Difference between revisions of "Lymph node pathology"

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==Kikuchi disease==
==Kikuchi disease==
===General===
===General===
*AKA ''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>
*AKA ''histiocytic necrotising lymphadenitis'' (HNL).<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>
*Rare disease that may mimic cancer, esp. lymphoma.
*Rare disease that may mimic cancer, esp. lymphoma.
*Treatment: oral corticosteroids.
**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>
 
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.


===Micrograph===
===Micrograph===
Features:<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>
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>
*Necrosis.
*Histiocytes.
*Histiocytes.  
*Necrosis (due to apoptosis) - paracortical areas.<ref name=pmid20121621/>
*Lymphocytes (CD8 +ve).
*Plasmacytoid dendritic cells.
 
Negatives:
*No PMNs.
 
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 nucleolous.
 
Images:
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?s=20080802171644281 Kikuchi disease (surgicalpathologyatlas.com)].
*[http://www.healthsystem.virginia.edu/internet/hematology/hessedd/benignhematologicdisorders/normal-hematopoietic-cells/dendritic-cell.cfm?drid=214 Dendritic cell (virginia.edu)].


===IHC===
===IHC===
*CD68 +ve.
*CD68 +ve.
*CD20, CD3, and CD30 - mixed.  
*CD8 +ve.
*CD4, CD20, CD3, and CD30 - mixed.  
**Done to excluded lymphoma; should show a mixed population of lymphocytes.
**Done to excluded lymphoma; should show a mixed population of lymphocytes.


Revision as of 17:10, 3 June 2010

This article deals with lymph node pathology. An introduction to the lymph node is in the lymph nodes article.

Kikuchi disease

General

  • AKA histiocytic necrotising lymphadenitis (HNL).[1]
  • Rare disease that may mimic cancer, esp. lymphoma.
    • May cause fever & systemic symptoms.[2]

Epidemiology:[2]

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

Treatment:

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

DDx:

  • Non-Hodgkin lymphoma.
  • Systemic lupus erythematosus.

Micrograph

Features (the three main features - just as the name suggests):[4]

  • Histiocytes.
  • Necrosis (due to apoptosis) - paracortical areas.[2]
  • Lymphocytes (CD8 +ve).
  • Plasmacytoid dendritic cells.

Negatives:

  • No PMNs.

Notes:

  • Dendritic cell - vaguely resembles a macrophage:[5]
    • Long membrane projections - key feature.
    • Abundant blue-grey cytoplasm, +/- ground-glass appearance.
    • Nucleus: small, ovoid, usu. single nucleolous.

Images:

IHC

  • CD68 +ve.
  • CD8 +ve.
  • CD4, CD20, CD3, and CD30 - mixed.
    • Done to excluded lymphoma; should show a mixed population of lymphocytes.

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