Kimura's disease: a case report

Kimura's disease is a rare, idiopathic condition that usually affects young men of Asian descent. The decrease is characterized by swelling and lesions in the head and neck region, with involvement of the subcutaneous soft tissue, major salivary glands, and lymph nodes. Patients almost always have eosinophilia and elevated serum immunoglobulin E levels. The diagnosis is established by biopsy. Kimura's disease is usually self-limiting. Its etiology is unknown but is thought to be a manifestation of an aberrant allergic response. In this paper, we describe the case of a 30-year-old patient who was diagnosed with Kimura's disease at our institution.     

Sleep apnea due to Kimura's disease of the larynx. Report of a case

Kimura's disease is a benign chronic granulomatous disease which presents as a subcutaneous swelling in the head and neck area. The histopathological feature consists of granuloma-forming lymphoid follicles with eosinophil infiltration. Kimura's disease of the larynx is very rare, and only a few cases have been reported. We report a 14-year-old boy who presented with sleep apnea. Laryngological study revealed a submucosal swelling of the bilateral false vocal cord. Histopathological examination showed lymphoid hyperplasia with marked infiltration of eosinophils, which was diagnosed as Kimura's disease. After laser surgery, he had recurrent swelling of the false cord. The patient was given 30 mg of prednisolone, which was gradually tapered. The laryngeal swelling resolved, and the sleep apnea immediately improved after the treatment. However, a low dose of prednisolone was necessary to maintain the remission. Oral administration of pranlukast successfully supported the tapering of prednisolone.     

Kimura's disease in children: a 9 years prospective study

Kimura's disease is a rare form of chronic inflammatory disorder involving subcutaneous tissue, predominantly in the head and neck region and frequently associated with lymphadenopathy and/or salivary gland enlargement. The nodular lesions are deep seated in subcutaneous tissue and clinically may mimic a neoplasm. Hence head and neck surgeons need to be aware of clinical presentation of Kimura's disease. OBJECTIVES: To study the clinical presentations, management and complications of Kimura's disease in pediatric age group. STUDY DESIGN: Prospective study. MATERIALS AND METHODS: The duration of study was 9 years (January 1998 to December 2006), comprising of 18 patients. Only histopathologically proven cases were included in this study. Blood eosinophil count and serum IgE estimation were done in all these patients. All the patients underwent fine needle aspiration cytology study. In 15 patients excision biopsy was done and resected specimen was sent for histopathological examination. In three cases, only biopsy was done to confirm the diagnosis. RESULTS: All the patients presented with painless swelling in the head and neck region. Post-auricular region was the commonest site (50%). Sixteen patients (88.8%) had blood eosinophilia and in 15 patients (83.3%) serum IgE level was elevated. Fifteen cases were treated by surgery and three cases were treated with steroids. Out of 18 cases, 15 cases were symptom free at the end of 1 year. Among 15 patients who underwent surgery, only one had recurrence (6.6 %). Out of three patients who were treated with corticosteroids, two came back with recurrence (66.6%). In our study, totally three patients had recurrence (16.6%). One patient had nephrotic syndrome (5.5%). CONCLUSION: Post-auricular region is the commonest site of involvement. Incidence is more common in the second decade of life. Recurrence rate is more with steroid therapy. Surgery is the best modality of treatment. The only systemic complication is nephrotic syndrome.     

Kimura’s disease: Rare cause of head & neck swelling

Kimura ’s disease presents as subcutaneous painless swelling in head and neck region often mimicking inflammatory or neoplaitic disease. This case report draws attention of otolaryngologist-head & neck surgeons to recognise this rare clinical entity.     

Spontaneous facial subcutaneous emphysema

Patients with spontaneous pneumomediastinum present with various manifestations, but it is extremely rare for head and neck signs to be the sole presenting feature. In fact, our search of the literature found only 1 previously documented case of spontaneous facial subcutaneous emphysema of the head and neck. In this article, we report what to the best of our knowledge is the second such case-and the first in which pneumomediastinum manifested as an isolated cheek swelling.     

Head and neck manifestations of disseminated coccidioidomycosis

OBJECTIVES/HYPOTHESIS: Coccidioidomycosis is a fungal disease endemic to semiarid regions in the southwestern United States, northern Mexico, and parts of South America. Although this is primarily a pulmonary disease, approximately 0.5% to 1.0% of infected individuals develop disseminated disease affecting skin, subcutaneous tissue, bone, joints, and meninges. The objectives of the study were to present three cases of head and neck manifestations of disseminated coccidioidomycosis and to review the literature of head and neck presentations, diagnosis, and treatment of this potentially life-threatening disease. STUDY DESIGN: Case reports and literature review. METHODS: A Medline search was performed with the keyword "coccidioidomycosis." Of 1719 articles in all, 47 were selected for their relevance to otolaryngology, diagnosis, or treatment. RESULTS: Virtually all head and neck manifestations in patients with disseminated coccidioidomycosis involved the skin, with a predilection for the central face. Systemic symptoms such as fever and cough are often subtle, making the diagnosis difficult. Infections of multiple sites of the head and neck have been reported, including life-threatening airway lesions. CONCLUSION: The incidence of patients with coccidioidomycosis has been steadily increasing since the late 1980s in endemic areas. Otolaryngologists are increasingly being called on to diagnose and manage the head and neck manifestations of the disease caused by Coccidioides immitis.     

Polymyositis presenting as a neck mass.

Polymyositis is a rare disease entity belonging to the class of enigmatic disorders known as the collagen vascular diseases. It is characterized by proximal muscle weakness. More than 50% of the patients with this disease have development of head and neck manifestations, most commonly a heliotrope rash or dysphagia. Weakness and atrophy of neck muscles, and lolling of the neck have also been described. We report a case of polymyositis presenting as a neck mass, a heretofore undescribed manifestation of this disease in the head and neck. A review of the literature and an interdisciplinary approach to the diagnosis and management of this unusual disease will be described.     

A fatal case of necrotizing fasciitis of the neck

Necrotizing fasciitis is a rare but life-threatening soft-tissue infection primarily involving the superficial fascia and subcutaneous tissue. Only early diagnosis and aggressive therapy including broad-spectrum antibiotics and surgical intervention can avoid systemic toxicity associated with a high mortality rate. Necrotizing fasciitis is rarely seen in the head and neck region. In this article, we report a fatal case of necrotizing fasciitis in the neck of 75-years-old female patient and reviewed the microbiology, diagnosis, treatment and prognosis of this rare infection together with literature data.     

Angiolymphoid hyperplasia with eosinophilia. A case report and review of the literature

A patient had skin and subcutaneous manifestations of angiolymphoid hyperplasia with eosinophilia. The diagnosis and treatment of this angioproliferative disease with a predilection for the head and neck were determined, and recommendations were made for avoiding surgical misadventure.     

Head and neck infantile myofibromatosis--a report of three cases

Infantile myofibromatosis (IM) is a proliferative disorder characterized by the development of single or multiple nodular lesions arising from cutaneous, subcutaneous, muscular, bone or visceral structures. This proliferation may occur at any anatomical site, but in 30% of the cases it involves the head and neck. We report here three cases of head and neck IM occurring in young children and presenting as solitary lesions. The clinical heterogeneity and the misleading histopathological appearances can make the diagnosis difficult. The treatment is surgical but the low rate of recurrence and the possibility of spontaneous tumoral regression may lead to conservative surgery or therapeutic abstention.     

Iatrogenic subcutaneous cervicofacial and mediastinal emphysema

Subcutaneous emphysema of the head, neck and mediastinum occurs with a variety of disease processes. Most cases involve the passive escape of air from the aerodigestive tract into subcutaneous tissues. The many causes include head and neck surgical procedures, tracheal and esophageal trauma, intraoral trauma, foreign bodies and neoplasms of the aerodigestive tract, and pulmonary barotrauma from mechanical ventilation or in patients with pulmonary disorders. Subcutaneous emphysema secondary to active injection of air has recently been reported following certain dental procedures. An interesting case of diffuse cervicofacial and mediastinal emphysema following a difficult extraction of an infected lower molar tooth with a high-pressure air drill is presented. The patient required airway observation and high-dose antibiotic therapy. Early recognition of this unique problem is essential in preventing such life-threatening complications as airway obstruction, mediastinitis, deep neck infection, and cardiac failure. Diagnostic and therapeutic recommendations are included.     

Hodgkin's disease of the head and neck in human immunodeficiency virus-infected patients.

INTRODUCTION: Hodgkin's disease can occur in immunocompromised patients. However, the head and neck manifestations of Hodgkin's disease in human immunodeficiency virus (HIV)-infected patients remain ill defined. The aim of this study was to describe Hodgkin's disease of the head and neck in HIV-infected patients and compare it with noninfected patients. MATERIALS AND RESULTS: Sixteen patients presented with Hodgkin's disease of the head and neck to the King's County Hospital Center, Brooklyn, New York, beginning in January of 1991. Five patients were infected with HIV. Hodgkin's disease involved the head and neck regions in 90.5% of cases, occurring in 100% of HIV-infected and in 81% of noninfected patients. Manifestations of Hodgkin's disease were isolated to the head and neck region in only 20% of HIV-infected and in 27% of noninfected patients. Lymphatic structures were involved in all cases with head and neck involvement. Systemic or group B symptoms (fever, night sweats, fatigue, and weight loss of more than 10% of normal body weight) were present in 40% of HIV-infected patients and in 27% of noninfected patients. Advanced stage disease (Stage III/IV) was diagnosed in 80% of HIV-infected patients compared with 45% of noninfected patients. The mixed cellularity subtype was most common in HIV-infected patients (75%), whereas the nodular sclerosis subtype predominated in noninfected patients (50%). CONCLUSIONS: The data combined with our report of the literature suggest that the course, presentation, and outcome of Hodgkin's disease is markedly altered in HIV-infected patients. An aggressive approach to the diagnosis and management is suggested in this patient population.     

Non-hodgkin's lymphoma of the head and neck: The university of iowa experience

The evaluation of a patient with a mass in the head and neck may require the consideration of lymphoma in the process of differential diagnosis. Non-Hodgkin's lymphoma is a well-described heterogeneous group of lymphoid malignancies characterized by a natural history ranging from indolent to aggressive growth. Little has been written, however, concerning the specific features of this disease in the head and neck. Between 1974 and 1984, 287 patients were treated for non-Hodgkin's lymphoma presenting in the head and neck. A multivariant analysis of these cases forms the basis of this report. All case material was reviewed and classified according to the working formulation of the National Cancer Institute and the Ann Arbor Classification System for lymphomas. Sites of initial presentation, methods of diagnosis, choice of therapy and subsequent response to treatment were related to the manifestations of non-Hodgkin's lymphoma in the head and neck. Of particular interest to the head and neck surgeon is the constellation of presenting signs and symptoms which point one to the possibility of non-Hodgkin's lymphoma.     

Sclerosing rhabdomyosarcoma: a rare variant with predilection for the head and neck

OBJECTIVES/HYPOTHESIS: Sclerosing rhabdomyosarcoma is a newly described variant of rhabdomyosarcoma with a predilection for the head and neck. Little has been written on the topic, because of the scarcity of the disease and its recent recognition as a distinct entity. The present report describes the fifth confirmed case of sclerosing rhabdomyosarcoma and is the first report in the otolaryngology literature. STUDY DESIGN: Case report. METHODS: The authors have reported the case of a 66-year-old woman with a 35-year history of heavy cigarette smoking and daily alcohol consumption and a 2-month history of progressive dysphagia and dysarthria secondary to an enlarging tongue mass. Urgent tracheotomy was performed for impending respiratory embarrassment. Direct laryngoscopy revealed a bulky, exophytic mass involving the base of tongue. Specimens were obtained and submitted for analysis. RESULTS: Initial frozen-section analysis of the specimens favored carcinoma, although subsequent immunohistochemical analysis disproved this. The diagnosis of sclerosing rhabdomyosarcoma was based on microscopic appearance and patterns of gene expression, including the expression of desmin and myogenin. A search of the literature revealed only four confirmed cases of sclerosing rhabdomyosarcoma. With the inclusion of the oropharyngeal tumor in the present report, three of the five confirmed cases have occurred in the head and neck. CONCLUSION: Sclerosing rhabdomyosarcoma is a rare variant of rhabdomyosarcoma that has a predilection for the head and neck. The clinical presentation may mimic carcinoma. The otolaryngologist-head and neck surgeon must be familiar with this disease entity.     

头颈部转移性透明细胞癌5例并文献复习

目的 探讨泌尿系统透明细胞癌转移至头颈的部位和治疗方法.方法 总结我院2011年至2018年收治的具有完整临床资料的5例头颈部转移性透明细胞癌,分析原发疾病、原发病治疗方法、转移时间、转移部位、转移灶治疗方法、预后等临床资料.结果 5例透明细胞癌原发灶位于肾脏4例、膀胱1例,原发灶均行根治性手术.转移时间为原发灶术后1...     

Cervical necrotizing soft tissue infection — A case report

A small but nevertheless important part of a surgeons experience comprises necrotizing soft tissue infections of the head and neck. These infections are characterized by their fulminating, devastating, and rapid-progressing course resulting in extensive necrosis of fascia, subcutaneous tissues, skin and muscle. Although necrotizing facilities is a more frequently used terminology, the authors prefer to use the term necrotizing soft tissue infection to describe this potentially fatal condition. A case of cervical necrotizing soft tissue infection of dental origin is reported here. The purpose of this report is to heighten awareness of necrotizing soft tissue infections in any patient with an infection of the neck. The article also outlines an appropriate management strategy for use in such patients with emphasis on prompt diagnosis and early radical surgical debridement.     

Cervical necrotizing fasciitis with mediastinitis: a rare occurrence in the pediatric age

Necrotizing fasciitis (NF) is a life-threatening, progressive, bacterial soft tissue infection characterized by necrosis of skin, subcutaneous tissues, fasciae, and muscles. It usually occurs in adults and is most often localized to the abdominal wall, the extremities, the perineum, the pelvis, and the thoracic region. Localization to the head and neck area is rarely encountered, especially in pediatric patients. Early diagnosis and prompt, aggressive surgical treatment associated with intravenous, broad-spectrum antibiotic therapy are mandatory to successfully control the disease. To date, only anecdotal cases of cervical NF in the pediatric age have been described. We report a case of cervical NF with mediastinitis in a 13-year-old girl who underwent successful immediate surgery and prolonged intravenous antibiotic therapy. A literature review is also presented with particular emphasis on etiology, clinical and radiological presentation, diagnosis, and treatment of this rare disorder.     

Dermatofibrosarcoma protuberans: Rare cause of head and neck swelling

Dermatofibrosarcoma protuberance of head and neck is a rare neoplasm and accounts for less than one percent of Head and Neck Neoplasm. The objective of this report is to understand etiology, presentation, histopathologic identification and treatment option for this tumour. The goal of current report is to acquaint the clinician with presentation and treatment option for this disease.     

Invasive Aspergillus of the head and neck

Invasive fungal infections of the head and neck are uncommon. The most common organism is Mucor which is classically seen in diabetic individuals in or immediately after a bout of ketoacidosis. This report outlines our experience of four cases of invasive fungal disease caused by the Aspergillus species. All four patients in this series were profoundly granulocytopenic. Three of the four patients remained profoundly immunocompromised and succumbed to infections. One patient recovered immune competence and became a long term survivor after antifungal chemotherapy and debridement of necrotic tissue. The literature on invasive Aspergillus of the head and neck is reviewed. Some recent insights in the medicine literature concerning the epidemiology of the more common pulmonary form of this invasive disease are also discussed.     

Breast metastasis from a pharyngeal carcinoma

The reported incidence of metastatic disease in head and neck cancer is increasing. The most common site of metastatic involvement in squamous carcinoma of the head and neck is the lung followed by liver, mediastinal nodes and bone. The breast is rarely infiltrated by metastatic disease, 2 per cent or less of clinically detected breast lumps being of non-mammary origin, most frequently malignant melanoma, lymphoma/leukaemia and primary lung carcinoma. A 73-year-old female presented with a primary posterior pharyngeal wall squamous carcinoma and bilateral enlarged neck nodes. She developed an isolated breast metastasis while receiving palliative radiotherapy and died seven months after presentation. Clinically detected breast metastasis in head and neck squamous cell carcinoma was first documented by Toombs and Kalisher in 1977. This is the first report of such a case originating in the posterior pharyngeal wall. The prognosis is invariably poor.