Kimura's disease of the epiglottis: resection by a lateral pharyngotomy approach.

Abstract

Kimura’s disease is a chronic non-neoplastic entity first described by Kimura et al in 1948. It predominantly occurs in Asian males during the second and third decades of life. The major physical manifestation is slowly enlarging subcutaneous masses often found in the head and neck, especially in the salivary glands, usually in association with peripheral blood and tissue eosinophilia and a markedly increased serum IgE concentration. Although many cases have been reported, development in the larynx is very rare, possibly leading to difficulties in diagnosis. We report a case of Kimura’s disease presenting as an epiglottic mass, which was resected by a lateral pharyngotomy approach (LPA). A 52-year-old female presented to our department with a 10-month history of sensation of a foreign body in her pharynx. ENT examination revealed a 30-mm, well-defined, submucosal epiglottic mass (Fig 1). No enlarged lymph nodes were palpable in cervical regions, and there were no lesions in the salivary glands. MRI showed a diffuse enlargement of the epiglottis with a low-intensity signal in both T1and T2-weighted images. CT also showed an epiglottic mass with slight enhancement (Fig 2). These findings suggested a tumorous lesion in the epiglottis, such as malignant lymphoma. The white blood cell (WBC) count was 6800/mm, with 12.5 percent eosinophils. We did not measure serum IgE concentration. During direct laryngoscopy with the patient under general anesthesia, we detected a submucosal tumor covered with a normal mucous membrane in the epiglottis, making the laryngeal space at the epiglottic level very narrow. We incised the mucous membrane and took a biopsy sample from the mass. These findings suggested low-grade malignant lymphoma. The specimen was too small to make a definite diagnosis pathologically, so we performed an LPA to obtain a larger sample. The mass was found to be closely adhered to the epiglottis, so subtotal removal was performed. The mass was firm, reddish-white, and measured 4 3 3 cm. Histopathologically, multiple hyperplastic

DOI: 10.1016/j.otohns.2009.06.089

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Cite this paper

@article{Kawata2010KimurasDO, title={Kimura's disease of the epiglottis: resection by a lateral pharyngotomy approach.}, author={Ryo Kawata and Katsuhiro Yoshimura and Takahiro Ichihara and Hiroshi Takenaka and Motomu Tsuji}, journal={Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery}, year={2010}, volume={142 1}, pages={148-9} }