木村病43例临床分析
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摘要
目的探讨木村病(KD)的临床特点、诊断及鉴别诊断、治疗方法及预后。方法回顾性分析郑州大学第一附属医院2000年1月至2018年1月收治的经病理确诊的43例木村病患者的临床资料。结果 43例患者均以局部无痛性肿块为主要表现就诊,35例单部位发病(81.40%),8例多部位发病(18.60%)。41例患者外周血嗜酸性粒细胞比例增高(95.35%),其中嗜酸性粒细胞计数增高的有39例(90.70%),12例患者检测了血清IgE,11例显著升高(91.67%)。5例患者行骨髓穿刺检查,均提示嗜酸性粒细胞比例偏高。2例患者伴有肾病综合征。所有患者视病情接受手术、糖皮质激素、局部放疗或联合治疗。27例首次治疗采用手术治疗,复发11例(40.74%),5例首次治疗采用激素药物治疗,复发3例(60.00%),3例首次治疗采用局部放射治疗,复发1例(33.33%),4例首次治疗采用手术+激素药物,复发1例(25.00%),4例首次治疗采用手术+放疗,复发0例。结论木村病是少见病,通常表现为缓慢增大的无痛性皮下肿块,最常见的发病部位为腮腺,其次为颈部、耳周、眼眶、腹股沟、肘关节等。诊断主要依据临床表现、血常规、免疫球蛋白检测、病理检查。手术治疗是首选治疗方法,但易复发,术后联合低剂量放疗可降低复发率。
Objective To investigate the clinical features, diagnosis, differential diagnosis, treatment and prognosis of Kimura's disease.Methods The clinical data of 43 patients with Kimura's disease diagnosed by pathology from January 2000 to January 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results All the 43 patients were treated with local painless masses, 35 cases had single site(81.40%) and 8 cases had multiple sites(18.60%). The proportion of eosinophils in peripheral blood increased in 41 patients(95.35%), among which 39 patients(90.70%) had elevated eosinophil counts, 12 patients had serum IgE, and 11 patients had a significant increase(91.67%). Five patients underwent bone marrow puncture, indicating a high proportion of eosinophils. Two patients were accompanied by nephrotic syndrome. All patients underwent surgery, glucocorticoids, local radiotherapy or combination therapy depending on the condition. Twenty-seven cases were treated with surgery for the first time, 11 cases(40.74%) recurred, 5 cases were treated with hormonal drugs for the first time, 3 cases(60.00%) were relapsed, 3 cases were treated with local radiotherapy for the first time, and 1 case(33.33%) was relapsed, 4 cases were treated with surgery + hormone drugs for the first time, 1 case(25.00%) recurred, 4 cases were treated with surgery + radiotherapy for the first time, and 0 case recurred.Conclusion Kimura's disease is a rare disease, usually manifested as a slow-increased painless subcutaneous mass. The most common site of the disease is the parotid gland, followed by the neck, ear circumference, eyelids, groin, elbow joints, etc. Diagnosis is mainly based on clinical manifestations, blood routine, immunoglobulin detection, and pathological examination. Surgical treatment is the preferred treatment, but easy to relapse, combined with low-dose radiotherapy can reduce the recurrence rate.
Objective To investigate the clinical features, diagnosis, differential diagnosis, treatment and prognosis of Kimura's disease.Methods The clinical data of 43 patients with Kimura's disease diagnosed by pathology from January 2000 to January 2018 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.Results All the 43 patients were treated with local painless masses, 35 cases had single site(81.40%) and 8 cases had multiple sites(18.60%). The proportion of eosinophils in peripheral blood increased in 41 patients(95.35%), among which 39 patients(90.70%) had elevated eosinophil counts, 12 patients had serum IgE, and 11 patients had a significant increase(91.67%). Five patients underwent bone marrow puncture, indicating a high proportion of eosinophils. Two patients were accompanied by nephrotic syndrome. All patients underwent surgery, glucocorticoids, local radiotherapy or combination therapy depending on the condition. Twenty-seven cases were treated with surgery for the first time, 11 cases(40.74%) recurred, 5 cases were treated with hormonal drugs for the first time, 3 cases(60.00%) were relapsed, 3 cases were treated with local radiotherapy for the first time, and 1 case(33.33%) was relapsed, 4 cases were treated with surgery + hormone drugs for the first time, 1 case(25.00%) recurred, 4 cases were treated with surgery + radiotherapy for the first time, and 0 case recurred.Conclusion Kimura's disease is a rare disease, usually manifested as a slow-increased painless subcutaneous mass. The most common site of the disease is the parotid gland, followed by the neck, ear circumference, eyelids, groin, elbow joints, etc. Diagnosis is mainly based on clinical manifestations, blood routine, immunoglobulin detection, and pathological examination. Surgical treatment is the preferred treatment, but easy to relapse, combined with low-dose radiotherapy can reduce the recurrence rate.
引文
[1] GLIBBERY N,MUSCAT K,CASCARINI L.Kimura’s disease of the parotid gland with cutaneous features in a Caucasian female patient [J].J Surg Case Rep,2018,2018(4):rjy067.
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[8] 陈青立,DWA S,BAJRACHARYA K,等.嗜酸性粒细胞增生性淋巴肉芽肿的免疫研究进展[J].国际口腔医学杂志,2016,43(2):181-186.
[9] OBATA Y,FURUSU A,NISHINO T,et al.Membranous nephropathy and Kimura’s disease manifesting a hip mass.A case report with literature review[J].Intern Med,2010,49(14):1405-1409.
[10] 黄伟钦,唐丽娜,沈友洪,等.超声对木村病的诊断价值[J].中华医学杂志,2015,95(37):3054-3056.
[11] 杨光明,罗竹人,郭春英,等.头颈部木村病的CT、MRI影像学表现[J].现代生物医学进展,2018,18(4):667-671.
[12] 李国,王振平,袁利,等.木村病的影像表现及文献复习[J].实用放射学杂志,2017,33(4):510-512.
[13] PUNIA R P,AULAKH R,GARG S,et al.Kimura’s disease:clinicopathological study of eight cases[J].J Laryngol Otol,2013,127(2):170-174.
[14] 何晓,徐艳萍,王言言.木村病诊疗体会及临床分析[J].中国耳鼻咽喉头颈外科,2016,23(7):413-414.
[15] 吕海丽,王振霖,张名霞,等.木村病的临床诊断与治疗[J].中国耳鼻咽喉颅底外科杂志,2015,21(1):43-5.
[16] 刘祖平,付晓霞.木村病临床病理分析[J].现代实用医学,2010,22(4):471-472.
[17] 邓维叶,高云飞,陈艳峰,等.Ki-67在木村病患者中的表达和复发相关因素分析[J].中山大学学报(医学科学版),2014,35(4):584-588.
[18] 杨珂.木村病的临床研究进展[J].辽宁医学院学报,2012,33(2):179-181.
[2] SHERPA M,LAMICHANEY R,ROY A D.Kimura’s disease:A diagnostic challenge experienced with cytology of postauricular swelling with histopathological relevance [J].J Cytol,2016,33(4):232-235.
[3] 孙国臣,刘峰,孙彦,等.37例木村病临床分析[J].临床耳鼻咽喉头颈外科杂志,2018,32(10):782-786.
[4] DOKANIA V,PATIL D,AGARWAL K,et al.Kimura’s disease without peripheral eosinophilia:an unusual and challenging case simulating venous malformation on imaging studies-case report and review of literature [J].J Clin Diagn Res,2017,11(6):ME1-ME4.
[5] 胡袒,伍骥,吴迪,等.Kimura病1例报道并81例文献复习[J].中国骨与关节杂志,2015,(9):681-686.
[6] YAMAMOTO T,MINAMIGUCHI S,WATANABE Y,et al.Kimura’s disease of the epiglottis:a case report and review of literature [J].Head Neck Pathol,2014,8(2):198-203.
[7] 刘立梅,高清平,王则胜,等.木村病45例临床分析[J].内科急危重症杂志,2015,21(2):101-104.
[8] 陈青立,DWA S,BAJRACHARYA K,等.嗜酸性粒细胞增生性淋巴肉芽肿的免疫研究进展[J].国际口腔医学杂志,2016,43(2):181-186.
[9] OBATA Y,FURUSU A,NISHINO T,et al.Membranous nephropathy and Kimura’s disease manifesting a hip mass.A case report with literature review[J].Intern Med,2010,49(14):1405-1409.
[10] 黄伟钦,唐丽娜,沈友洪,等.超声对木村病的诊断价值[J].中华医学杂志,2015,95(37):3054-3056.
[11] 杨光明,罗竹人,郭春英,等.头颈部木村病的CT、MRI影像学表现[J].现代生物医学进展,2018,18(4):667-671.
[12] 李国,王振平,袁利,等.木村病的影像表现及文献复习[J].实用放射学杂志,2017,33(4):510-512.
[13] PUNIA R P,AULAKH R,GARG S,et al.Kimura’s disease:clinicopathological study of eight cases[J].J Laryngol Otol,2013,127(2):170-174.
[14] 何晓,徐艳萍,王言言.木村病诊疗体会及临床分析[J].中国耳鼻咽喉头颈外科,2016,23(7):413-414.
[15] 吕海丽,王振霖,张名霞,等.木村病的临床诊断与治疗[J].中国耳鼻咽喉颅底外科杂志,2015,21(1):43-5.
[16] 刘祖平,付晓霞.木村病临床病理分析[J].现代实用医学,2010,22(4):471-472.
[17] 邓维叶,高云飞,陈艳峰,等.Ki-67在木村病患者中的表达和复发相关因素分析[J].中山大学学报(医学科学版),2014,35(4):584-588.
[18] 杨珂.木村病的临床研究进展[J].辽宁医学院学报,2012,33(2):179-181.