Synchronous Kimura lesions at two different sites-a diagnostic dilemma!

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.

Keywords: Kimura; eosinophilia; lymphadenopathy; parotidectomy.

Figure 1

MR angiogram of right thigh showing diffuse vascular neoplasm.

Figure 2

CT head showing right parotid neoplasm.

Figure 3

Microphotograph showing follicular hyperplasia with reactive germinal centers, well-formed mantle zones, eosinophilic folliculolysis, and eosinophilic infiltrates in the germinal centers (H&E, ×40).