Kimura Disease Involving a Caruncle
A healthy 35-year-old woman presented with a history of a painless, slow-growing nodule in the left eye caruncle over the previous 2 months (). On examination, neither proptosis nor ptosis was noted. The lesion was not fixed to the underlying tissue, was freely mobile, and had a firm consistency. Eversion of the upper and lower eyelids revealed that the lesion was confined to the caruncle without extension to the fornix or palpebral conjunctiva. The visual acuity was 20 / 20 and ocular movement was in the normal range. The ocular examination was otherwise unremarkable. On physical examination, there was no regional lymphadenopathy.\nThe complete blood cell count was within the normal range. The venereal disease research laboratory test, erythrocyte sedimentation rate, serum angiotensin converting enzyme level, and chest radiograph were all normal. The serum IgE level was not elevated. Microalbuminuria was present. She had no prior significant medical history; however, she declined additional work-up.\nOne week following presentation, the patient underwent an excisional biopsy of the left eye to confirm the diagnosis. A 1.3 × 0.5 × 0.3 cm sized nodule was removed and subsequently sent for histopathologic examination. Gross examination of the mass revealed a smooth, firm nodule; infiltration to the underlying tissues was not detected. Microscopic examination with hematoxylin-eosin staining showed follicular lymphoid hyperplasia with germinal center and perifollicular fibrosis (). Higher magnification revealed an eosinophil infiltrate with proliferation of vascular channels, especially the capillaries (). Vascular channels were lined by normal-appearing flat, spindle-shaped endothelial cells (). Immunohistochemical staining for CD20 and CD3 showed T-cells surrounding well-formed lymphoid follicles with germinal centers containing B-cells ().\nOn the basis of these histopathologic findings, we established a diagnosis of Kimura disease. At the last follow-up 6 months after surgery, the patient had no evidence of a recurrence.