Difference between revisions of "Kikuchi disease"

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#redirect [[Lymph_node_pathology#Kikuchi_disease]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg
| Width      =
| Caption    = Kikuchi disease. [[H&E stain]].
| Micro      = histiocytes, necrosis (paracortical areas) without neutrophils, bland lymphocytes, plasmacytoid dendritic cells
| Subtypes  =
| LMDDx      = [[systemic lupus erythematosus lymphadenopathy]]
| Stains    =
| IHC        = done to exclude lymphoma
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[lymph node]] - see ''[[lymph node pathology]]''
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-fever
| Symptoms  =
| Prevalence =
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = usu. good - self-limited
| Other      =
| ClinDDx    = [[lymphoma]], other causes of lymphadenopathy
}}
'''Kikuchi disease''', is a rare [[lymph node pathology|pathology of the lymph nodes]].


It is also known as '''histiocytic necrotising lymphadenitis''',<ref name="pmid15570824">{{cite journal |author=Kaushik V, Malik TH, Bishop PW, Jones PH |title=Histiocytic necrotising lymphadenitis (Kikuchi's disease): a rare cause of cervical lymphadenopathy |journal=Surgeon |volume=2 |issue=3 |pages=179–82 |year=2004 |month=June |pmid=15570824 |doi= |url=}}</ref> abbreviated '''HNL''', and '''Kikuchi-Fujimoto disease'''.
==General==
*Rare disease that may mimic [[cancer]], esp. [[lymphoma]].
**May cause fever & systemic symptoms.<ref name=pmid20121621>{{cite journal |author=Hutchinson CB, Wang E |title=Kikuchi-Fujimoto disease |journal=Arch. Pathol. Lab. Med. |volume=134 |issue=2 |pages=289–93 |year=2010 |month=February |pmid=20121621 |doi= |url=}}</ref>
*Associated with the subsequent diagnosis of [[systemic lupus erythematosus]].<ref name=pmid24157995>{{Cite journal  | last1 = Scully | first1 = DF. | last2 = Walsh | first2 = C. | last3 = Eskander | first3 = HF. | last4 = Kane | first4 = D. | title = Kikuchi-Fujimoto disease--an unusual mimicker? | journal = N Z Med J | volume = 126 | issue = 1383 | pages = 85-8 | month = Sep | year = 2013 | doi =  | PMID = 24157995 }}</ref>
Epidemiology:<ref name=pmid20121621/>
*Usually <40 years old.
*Asian.
*Female:Male = 3:1.<ref>URL: [http://emedicine.medscape.com/article/210752-overview http://emedicine.medscape.com/article/210752-overview]. Accessed on: 3 June 2010.</ref>
Treatment:
*Usually self-limited.<ref name=pmid20121621/>
*Oral corticosteroids.
DDx:
*[[Non-Hodgkin lymphoma]].
*[[Systemic lupus erythematosus]].
**Have ''hematoxyphil bodies'' in necrotic foci.
***Dark blue irregular bodies on H&E.
==Micrograph==
Features (the three main features - just as the name suggests):<ref>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 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.</ref>
*Histiocytes.
**May be crescentic.
*Necrosis (due to [[apoptosis]]) - paracortical areas.<ref name=pmid20121621/>
**[[Necrosis]] without neutrophils - '''key feature'''.
*Lymphocytes (CD8 +ve).
*Plasmacytoid dendritic cells.
Notes:
*Dendritic cell - vaguely resembles a macrophage:<ref>URL: [http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214 http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214]. Accessed on: 3 June 2010.</ref>
**Long membrane projections - '''key feature'''.
**Abundant blue-grey cytoplasm, +/- ground-glass appearance.
**Nucleus: small, ovoid, usu. single nucleolus.
===Images===
<gallery>
Image:Histiocytic_necrotizing_lymphadenitis_-_intermed_mag.jpg | Kikuchi disease - intermed. mag. (WC)
Image:Histiocytic_necrotizing_lymphadenitis_-_high_mag.jpg | Kikuchi disease - high mag. (WC)
Image:Histiocytic_necrotizing_lymphadenitis_-_very_high_mag.jpg | Kikuchi disease - very high mag. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case200.html Kikuchi disease - several crappy images (upmc.edu)].
==IHC==
*CD68 +ve.
*CD8 +ve - usu. predominant.
*CD4, CD20, CD3, and CD30 - mixed.
**Done to excluded lymphoma; esp. large cell lymphomas;<ref name=pmid19577167>{{cite journal |author=Good DJ, Gascoyne RD |title=Atypical lymphoid hyperplasia mimicking lymphoma |journal=Hematol. Oncol. Clin. North Am. |volume=23 |issue=4 |pages=729–45 |year=2009 |month=August |pmid=19577167 |doi=10.1016/j.hoc.2009.04.005 |url=}}</ref> should show a mixed population of lymphocytes.
*Others:
**CD56 -ve.
==See also==
*[[Lymph node pathology]].
*[[Necrosis]].
==References==
{{Reflist|2}}
[[Category:Lymph node pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 14:31, 11 January 2014

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

Kikuchi disease, is a rare pathology of the lymph nodes.

It is also known as histiocytic necrotising lymphadenitis,[1] abbreviated HNL, and Kikuchi-Fujimoto disease.

General

Epidemiology:[2]

  • Usually <40 years old.
  • Asian.
  • Female:Male = 3:1.[4]

Treatment:

  • Usually self-limited.[2]
  • Oral corticosteroids.

DDx:

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

  1. ↑ 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. ↑ 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.
  3. ↑ 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.
  4. ↑ URL: http://emedicine.medscape.com/article/210752-overview. Accessed on: 3 June 2010.
  5. ↑ 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.
  6. ↑ URL: http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214. Accessed on: 3 June 2010.
  7. ↑ 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.
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