Kimura's disease of the left arm

Abstract

Kimura's disease is a rare, benign entity that causes subcutaneous angioblastic lymphoid hyperplasia with eosinophilia. It usually presents with subcutaneous lymphoid swellings with regional lymphadenopathy and salivary gland masses. Kimura's disease is frequently associated with renal involvement, which includes proteinuria and nephrotic syndrome as the most common presentations. This report presents a case of a man in his early 20s with a swelling in the medial aspect of the distal left arm with two previous episodes of nephrotic syndrome. Multiple enlarged axillary lymph nodes and epitrochlear nodes were noted. Ultrasonography revealed a mixed echogenic mass with enlarged lymph nodes. MRI showed a heterogeneous hyperintense lesion. Image-guided fine-needle aspiration showed multiple lymphocytes and eosinophils suggestive of Kimura's disease. The swelling was surgically excised under general anaesthesia. Histopathology of the excised mass confirmed the diagnosis of Kimura's disease.

Keywords: General surgery; Pathology; Screening (oncology); Surgery; Ultrasonography.

Figure 1

Physical findings and ultrasonography comparison. (A) Physical findings. (B) Mixed echogenic mass in the subcutaneous plane (marked in red) with an underlying lymph node (marked in white/black) over the underlying triceps (marked in orange).

Figure 2

MRI findings. (A) Coronal view indicating heterogeneously hyperintense tissue with fat stranding (marked in white). (B) Coronal view showing mass abutting major vessels (marked in red). (C) Sagittal view suggesting the position of heterogeneously hyperintense tissue (marked in white) with respect to the humerus.

Figure 3

Excisional biopsy histopathology. (A) Numerous follicles with marked hyperplasia with reactive germinal centres (marked in black), proliferation of post-capillary venules (marked in red) and moderate sclerosis (marked in green) (10×). (B) Eosinophilic germinal centre (marked in solid black) with lymphoid hyperplasia (marked in black line arrow) (40×). (C) Numerous eosinophils (a few marked in blue) with plasma cells (100×).