Kimura's disease: a diagnostic and therapeutic challenge.
BACKGROUND
Kimura's disease (KD) is a rare, benign, chronic inflammatory disease with unknown aetiology. Its manifestation is protean. KD has a predilection for the head and neck area, and typically presents as tumour-like lesions that could be easily misdiagnosed. We review our experience with four recent cases.


METHODS
Over a four-year period, all patients admitted to Singapore General Hospital with KD of the head and neck region were retrospectively reviewed. Biodata, presenting symptoms and clinical parameters, especially serum eosinophil levels, preoperative investigations, type of surgical procedures and outcome were documented.


RESULTS
Four patients presented with KD of the head and neck and displayed varied manifestations of the disease. All the patients had raised serum eosinophil levels. None of them had renal involvement. Preoperative computed tomography were performed in two of the patients and showed features suggestive of KD. Fine-needle aspiration cytology that was performed in two patients was not useful in the diagnosis. All the patients underwent surgical excision of the lesions. Only one patient had multiple recurrence, both at the original and remote sites in the head and neck.


CONCLUSIONS
The clinical presentation and behaviour of KD is very variable. Preoperative imaging is useful in the diagnosis of the disease but the final diagnosis is histological. Surgical excision is the current treatment of choice but recurrence is common. A high index of suspicion and awareness is vital in the early diagnosis and management of KD.
Yuen
H W
HW
Department of Otorhinolaryngology, Singapore General Hospital, Outram Road, Singapore 169608. yuen_a@yahoo.com.sg
Goh
Y H
YH
Low
W K
WK
Lim-Tan
S K
SK
D000293:Adolescent; D000328:Adult; D000796:Angiolymphoid Hyperplasia with Eosinophilia / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D004804:Eosinophils; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies