And Kimuras Disease

Synonyms for angiolymphoid hyperplasia with eosino-philia are epithelioid haemangioma, benign angioma-tous nodules of face and scalp, atypical pyogenic granuloma, and several other terms. Although this entity was first described by Kimura, "Kimura's disease" is now believed to be a different condition (see below).

Angiolymphoid hyperplasia with eosinophilia may occur anywhere in the skin, especially on the scalp and face, but there is a particular predilection for the external auricle and external auditory meatus. It is a lesion of young and middle-aged of both sexes and all races.

Grossly, there are sessile or plaque-like red or reddish-blue lesions from 2 to 10 mm in diameter, which may coalesce to form large plaques that obstruct the ear canal. On transection the lesion is seen to be present in the dermis and subcutaneous tissue. Microscopically, there is a mixture of two proliferated elements in the dermis: blood vessels and lymphoid tissue. The blood vessels are mainly capillaries lined by plump, often protruding (hobnailed) sometimes multilayered, endothelial cells (Fig. 8.3). Occasionally an artery or vein showing intimal fibrous thickening is part of the vascular component. Solid clusters of cells, which are often vacuolat-ed, show features intermediate between endothelial cells and histiocytes are also observed [6]. The lymphoid tissue may possess germinal centres. Eosinophils (often extremely numerous), mast cells and macrophages may also be prominent.

Kimura's disease is commoner in orientals, mainly affecting young males. It is a chronic inflammatory condition of unknown aetiology. It presents as large, deep and often disfiguring, subcutaneous masses in the pre-auricular, parotid and submandibular regions. Often, there is enlargement of regional lymph nodes. Occasion

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