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CASE REPORT
Year : 2004  |  Volume : 20  |  Issue : 2  |  Page : 179-180
 

Extrinsic ureteral obstruction due to retroperitoneal Kimura's disease


1 Department of Urology, Medical College, Trivandrum, India
2 Department of Pathology, Medical College, Trivandrum, India

Correspondence Address:
A S Albert
Department of Urology, Medical College, Trivandrum - 695 011
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Kimura disease, ureteral obstruction.


How to cite this article:
Vinod K V, Albert A S, Sankar S. Extrinsic ureteral obstruction due to retroperitoneal Kimura's disease. Indian J Urol 2004;20:179-80

How to cite this URL:
Vinod K V, Albert A S, Sankar S. Extrinsic ureteral obstruction due to retroperitoneal Kimura's disease. Indian J Urol [serial online] 2004 [cited 2019 Aug 18];20:179-80. Available from: http://www.indianjurol.com/text.asp?2004/20/2/179/20757



   Case Report Top


A 16-year-old boy presented with left sided colicky abdominal pain of 2 weeks duration. Ultrasonographic evaluation detected left hydronephrosis with dilated up­per ureter. There was a retroperitoneal mass lesion. CT scan showed a 32 x 26 mm retroperitoneal tumour com­pressing the ureter just below the pelviureteric junction producing hydroureteronephrosis [Figure - 1]. On exploration, the tumour was a well-encapsulated lesion in the retroperi­toneum engulfing the upper ureter all around. There was minimal fibrosis around the lesion. Excision of the mass was done with resection of the involved portion of the ureter. End to end ureteric anastamosis was done. His­topathology showed the tumour to be Kimura's disease with secondary retroperitoneal fibrosis [Figure - 2]. Follow up after 6 months showed complete resolution of hydrone­phrosis. No recurrence was made out.


   Comments Top


Kimura's disease is a chronic inflammatory disorder presenting usually as painless deep subcutaneous swell­ings in the head and neck region or in the salivary glands. It is found commonly in the Asian region with a male pre­dilection. Its incidence is reported in rare locations like kidney and spermatic cord. Its incidence is not yet reported in the retroperitoneum. Kimura's disease represents an aberrant immune reaction to an unknown stimulus. Pe­ripheral blood eosinophilia and raised serum IgE levels are signature features. For initial diagnosis, excision bi­opsy is important. Fine needle aspiration cytology may be valuable in the diagnosis of recurrent lesions. [1] The main pathologic changes in the lymph nodes include florid ger­minal centers, vascularization of the germinal centers, in­crease post capillary venules in the paracortex and fibrosis. There is eosinophilic microabscess formation and eosi­nophilic folliculolysis. IgE deposits are demonstrated in the germinal centers. Kimura's disease closely resembles angiolymphoid hyperplasia with eosinophilia which is a distinct entity. The lesions are benign and there is no report of malignant transformation. Recurrence is com­mon.

Corticosteroids and cyclosporine have been used with good results in some cases. Radiotherapy is effective with an optimum dosage of 26-30 Gy. [3] Complete surgical ex­cision whenever feasible is the preferred treatment despite a high recurrence rate.

 
   References Top

1.Deshpande AH, Nayak S, Munshi MM, Bobhate SK. Kimura's dis­ease: Diagnosis by aspiration cytology. Acta Cytol 2002; 46 (2): 357-63.  Back to cited text no. 1    
2.Kuo TT, Shih LY, Chan HI. Kimura's disease. Involvement of re­gional lymph nodes and distinction from angiolymphoid hyperpla­sia with eosinophilia. Am J Surg Pathol 1989; 13: 901-2.  Back to cited text no. 2    
3.Hareyama M, Oouchi A, Nagakura H, Asakura K, Saito A, Satoh M et al. Radiotherapy for Kimura's disease: the optimum dosage. Int J Radiat Oncol Biol Phys 1998; 40: 647-51.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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