|Year : 2004 | Volume
| Issue : 2 | Page : 179-180
Extrinsic ureteral obstruction due to retroperitoneal Kimura's disease
KV Vinod1, AS Albert1, S Sankar2
1 Department of Urology, Medical College, Trivandrum, India
2 Department of Pathology, Medical College, Trivandrum, India
A S Albert
Department of Urology, Medical College, Trivandrum - 695 011
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
| Case Report|| |
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|| |
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.  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.  Complete surgical excision whenever feasible is the preferred treatment despite a high recurrence rate.
| References|| |
|1.||Deshpande AH, Nayak S, Munshi MM, Bobhate SK. Kimura's disease: Diagnosis by aspiration cytology. Acta Cytol 2002; 46 (2): 357-63. |
|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. |
|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. |
[Figure - 1], [Figure - 2]