头颈部Kimura病的影像表现与临床病理分析

目的:探讨头颈部Kimura病的影像学表现及临床病理特点。方法:回顾性分析7例经病理证实、临床资料完整的Kimura病CT及MR表现。结果:7例患者临床体征均为一侧或两侧颌面部和腮腺区无痛性肿大或肿块,及局部淋巴结肿大,并伴随外周血嗜酸细胞(33%～72%)及免疫球蛋白E(1 500～6 000U/ml)明显升高。CT及MRI表现为双侧腮腺弥漫性增大,内见多发结节,CT呈等低密度,MR T1W呈低信号,T2W及SPAIR呈高信号,CT及MRI增强扫描呈较明显强化,周围脂肪间隙模糊,周围软组织轻度肿胀。颏下、双侧颌下、颈动脉鞘区可见多发肿大淋巴结。镜下可见大量淋巴组织反应性增生,有明显的淋巴滤泡形成,并有大量嗜酸粒细胞浸润形成嗜酸粒细胞性微脓肿。免疫组化示CD20(+)、CD3(+)、CD1(+)、S-100少数细胞散在(+)。结论:头颈部Kimura病的影像学表现有一定的特征性,结合临床及实验室检查,可以提出Kimura病的诊断,但最终诊断须依靠组织病理学。

Imaging findings of Kimura disease in head and neck and its clinical pathological analysis

Objective:To discuss the imaging findings and the clinical and pathologic features of Kimura disease.Methods:The CT and MRI findings of 7 cases with Kimura disease that had complete clinical data were retrospectively analyzed.Results:7 cases had common clinical features with an asymptomatic mass and local lymphadenopathy,most lesions occurred in the parotid and submandibular regions.There was accompanying peripheral blood eosinophilia(33%～72%),and increased serum IgE concentrations(1 500～6 000 U/ml) also were observed.On CT and MRI,they appeared as a diffusely enlarged parotid gland with a normal acinar pattern combined with a soft-tissue mass with an ill-defined border extending from the periphery of the gland.Most the masses had been shown low density,lower signal intensity on T1,and slightly higher signal intensity on T2,and the masses were mostly been well enhanced on CT and MRI.There were some enlarged lymph nodes in the submental,submandibular and carotid sheath regions.On the Micrograph,there were proliferation of lymphatic tissue and eosinophils,the formation of folliculus lymphaticus and microabscess of eosinophils were also observed.Immunohistochemisty showed CD20(+),CD3(+),CD1(+),and S-100(±).Conclusion:The imaging findings of Kimura disease have some characteristic features,the diagnosis can be made combined with clinic and laboratory examination,but the final diagnosis must depend on pathology.