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<p>Kimura disease is an enigmatic chronic inflammatory disorder with a predilection for the head and neck region, characterized by tissue eosinophilia, vascular proliferation, and elevated serum IgE. While typically manifesting as subcutaneous nodules or lymphadenopathy, primary involvement of the larynx and more specifically the epiglottis is vanishingly rare, with only a handful of cases described globally. We report the case of a 61-year-old male who presented with progressive hoarseness and solid-food dysphagia without constitutional symptoms. Flexible laryngoscopy revealed a smooth, vascular-appearing mass occupying the laryngeal surface of the epiglottis. A provisional diagnosis of a benign neoplasm or inflammatory pseudotumor was made. The lesion was excised via microlaryngoscopy. Histopathological examination demonstrated dense eosinophilic infiltration, florid lymphoid follicle formation with germinal centers, and capillary proliferation with endothelial hyperplasia hallmarks of Kimura disease. Peripheral eosinophilia and a markedly elevated serum IgE level (2,400 IU/mL) supported the diagnosis. Kimura disease should be contemplated in the differential diagnosis of epiglottic lesions, especially when vascular architecture and eosinophilic inflammation predominate. This case underscores the critical role of histopathology in unveiling rare immunoinflammatory mimics of laryngeal neoplasms, thereby averting diagnostic missteps and guiding appropriate therapy.</p>

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Not All That Swells is Malignant: An Epiglottic Lesion That Defied the Laryngoscope and Unveiled Kimura Disease

  • 期刊论文

  • 发表日期：

    2025年10月18日

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  • Sandeep Dabhekar,
  • Rohit Bhondekar,
  • Nittika Garg,
  • K. Khadeeja

摘要

Kimura disease is an enigmatic chronic inflammatory disorder with a predilection for the head and neck region, characterized by tissue eosinophilia, vascular proliferation, and elevated serum IgE. While typically manifesting as subcutaneous nodules or lymphadenopathy, primary involvement of the larynx and more specifically the epiglottis is vanishingly rare, with only a handful of cases described globally. We report the case of a 61-year-old male who presented with progressive hoarseness and solid-food dysphagia without constitutional symptoms. Flexible laryngoscopy revealed a smooth, vascular-appearing mass occupying the laryngeal surface of the epiglottis. A provisional diagnosis of a benign neoplasm or inflammatory pseudotumor was made. The lesion was excised via microlaryngoscopy. Histopathological examination demonstrated dense eosinophilic infiltration, florid lymphoid follicle formation with germinal centers, and capillary proliferation with endothelial hyperplasia hallmarks of Kimura disease. Peripheral eosinophilia and a markedly elevated serum IgE level (2,400 IU/mL) supported the diagnosis. Kimura disease should be contemplated in the differential diagnosis of epiglottic lesions, especially when vascular architecture and eosinophilic inflammation predominate. This case underscores the critical role of histopathology in unveiling rare immunoinflammatory mimics of laryngeal neoplasms, thereby averting diagnostic missteps and guiding appropriate therapy.