title: Kimura's disease with unusual eosinophilic epithelioid granulomatous reaction: a finding possibly related to eosinophil apoptosis.
abstract: We report and discuss a case of Kimura's disease with an unusual eosinophilic epithelioid granulomatous reaction. A 3-year-old Japanese boy with eosinophilia and a high concentration of IgE developed lymphadenopathy and multiple cervical masses. A lymph node biopsy demonstrated the infiltration of eosinophils in the stroma, which is consistent with the findings of Kimura's disease. Interestingly, a number of apoptotic eosinophils was detected in the infiltrating eosinophils. Multiple epithelioid granulomas with central eosinophilic abscesses and necrosis were also observed. Macrophages and giant cells had phagocytosed the apoptotic eosinophils at the edge of the granulomas. In situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay showed that the TUNEL-positive eosinophils were both in the macrophages and in the central eosinophilic abscesses of the granulomas. These findings suggest that the eosinophils had undergone an accelerated apoptosis in this case of Kimura's disease, and that the epithelioid granulomas were produced by phagocytosis of the apoptotic eosinophils by macrophages.
authors.affiliation: Department of Clinical Pathology, Toyooka Hospital, Toyooka City, Hyogo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hosaka
authors.forename: Toshinori
authors.initials: T
authors.lastname: Minato
authors.forename: Shinsaku
authors.initials: S
authors.lastname: Yoshida
authors.forename: Junko
authors.initials: J
authors.lastname: Toki
authors.forename: Guoxing
authors.initials: G
authors.lastname: Yang
authors.forename: Hiroko
authors.initials: H
authors.lastname: Hisha
authors.forename: Susumu
authors.initials: S
authors.lastname: Ikehara
mesh_terms: D000796:Angiolymphoid Hyperplasia with Eosinophilia / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D017209:Apoptosis; D002675:Child, Preschool; D004803:Eosinophilic Granuloma / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D004804:Eosinophils / Q000378:metabolism / Q000473:pathology*; D015622:Epithelioid Cells / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007124:Immunoenzyme Techniques; D007073:Immunoglobulin E / Q000097:blood; D020287:In Situ Nick-End Labeling; D008198:Lymph Nodes / Q000378:metabolism / Q000473:pathology; D008206:Lymphatic Diseases / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D008297:Male; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D007073:Immunoglobulin E; C067980:CD68 antigen, human; D000097382:CD68 Molecule