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Age / Sex : 13 / M
Chief complaint : Right upper arm mass (O: 3YA)
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Courtesy: Woo young Kang, Chungbuk national university hospital
Diagnosis: Kimura’s disease
Discussion
Findings:
MRI shows
ill-defined contiguous masses with high signal intensity on T2-weighted image,
low signal intensity on T1-weighted image and homogeneous enhancement,
surrounding soft tissue edema and serpentine signal voids in subcutaneous layer
and intermuscular fascia of distal upper arm.
Differential Diagnosis:
Reactive
lymphadenopathy
Tuberculous
lymphadenopathy
Lymphoma
Diagnosis:
Kimura’s disease
Discussion:
Kimura’s
disease is a rare benign lymphoproliferative disorder of unknown etiology. This
disease usually occurs in Asian men. The common clinical features are asymptomatic
subcutaneous masses in the head and neck region, and local lymphadenopathies.
Other less frequent sites of involvement are the axilla, the groin, the popliteal
region, and the arm. The disease mostly involves soft tissue and regional lymph
nodes, and is usually accompanied by peripheral blood eosinophilia (more than
10% of the differential count) and elevated serum IgE concentration. The
imaging finding of Kimura’s disease in the upper extremity is a partially or
poorly defined subcutaneous mass of high signal intensity on T1- and
T2-weighted images with homogeneous enhancement, surrounding subcutaneous
edema, and internal flow voids in the medial epitrochlear region. The lesions of
Kimura’s disease are characterized histopathologically by prominent germinal
centers in involved lymph nodes with cellular, vascular, and fibrous
components, consisting of dense eosinophilic infiltrates in a background of
abundant lymphocytes and plasma cells, eosinophilic microabscesses with central
necrosis, Warthin-Finkeldey-type polykaryocytes and vascular proliferation of
germinal centers, increased postcapillary venules in the paracortex, and
sclerosis without arteriovenous shunts.
References:
Choi JA, Lee
GK, Kong KY et al. Imaging findings of Kimura's disease in the soft tissue of
the upper extremity. AJR 2005;184:193-199
Chung YG,
Jee WH, Kang YK, et al. Kimura's disease involving a long bone. Skeletal Radiol
2010;395:495-500
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