頭頸部木村氏症之治療－病例報告

Treatment of Kimura's Disease in Head and Neck-A Case Report

陳毓宏(Yu-Hung Chen) ； 黃穰基(Yong-Kie Wong)

《臺灣口腔顎面外科學會雜誌》 20卷4期 (2009/12) Pp. 272-279

https://doi.org/10.7104/TJOMS.200912.0272

摘要

木村氏症(Kimura's disease)爲一罕見、主要侵犯東方年輕男性之良性腫瘤，好發於頭頸部，以唾液腺爲最好發部位。該病症於1948年首次由Kimura等學者提出並命名，其致病機轉目前仍未釐清，有學者認爲應與免疫反應有關。木村氏症臨床特徵爲局部唾液腺或淋巴結腫大，血液學檢查可見嗜酸性白血球及IgE上升，病理切片特徵爲淋巴濾泡增生合併嗜酸性白血球浸潤。臨床上許多治療方法曾被提出，包括手術切除、免疫抑制劑(cyc1osporine)治療、抗過敏藥物(suplatast tosilate and cetirizine)治療、抗凝血藥物(oxpentifylline)治療、抗腫瘤藥物(all-trans-retinoic acid)治療、合併雷射手術、類固醇及白三烯受體拮抗劑(leucotriene-receptor blocker pranlukas)治療、尼古丁嚼片(nicotine chewable tablets)治療、靜脈注射抗腫瘤藥物(vincristine)治療及放射線治療等。整體的治療成效都很好，但是多處復發是常見的。本文報告一12歲男性病例，因左側耳後區域腫大前來本院就診。門診理學檢查顯示左側耳後區有一柔軟腫瘤，病理診斷爲疑似木村氏症(Kimura's disease)，於2007年6月29日接受手術將左側耳後區域腫瘤摘除，病理診斷確定爲木村氏症，術後使用皮質類固醇及抗過敏藥物（prednisolone及cetirizine）治療。目前病人定期回診中，術後追蹤近兩年，並無復發狀況。本文將針對本病症之臨床表現、診斷及治療做進一步討論。

關鍵字

木村氏症 ； 木村氏症治療 ； 嗜酸性白血球

並列摘要

Kimura's disease (KD) is a rare inflammatory disorder of unknown cause primarily seen in young Asian males. Clinically, it presents as solitary or multiple subcutaneous nodules, predominantly in the head and neck region, typically in the preauricular region, forehead, and scalp. The disease is characterized by a triad of painless subcutaneous masses in the head or neck region, blood and tissue eosinophilia, and markedly elevated serum immunoglobulin E levels.
Many treatment methods have been proposed for KD, including surgical excision, corticosteroids, immunosuppressive agents (cyclosporine), antiallergic drugs (Suplatast Tosilate and cetirizine), oxpentifylline, all-trans-retinoic acid, combined treatment with laser, steroids and leucotriene-receptor blocker pranlukas, nicotine chewable tablets, i.v. vincristine and radiotherapy. Overall, the prognosis is favorable, but multiple relapses are possible. In this article, a 12 years old boy diagnosed as Kimura's disease over left parotid gland region was reported. He received excision and medication with prednisolone and cetirzine. At the time of last follow-up there had been no recurrence and any related systemic diseases for 2 year.

並列關鍵字

Kimura's disease ； treatment of Kimura's disease ； eosinophilia