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Path Quiz Case-7
Diagnosis: 
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Epithelioid hemangioma (angiolymphoid hyperplasia with eosinophilia) Lobular capillary hemangioma (pyogenic granuloma Masson's Tumour (Intravascular papillary endothelial hyperplasia) Acro-angiodermatitis / pseudo-Kaposi's sarcoma Reactive angioendotheliomatosis Targetoid hemosiderotic hemangioma(Hobnail hemangioma) Spindle cell hemangioma / hemangioendothelioma Kaposiform hemangioendothelioma Papillary intralymphatic angioendothelioma (Dabska's tumour) Composite hemangioendothelioma Epithelioid hemangioendothelioma Dermatofibroma (aneurysmal variant) |
 Site created by Dr Sampurna Roy MD
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Acrodermatitis chronica atrophicans
African Histoplasmosis (Histoplasma Duboisii) AIDS: Cutaneous lesion associated with AIDS |
Kimura's disease is a rare, benign chronic inflammatory condition which commonly occurs among the Oriental population.
The exact cause of this disease is unknown but it is believed to result from an immunological reaction that is allergic or autoimmune in nature.
The lesion shows no evidence of malignant transformation. Recurrence may occur following surgical excision.
Although the Asians are commonly affected some cases have been reported in the Caucasians and in the African population.
Age: Usually occurs in the second and third decade of life.
Site: Commonly located in the head and neck region particularly in the pre or post auricular region and rarely in the oral mucosa, orbit, and the scalp.
Rarely, Kimura's disease may occur in the parotid or other salivary glands.
Other rare sites include limbs and trunk, vulva, spermatid cord, inguinal and axillary lymph nodes and peripheral nerves.
Clinical presentation: The patient presents with painless subcutaneous nodules or plaques.
Lymphadenopathy is present in more than 50% cases.
Kimura's disease is often associated with peripheral blood eosinophilia, raised ESR and serum IgE.
Accurate diagnosis of Kimura's disease is based on clinical and histological findings.
Microscopic features:
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Features of the skin lesion :
1. Lymphoid follicles with prominent germinal centre.
2. Fibrous tissue surrounding the lymphoid follicles.
3. Inflammatory cellular infiltrate in the interfollicular area consisting of small lymphocytes, plasma cells and eosinophils. In areas, scattered eosinophilic microabscesses are identified.
4. Thin-walled blood
vessels are increased in number lined by flat or cuboidal endothelial cells.
Features of the involved lymph node:
1. Marked hyperplasia of the germinal centre. Germinal centres are often well vascularized and contain eosinophilic deposits and polykaryocytes (Warthin-Finkeldey type).
2. Extensive eosinophilic infiltration consisting of mature eosinophils in follicular and interfollicular areas and occasional eosinophilic microabscess formation.
3. Proliferation of thin-walled blood vessels in the paracortex.
4. Increase in the number
of plasma cells and mast cells in the paracortex.
Differential diagnosis:
Angiolymphoid hyperplasia with
eosinophilia :
Previously, angiolymphoid hyperplasia with eosinophilia and Kimura's disease
were regarded as the same lesion. But these conditions are now regarded as
two separate entities.
1. Multiple, small well circumscribed dermal or subcutaneous papules or nodules with well-defined borders. (In Kimura's the lesion is located in the deep soft tissue or the subcutis without significant change of the overlying skin initially ).
2. Less frequently associated with lymphadenopathy and peripheral blood eosinophilia.
3. Histologically, unlike Kimura's disease the blood vessels are lined by plump epithelioid like endothelial cells. These cells demonstrate large nucleus and abundant eosinophilic cytoplasm. Prominent cytoplasmic vacuoles are present.
4. Dense lymphocyic infiltration is present in only some cases of ALHE.
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ABSTRACT Kimura T et al. Unusual granulation combined with hyperplastic changes of lymphatic tissue. Trans Soc Pathol Jpn. 1948;37: 179-180
Kimura
disease: a clinicopathologic study of 21 cases. Kimura’s Disease: A Diagnostic Challenge .PEDIATRICS Vol. 110 No. 3 September 2002, pp. e39Angiolymphoid hyperplasia with eosinophilia should not be confused with Kimura's disease. Acta Ophthalmol. Scand 2001;79: 91-93Kimura's disease in a chronic hemodialysis patient. Am J Nephrol 2001;21(1):47-50 Steroid-sensitive anemia in a boy on dialysis--an association with Kimura disease.Pediatr Nephrol 2000;15(3-4):183-5
Kimura's disease and
angiolymphoid lymphoid hyperplasia with eosinophilia: clinical and
histopathological differences. J Am Acad Dermatol 1992; 27: 954-958
Congenital Cystic Adenomatoid Malformation
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Acute Respiratory Distress Syndrome
;Sarcoidosis
;Bronchiolitis
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Emphysema
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Bronchial Asthma
;Chronic Bronchitis
Pulmonary
Alveolar Proteinosis
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Lipid Pneumonia ;
Pulmonary Hypertension
;Pulmonary edema
;Pulmonary Infection
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Pneumococcal Pneumonia
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Haemophilus influenza Infection;Klebsiella Pneumoniae
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Mycoplasma Pneumonia
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Pneumocystis Pneumonia
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Legionellosis ;
Localized Fibrous Tumour of the Pleura
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Biphasic Epithelial/Mesenchymal Lung Tumours
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Pulmonary
Carcinosarcoma
;Pulmonary Blastoma
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Large Cell Neuroendocrine tumour; |
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Myxoid
Tumours of Soft Tissue Classification of Soft Tissue Tumour Gross examination of soft tissue specimen A practical approach to histopathological reporting of soft tissue tumours Grading of soft tissue tumours Fibroblastic/Myofibroblastic tumours |
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