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Year : 2013  |  Volume : 4  |  Issue : 1  |  Page : 66-67  

SkIndia Quiz 8: Multiple subcutaneous swellings around the ears

Department of Dermatology, Command Hospital, Pune, India

Date of Web Publication3-Jan-2013

Correspondence Address:
Biju Vasudevan
Department of Dermatology, Command Hospital (Southern Command), Wanowrie, Pune
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5178.101816

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How to cite this article:
Vasudevan B, Verma R, Pragasam V, Moorchung N, Mitra D, Neema S. SkIndia Quiz 8: Multiple subcutaneous swellings around the ears. Indian Dermatol Online J 2013;4:66-7

How to cite this URL:
Vasudevan B, Verma R, Pragasam V, Moorchung N, Mitra D, Neema S. SkIndia Quiz 8: Multiple subcutaneous swellings around the ears. Indian Dermatol Online J [serial online] 2013 [cited 2020 Oct 1];4:66-7. Available from: http://www.idoj.in/text.asp?2013/4/1/66/101816

A 48 year old male presented with the complaint of lumps below and behind both the ears since nine years. The lumps were painless, insidious in onset and gradually progressive. There was no associated weight loss or other systemic symptoms. General and systemic examination revealed normal findings. Local examination revealed multiple nodules in the parotid and retroauricular regions bilaterally, which were soft to firm in consistency, non- tender, and were not fixed to the underlying structures or the overlying skin [Figure 1]. Multiple cervical lymph nodes were enlarged. The peripheral blood smear showed eosinophilia of 80% with absolute eosinophil count of 11,000/mm 3 . Serum Immunoglobulin E (IgE) was raised. Magnetic Resonance Imaging revealed bilateral parotid swelling with enlarged level I to V cervical lymph nodes bilaterally. Fine Needle Aspiration Cytology from cervical lymph node showed reactive lymphoid tissue.
Figure 1: Cutaneous lesions (a) Bilateral parotid swelling (b) Multiple nodules in right retro- auricular region

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Biopsy from the right retroauricular nodule revealed multilobulated masses in the deep dermis [Figure 2]a. Within the lobules, there was proliferation of vessels surrounded by dense eosinophilic infiltrate. Lymphoid follicles with germinal centres and fibrinoid material within the germinal centres along with eosinophilic abscesses were present [Figure 2]b and [Figure 3]. Bilateral excision of the nodules was done 4 years back with skin grafting. However, the nodules recurred 6 months after surgery.
Figure 2: Histopathology revealing (a) Multiple lymphoid aggregates in dermis (H and E, 10x) (b) Follicular architecture with eosinophilic abscess (H and E, 10x)

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Figure 3: Extensive eosinophilic infiltrate in the nodule (H and E, 40x)

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   What is the Diagnosis? Top

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   References Top

1.Katagiri K, Itami S, Hatano Y, Yamaguchi T, Takayasu S. In vivo expression of IL-4, IL-5, IL-13 and IFN-c mRNAs in peripheral blood mononuclear cells and the effect of cyclosporin A in a patient with Kimura's disease. Br J Dermatol 1997;137:972-7.  Back to cited text no. 1
2.Teraki Y, Katsuta M, Shiohara T. Lichen amyloidosis associated with Kimura's disease: Successful treatment with cyclosporine. Dermatology 2002;204:133-5.  Back to cited text no. 2
3.Abuel- Haija M, Hurford MT. Kimura disease. Arch Pathol Lab Med 2007;131:650-1.  Back to cited text no. 3
4.Iwai H, Nakae K, Ikeda K, Ogura M, Miyamoto M, Omae M, et al. Kimura disease: Diagnosis and prognostic factors. Otolaryngol Head Neck Surg 2007;137:306-11.  Back to cited text no. 4
5.Wang YS, Tay YK, Tan E, Poh WT. Treatment of Kimura's disease with cyclosporine. Journal of Dermatolog Treat 2005;16:242-4.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure 3]


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