Kikuchi disease

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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

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.