Case Report: A Rare Case of Nasal Forehead Mass in Kimura's Disease

Abstract

Background: Kimura's disease is a rheumatic immune disease and head and neck lymph nodes are often involved. A mass occurring in the nasal forehead is rare. Good prognosis after surgical resection by glucocorticoid therapy is more rare. Case Summary: We report the rare case of a nasal forehead mass in a 45-year-old male patient with Kimura's disease. The patient underwent resection of the mass in October 2018 in a local hospital and the postoperative pathology was unclear. He then underwent a second resection in our department in December 2019 mainly because growth of the mass was affecting his appearance. Postoperative pathology confirmed that the patient had Kimura's disease, and he accepted systemic treatment with prednisone. We followed the patient for 10 months after surgery. He is now recovering well and continues to be closely monitored during follow-up. Conclusion: It is rare that the painless mass in the nasal forehead is diagnosed as a Kimura's disease.After completely resection of the mass and systemic treatment with prednisone, the patient had a good outcome. We provide experience for the treatment of Kimura's disease in nasal forehead.

Keywords: Kimura disease; case report; nasal forehead mass; prednisone; surgery.

Figure 1

CT and MRI images. (A–C) Show iso- and hyper-intense signal in T2 sequence of the patient's cranium MRI images. Panel (A) is a coronal T2 image. Panel (B) is an axial T2 image. Panel (C) is a sagittal T2 image. Panel (D) is a CT image, with the red arrow indicating the mass.

Figure 2

Pathology images. In the proliferative fibrous tissue, there were proliferative lymphoid tissue, lymphoid follicles, a large number of eosinophils between the follicles, proliferative small vessels in the follicles, and local infiltration of striated muscle. Panel (A) is pathological images taken with an optical microscope at 40× magnification and image (B) was taken at red rectangle. Panel (B) is pathological images taken with an optical microscope at 100× magnification and image (C) was taken at red rectangle. Panel (C) is pathological images taken with an optical microscope at 200× magnification and image (D) was taken at red rectangle. Panel (D) is pathological images taken with an optical microscope at 400× magnification which show many eosinophils in the tissue.

Figure 3

Images before and after surgery. (A) Photo taken prior to surgery, showing the local updrift at the nasal forehead which in the black circle. (B) Six months after surgery, the area is of normal appearance without recurrence.