Kikuchi disease
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Kikuchi disease, is a rare pathology of the lymph nodes.
| Kikuchi disease | |
|---|---|
| Diagnosis in short | |
 Kikuchi disease. H&E stain. | |
|
| |
| LM | histiocytes, necrosis (paracortical areas) without neutrophils, bland lymphocytes, plasmacytoid dendritic cells |
| LM DDx | systemic lupus erythematosus lymphadenopathy |
| IHC | done to exclude lymphoma |
| Site | lymph node - see lymph node pathology |
|
| |
| Signs | +/-fever |
| Prognosis | usu. good - self-limited |
| Clin. DDx | lymphoma, other causes of lymphadenopathy |
It is also known as histiocytic necrotising lymphadenitis,[1] abbreviated HNL, and Kikuchi-Fujimoto disease.
General
- Rare disease that may mimic cancer, esp. lymphoma.
- May cause fever & systemic symptoms.[2]
- Associated with the subsequent diagnosis of systemic lupus erythematosus.[3]
Epidemiology:[2]
- Usually <40 years old.
- Asian.
- Female:Male = 3:1.[4]
Treatment:
- Usually self-limited.[2]
- Oral corticosteroids.
DDx:
- Non-Hodgkin lymphoma.
- Systemic lupus erythematosus.
- Have hematoxyphil bodies in necrotic foci.
- Dark blue irregular bodies on H&E.
- Have hematoxyphil bodies in necrotic foci.
Micrograph
Features (the three main features - just as the name suggests):[5]
- Histiocytes.
- May be crescentic.
- Necrosis (due to apoptosis) - paracortical areas.[2]
- Necrosis without neutrophils - key feature.
- Lymphocytes (CD8 +ve).
- Plasmacytoid dendritic cells.
Notes:
- Dendritic cell - vaguely resembles a macrophage:[6]
- Long membrane projections - key feature.
- Abundant blue-grey cytoplasm, +/- ground-glass appearance.
- Nucleus: small, ovoid, usu. single nucleolus.
Images
Kikuchi disease - intermed. mag. (WC)
Kikuchi disease - high mag. (WC)
Kikuchi disease - very high mag. (WC)
www:
IHC
- CD68 +ve.
- CD8 +ve - usu. predominant.
- CD4, CD20, CD3, and CD30 - mixed.
- Done to excluded lymphoma; esp. large cell lymphomas;[7] should show a mixed population of lymphocytes.
- Others:
- CD56 -ve.
See also
References
- ↑ Kaushik V, Malik TH, Bishop PW, Jones PH (June 2004). "Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy". Surgeon 2 (3): 179–82. PMID 15570824.
- ↑ 2.0 2.1 2.2 2.3 Hutchinson CB, Wang E (February 2010). "Kikuchi-Fujimoto disease". Arch. Pathol. Lab. Med. 134 (2): 289–93. PMID 20121621.
- ↑ Scully, DF.; Walsh, C.; Eskander, HF.; Kane, D. (Sep 2013). "Kikuchi-Fujimoto disease--an unusual mimicker?". N Z Med J 126 (1383): 85-8. PMID 24157995.
- ↑ URL: http://emedicine.medscape.com/article/210752-overview. Accessed on: 3 June 2010.
- ↑ URL: http://www.ispub.com/journal/the_internet_journal_of_head_and_neck_surgery/volume_1_number_1_30/article_printable/kikuchi_s_lymphadenitis_in_a_young_male.html. Accessed on: 1 June 2010.
- ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214. Accessed on: 3 June 2010.
- ↑ Good DJ, Gascoyne RD (August 2009). "Atypical lymphoid hyperplasia mimicking lymphoma". Hematol. Oncol. Clin. North Am. 23 (4): 729–45. doi:10.1016/j.hoc.2009.04.005. PMID 19577167.