MR imaging of cheek lesions of Kimura’s disease: Focusing on the signal abnormalities and the relationship with superficial musculoaponeurotic systems

Ryutarou Ukisu, Yuichiro Kawahara, Norihiro Hashizume, Tamio Kushihashi, Yoshinori Yamada, Yoshiyuki Kadokura

Department of Otolaryngology, Showa University Northern Yokohama Hospital, Yokohama, Japan.
Department of Radiology, Showa University Northern Yokohama Hospital, Yokohama, Japan.

DOI: 10.4236/mri.2013.24009                

Abstract

Background and Purpose: Kimura’s Disease (KD) is a rare benign chronic eosinophlic inflammatory disorder, characterized by angiolymphoid proliferation with peripheral eosinophilia and elevated serum immunoglobulin E. Most lesions occur in the head and neck regions. To the best of our knowledge, the relationship between subcutaneous cheek lesion of KD and the surrounding structures including superficial musculoaponeurotic systems (SMAS) has never been reported. The purpose of this study was to describe MR imaging findings of cheek subcutaneous lesion of KD and adjacent SMAS. Materials and Methods: Seven cheek subcutaneous lesions of 5 patients histopathologically proved KD were evaluated. We retrospectively evaluated the MR imaging findings of subcutaneous lesions for signal intensity in each imaging sequence, the border of the lesions, and appearance of SMAS. Results: All cheek lesions were displacing normal fat tissue. These lesions showed ill-defined border (7/7), slightly high signal intensity on T1-weighted images (7/7), and intermediate (1/7) or high signal intensity (6/7) on T2-weighted images. Cheek lesions were enhanced by intravenous injection of gadolinium to signal intensity close to that of fat tissue (3/4), and in one case, the avid enhancement of the mass was seen (1/4). All lesions attached to the outer surface of SMAS, however, only one out of 7 lesions distributed below the SMAS without tearing of the layers. SMAS below the lesion showed high signal intensity on T2-weighted images in two lesions (2/7). Conclusion: KD should be included in the differential diagnosis when a cheek mass presents with non-specific signal intensities and irregular border, which attaches to but does not interrupt SMAS on MR imaging.

Keywords

Kimura’s Disease; SMAS (Superficial Musculoaponeurotic Systems); MRI

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kimura, T., Yoshimura, S. and Ishikawa, E. (1948) Unusual granulomas combined with hyperplastic changes in lymphatic tissues. Trans Soc Pathol Jpn, 37, 179-180.
[2]	Chen, H., Thompson, L.D., Aguilera, N.S. and Abbondanzo, S.L. (2004) Kimura disease: A clinopathologic study of 21 cases. The American Journal of Surgical Pathology, 28, 505-513. http://dx.doi.org/10.1097/00000478-200404000-00010
[3]	Kapoor, N.S., O’Neill, J.P., Katabi, N., Wong, R.J. and Shah, J.P. (2012) Kimura disease: Diagnostic challenges and clinical management. American Journal of Otolaryngology, 33, 259-262. http://dx.doi.org/10.1016/j.amjoto.2011.05.005
[4]	Oguz, K.K., Ozturk, A. and Cila, A. (2004) Magnetic resonance imaging findings in Kimura’s disease. Neuroradiology, 46, 855-858. http://dx.doi.org/10.1007/s00234-004-1248-5
[5]	Prendergast, P.M. (2012) Anatomy of the head and neck. In: Shiffman, M.A. and Giuseppe Di, A., Eds., Cosmetic Surgery, Springer-Verlag, Inc., Berlin Heidelberg, 29-39.
[6]	Park, S.W., Kim, H.J., Sung, K.J., Lee, J.H., Park, I.S., et al. (2012) Kimura disease: CT and MR imaging findings. American Journal of Neuroradiology, 33, 784-788. http://dx.doi.org/10.3174/ajnr.A2854
[7]	Sun, Q.F., Xu, D.Z., Pan, S.H., Ding, J.G., Xue, Z.Q., Miao, C.S., Cao, G.J. and Jin, D.J. (2008) Kimura disease: Review of the literature. Internal Medicine Journal, 38, 668-672. http://dx.doi.org/10.1111/ j.1445-5994.2008.01711.x
[8]	Som, P.M. and Biller, H.F. (1992) Kimura disease involving parotid gland and cervical nodes: CT and MR findings. Journal of Computer Assisted Tomography, 16, 320-322. http://dx.doi.org/10.1097/ 00004728-199203000-00028
[9]	Takahashi, S., Ueda, J., Furukawa, T., et al. (1996) Kimura disease: CT and MR findings. American Journal of Neuroradiology, 17, 382-385.
[10]	Ginsberg, L.E. and McBride, J.A. (1998) Kimura’s disease. American Journal of Roentgenology, 171, 1508. http://dx.doi.org/10.2214/ajr.171.6.9843280
[11]	Hiwatashi, A., Hasuo, K., Shiina, T., Ohga, S., Hishiki, Y., Fujii, K. and Ishitoya, J. (1999) Kimura’s disease with bilateral auricular masses. American Journal of Neuroradiology, 20, 1976-1978.
[12]	Takeishi, M., Makino, Y., Nishioka, H., Miyawaki, T. and Kurihara, K. (2007) Kimura disease: Diagnostic imaging findings and surgical treatment. Journal of Craniofacial Surgery, 18, 1062-1067. http://dx.doi.org/10.1097/scs.0b013e3180f61249
[13]	Choi, J.A., Lee, G.K., Kong, K.Y., et al. (2005) Imaging findings of Kimura’s disease in the soft tissue of the upper extremity. American Journal of Roentgenology, 184, 193-199. http://dx.doi.org/10.2214/ ajr.184.1.01840193
[14]	Ghassemi, A., Prescher, A., Riediger, D. and Axer, H. (2003) Anatomy of the SMAS Revisited. Aesthetic Plastic Surgery, 27, 258-264. http://dx.doi.org/10.1007/s00266-003-3065-3
[15]	Lin, D.T., Coppit, G.L., Burkey, B.B. and Netterville, J.L. (2004) Tumors of the accessory lobe of the parotid gland: A 10-year experience. Laryngoscope, 114, 1652-1655. http://dx.doi.org/10.1097/ 00005537-200409000-00028
[16]	Kheterpal, I., Ku, G., Coleman, I., Yu, G., Ptitsyn, A.A., Floyd, E. and Gimble, J.M. (2011) Subcutaneous adipose tissue stromal vascular fraction cells vs. mature adipocytes based on DIGE, proteome of human. Journal of Proteomic Research, 10, 1519-1527. http://dx.doi.org/10.1021/pr100887r
[17]	Seregard, S. (2001) Angiolymphoid hyperplasia with eosinophilia should not be confused with Kimura’s disease. Acta Ophthalmologica Scandinavia, 79, 91-93. http://dx.doi.org/10.1034/j.1600-0420.2001.079001091.x