Kimura Disease Workup

Updated: Mar 15, 2022
  • Author: Alan Snyder; Chief Editor: William D James, MD  more...
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Workup

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]

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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, h 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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