnetic resonance imaging, is variable and is thought to be due, at least in part, to the variable degrees of vascular proliferation and fibrosis within individual lesions. However, diagnostic CT imaging of cervical nodes might be preferred over MRI by virtue of objective enhancement signal-intensity properties alone. Patients presenting with Kimura disease have been found to present intensely enhanced on CT (>120 HU) when compared with other common diseases affecting cervical lymph nodes.^[44]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.^[36]

The solid masses characteristic of Kimura disease may appear heterogeneously hyperintense with little diffusion restriction on T2-weighted MR images.^[45]

Histologic Findings

Lymphoid nodules with discrete germinal centers can occupy an area extending from the reticular dermis to the fascia and muscle. Follicular hyperplasia, marked eosinophilic infiltrate and eosinophilic abscesses, and the proliferation of postcapillary venules are characteristic histological findings.^[25]Centrally, thick-walled vessels are present with hobnail endothelial cells. Immunohistochemical evaluation of the lymphoid nodules demonstrates a polymorphous infiltrate without clonality.^{[19, 36]}Reports have also demonstrated the presence of plasmacytoid dendritic cells in a lesion of Kimura disease.^[46]Histopathological examination is an effective way to establish the diagnosis.^{[25, 12, 47]}

See the image below.

High-magnification micrograph of Kimura disease, hematoxylin and eosin stain. Thick-walled blood vessels with (plump) hobnail endothelial cells and abundant eosinophils. Courtesy of Nephron (own work) via Wikimedia Commons.

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Treatment & Management

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Media Gallery

High-magnification micrograph of Kimura disease, hematoxylin and eosin stain. Thick-walled blood vessels with (plump) hobnail endothelial cells and abundant eosinophils. Courtesy of Nephron (own work) via Wikimedia Commons.
Fifteen-year-old boy with nontender, firm swelling (5 cm x 3 cm) in the left cervical area of 8 months’ duration. Courtesy of Our Dermatology Online (http://www.odermatol.com/).

of 2

Author

Alan Snyder MD Candidate, Medical University of South Carolina College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

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.

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.

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.

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.

Kimura Disease Workup

Imaging Studies

Histologic Findings

References

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