Elsevier

American Journal of Otolaryngology

Volume 33, Issue 2, March–April 2012, Pages 259-262
American Journal of Otolaryngology

Case report
Kimura disease: diagnostic challenges and clinical management

https://doi.org/10.1016/j.amjoto.2011.05.005Get rights and content

Abstract

Kimura disease is a rare inflammatory lesion of the head and neck region, usually seen in young Asian men. Patients usually present with a painless mass involving a major salivary gland with lymphadenopathy. Current studies suggest an immunologic mechanism for the pathogenesis of this disease entity. Histopathologically, this tumor is composed of vascular proliferation and lymphoid infiltrate rich in eosinophils. The immunohistochemical findings are usually nonspecific but might help in eliminating malignancies. The role of fine needle aspiration (FNA) and biopsy procedure appears to be limited in making the histologic diagnosis of Kimura disease. The natural history of the disease, however, appears to be indolent, without any malignant transformation reported, although recurrence can be frequent. Here, we describe 2 cases of Kimura disease with differing presentations, diagnostic difficulties, and their clinical management. The difficulties encountered in establishing an accurate preoperative diagnosis and the complexity of surgical management highlight the need for an index of suspicion for this clinical entity while mandating appropriate surgical management to minimize operative morbidity and reduce the risk of recurrence.

Section snippets

Case reports

In case 1, in 1979, a 23-year-old Asian man presented with recurrent swelling of his left parotid region after undergoing 2 prior excisions for the same lesion in Taiwan in 1973 and again in 1975. Pathologic diagnoses from these excisions were reportedly consistent with Mickulicz disease. Examination revealed a firm mass over the angle of his jaw without obvious facial nerve involvement and cervical lymphadenopathy (Fig. 1). Laboratory values were remarkable for a peripheral eosinophilia (white

Discussion

Kim and Szeto [1] are reported to be the first to describe this rare inflammatory lesion of the head and neck in 1937, and Kimura et al [2] further classified the disease that is more commonly named after him in 1948. This is a benign disease usually seen in young Asian men with a peak incidence in the third decade [3], [4]. Rarely, these lesions have been reported in non-Asian patients. Kim-Kimura disease or Kimura disease characteristically involves the major salivary glands or lymph nodes in

Conclusion

Here, we present 2 cases of Kimura disease diagnosed in a single surgeon's practice of over 35 years, illustrating the rarity of this lesion. Salient features of the tumor are the atypical presentation of a firm mass in the head and neck, usually in young Asian men. Although most lesions will be associated with the parotid gland or the lymphatics of the neck, unusual locations must be considered. The innumerable minor salivary glands located throughout the oral cavity may give rise to these

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