Table 1:
Differential diagnoses of Kimura disease.
| Differential diagnosis | Clinical findings | Peripheral blood eosinophilia | Serum IgE levels | Cytological features | Histological features |
|---|---|---|---|---|---|
| Kimura disease | Site: Deep skin, soft tissue, and lymph node | Mostly present | Elevated | Polymorphous population with markedly increased eosinophils admixed with lymphocytes, plasma cells, and occasional giant cells | Florid reactive lymphoid hyperplasia with Warthin– Finkeldey type multinucleate giant cells present, vascular proliferation and eosinophilic infiltration are minimal |
| Angiolymphoid hyperplasia with eosinophilia | Site: Superficial skin and soft tissue | Rare | Normal | Abundant spindle to plump cells in a background of a polymorphous population of inflammatory cells with many eosinophils | The proliferation of thick-and thin-walled blood vessels with hypertrophic endothelial cells |
| Parasitic lymphadenopathy | Site: Lymph nodes | Present | Elevated | Part of parasite seen with numerous giant cells, plasma cells, and eosinophils | Parasitic remnants with plenty of eosinophils |
| Eosinophilic granuloma | Site: Bone | Absent | Normal | Characteristic Langerhans histiocytes with nuclear grooving in a background of polymorphous inflammation with eosinophils | Langerhans cells are diagnostic (CD1a and S100 positive), with prominent nuclear grooves and prominence of eosinophils and few osteoclasts |
| Hodgkin lymphoma | Site: Lymph nodes B symptoms usually present | Rare | Normal | Reed-Sternberg cells in a background of lymphocytes, plasma cells, eosinophils, and histiocytes | Prominence of eosinophils, plasma cells with atypical RS cells |
| Angioimmunoblastic T cell lymphoma | Site: Lymph nodes B symptoms usually present | May be present | Normal | Small to medium cells with moderate cytoplasm, condensed chromatin, and often indented nuclei | Medium-sized atypical neoplastic cells, lymphoid tissue fragments with transgressing vessels in a background of reactive lymphoid cells |
| Churg–Strauss syndrome | Site: Lungs and kidney | Present | Elevated | Eosinophilic abscesses, granulomas and Charcot– Leyden crystals | Necrotizing vasculitis and eosinophil-rich granulomatous inflammation |
RS: Reed–Sternberg