A 68-year-old male patient with no relevant medical history presented to the Hematology service in February 2024 with a 6-month history of asthenia, night sweats, and bilateral cervical lymphadenopathy ranging from 2.5 to 3 cm in diameter. He reported having previously consulted the internal medicine service, which then requested evaluation by head and neck surgery, considering an excisional lymph node biopsy performed on October 19, 2023.
The anatomopathological report of the cervical lymph node revealed morphological findings suggestive of a lymphoplasmacytic proliferative process. However, lacking immunohistochemistry studies initially, the paraffin block was sent for review to a high-complexity laboratory. Additionally, a culture was performed to detect Mycobacterium tuberculosis in the biopsied lymph node, which yielded negative results.
The immunohistochemical report from December 28, 2023, indicated morphological findings consistent with atypical paracortical hyperplasia with a Ki67 proliferation index of 60% in the paracortical region and 100% in residual germinal centers, suggesting a reactive process consistent with Kimura disease.
At the time of the hematology consultation, the B symptoms (systemic symptoms) had spontaneously resolved. Physical examination revealed a single cervical lymphadenopathy on the left side measuring less than 1 cm in diameter, mobile and painless, with no evidence of other abnormalities. Hemogram results were: Hb: 13 g/dL, white blood cells 7800/mm3 with preserved formula, platelets 185,000/mm3, lactate dehydrogenase 150 IU/L, normal protein electrophoresis profile with no evidence of abnormalities in liver function and negative serologies for HIV, hepatitis B, C, cytomegalovirus, and Epstein-Barr virus. Positron emission tomography was indicated to rule out metabolic foci suggestive of lymphoproliferative disease.
The follow-up with PET-CT yielded negative results for pathological hypercaptation in lymph nodes. Considering the diagnosis of Kimura disease associated with spontaneous resolution of the patient's symptoms, outpatient follow-up by hematology was advised. Upon the exclusion of various differential diagnoses, including cancer, the patient exhibited a remarkable sense of tranquility and confidence during the assessment of Kimura disease. This reaction underscores the positive impact of clear and precise medical communication, offering the patient a comprehensible understanding of their condition and alleviating potential concerns associated with more severe diagnoses.