We report a case of a 12-year-old boy with an eosinophilic granuloma of the soft tissue (Kimura's disease) in the right parotid region and the left submandibular region. In the blood examination, the eosinophil (28.8%) and serum IgE (6701 IU/ml) levels were remarkably increased. In the allergic RAST test, he was positive to house dust, mites and Japanese cedar, but was negative to Candida. The tumor in the left submandibular region was extirpated and steroid hormone therapy was performed. After treatment, the size of the tumor in the right parotid region was effectively reduced and the tumor in the left submandibular region has not recurred. Both eosinophils (12-3%) and serum IgE (about 1500 IU/ml) decreased after treatment.
Salivary gland tumors in children are relatively rare. Seven primary cases of major salivary gland tumor under the age of 17 years and a recurrent case we experienced in the last 20 years were reviewed. Of the primary cases, five were pleomorphic adenoma. The only malignancy was mucoepidermoid carcinoma. Another case was lymphangioma. The recurrent case was a 21-yearold man with mucoepidermoid carcinoma of the parotid gland. Because most epithelial salivary gland tumors in children are malignant or pleomorphic adenoma, we consider the following steps to be mandatory: 1) utilizing various diagnostic tools adequately,2) aiming for perfect resection without dependence upon postoperative radiotherapy, and 3) long-term follow-up after treatment.
Sjöogren's syndrome (SS) is thought to be uncommon in children. We have experienced two pediatric cases of SS in the last two years. Case 1 was an 11-year-old boy, and case 2 was an 8-year-old girl. They both had parotid enlargement and arthralgia. Neither was conscious of xerostomia, but case 1 had many caricus teeth and dry lips. The diagnosis of SS was based on histopathological changes in the minor salivary glands. The sialogram of case 2 was compatible with typical SS. In the laboratory studies of these cases, antinuclear antibodies, antiDNA antibodies, rheumatoid factor, anti-SS-A antibodies and hypergammaglobulinemia were observed. Case 2 was positive for anti-SS-B antibodies.
Forty-two cases of recurrent parotitis in children under 12 years of age were observed from 1989to 1997 in our institute. The patients consisted of 24 boys and 18 girls. The age of onset ranged from one to nine years, and was under 2 years in half of the patients and under 4 years in 85%. The average age of decrease in parotid swelling frequency was 6 years. As to their clinical course, the lesion was healed in 16 cases and not healed in 10 cases. The results in the remainder were not obtained. The average period until healing in 16 cases was 3 years and 5 months. Bacteria were found in saliva from 30 of 31 cases. The isolated bacteria were streptococcus viridans and neisseria. Penicillin-insensitive streptococcus pneumoniae (PISP) was isolated in one case. The titers of IgG, IgA and IgM were within the normal range. It seemed that there was little relation between the frequency in a year of parotid swelling and the clinical course. There did not appear to be any relation between the time of the onset of recurrent parotitis and the clinical course.