Allergy Asthma Respir Dis.  2018 Mar;6(2):131-134. 10.4168/aard.2018.6.2.131.

Anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease

• Shin Y
• Oh JY
• Lee YS
• Min KH
• Lee SY
• Shim JJ
• Kang KH
• Hur GY

• KMID: 2408811
• DOI: http://doi.org/10.4168/aard.2018.6.2.131

Abstract

Hypereosinophilia, defined as an absolute eosinophil count of >1,500/μL, can be caused by a number of allergic, infectious, paraneoplastic and neoplastic disorders. In cases of hypereosinophilia with lymphoid proliferation, pathological confirmation is essential to exclude either myeloid or lymphoid malignancy. A 38-year-old woman with both cervical lymphadenopathies and peripheral blood eosinophilia visited our clinic. She had already performed core biopsy of lymph nodes and diagnosed as Kimura disease at a regional hospital. At the time of our clinic visit, there were no palpable cervical lymph nodes. The blood test showed hypereosinophilia with a high total IgE level. There was no evidence of tissue infiltration of eosinophils except for duodenitis with eosinophilic infiltration. Based on these findings, she was diagnosed as Kimura disease. She treated with high-dose systemic corticosteroid (1 mg/kg) and additional immunosuppressants sequentially used cyclophosphamide and cyclosporine. However, her eosinophilia waxed and waned, and a left inguinal mass was newly found. Excisional biopsy findings showed large atypical lymphoid cells with numerous eosinophilis, and immunohistochemistry showed CD3+, CD20−, CD30+ and anaplastic lymphoma kinase (ALK). The final diagnosis was ALK-negative anaplastic large cell lymphoma. We report a case of anaplastic large cell lymphoma with marked peripheral eosinophilia misdiagnosed as Kimura disease. In the case of hypereosinophilia with lymphadenopathy, it is necessary to differentiate hematologic diseases through immunochemical staining.

Keyword

Eosinophilia; Anaplastic large cell lymphoma; Kimura disease

MeSH Terms

Adult
Ambulatory Care
Angiolymphoid Hyperplasia with Eosinophilia*
Biopsy
Cyclophosphamide
Cyclosporine
Diagnosis
Duodenitis
Eosinophilia*
Eosinophils
Female
Hematologic Diseases
Hematologic Tests
Humans
Immunoglobulin E
Immunohistochemistry
Immunosuppressive Agents
Lymph Nodes
Lymphatic Diseases
Lymphocytes
Lymphoma
Lymphoma, Large-Cell, Anaplastic*
Phosphotransferases
Cyclophosphamide
Cyclosporine
Immunoglobulin E
Immunosuppressive Agents
Phosphotransferases

Figure

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  Fig. 1. Summary of peripheral eosinophil counts and the regimen of treatment. Clinical course of the patient from the initial visit to final diagnosis. LN, lymph node.

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  Fig. 2. Pathologic findings of left inguinal lymph node. (A) Anaplastic large cell lymphoma showed marked hypercellularity with atypical cells with prominent nucleoli (H&E, ×200). (B) Positive staining of CD3 (×200). (C) Positive staining of CD30 (×200). (D) Negative staining of anaplastic lymphoma kinase (×200).

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  Fig. 3. Initial pathologic findings of left parotid gland lymph node. Suspected atypical lymphocytes were seen occasionally in lymphoproliferation with eosinophilic infiltration (H&E, ×200). Arrows indicate the suspected atypical lymphocytes.

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