Abstract
Purpose: To report an unusual presentation of orbital Kimura's disease in an elderly patient. Method: Case report. Result: A 78-year-old male presented with a slowly protruding left eyeball that had developed over 7 months. Extraocular muscle motility was mildly limited. Orbital CT scan revealed an enhanced tumor arising from the lacrimal gland, occupying almost the whole retrobulbar space. Chest X-ray revealed a pulmonary nodule over the right upper lung field. Under the impression of orbital lymphoproliferative disorder or metastatic lung cancer, he received diagnostic biopsy through lateral orbitotomy. Histological examination demonstrated follicular hyperplasia of lymphoid tissue with variable interollicular eosinophil infiltration and proliferation of thin wall vessels. A complete set of immunocytochemical analysis helped to reach a diagnosis of Kimura's disease. Immunostaining of CD3 and CD20 demonstrated structures of lymphoid follicles. Absence of CD10 and bcl-2a reactivity excluded the suspicion of lymphoid malignancy. Treatment with oral prednisolone, starting from 15mg per day, gradually stabilized the proptosis. Conclusion: This is a case of orbital Kimura's disease with the oldest-aged patient reported in Taiwan. Diagnosis was based on histopathological findings with complete immuno-histological analysis.
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