Changing clinical manifestations of a T-peripheral lymphoma: from hypereosinophilic syndrome to questionable Kimura's disease resulting in parotid mass.

The diagnosis of low-grade lymphoproliferative disorders during a long clinical course sometimes represents a great clinical challenge. The idiopathic hypereosinophilic syndrome (HES) represents a pre-malignant state in some patients and close follow-up is necessary to detect early signs of malignant transformation. Kimura's disease (KD) mimicking HES is an immune mediated inflammatory disorder that usually involves the head and neck region, primarily affecting the salivary glands, adjacent muscle and regional lymph nodes. Clinically, it is very difficult to differentiate KD from salivary gland lymphoid malignancies. Lymphomas may uncommonly present as a parotid mass. One, herein, would like to present a 35-year-old patient with changing clinical presentation patterns over a period of more than 6 years of follow-up. The first clinical presentation of the patient was HES. The 'diagnosis' of KD was reached after 4 years of management with HES. The final manifestation was parotid gland, preauricular and cutaneous manifestations of a peripheral T-cell lymphoma. This unique clinical presentation pattern of the patient may represent the distinct pathobiological progression of a clonal neoplastic lymphoproliferative disorder.