Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) and its differential diagnosis: analysis of 19 patients
Authors:
R. Kodet; V. Campr; M. Kalinová; K. Kamarádová; M. Mrhalová; J. Soukup
Authors place of work:
Ústav patologie a molekulární medicíny, 2. LF UK a FN Motol, Praha
Published in the journal:
Čes.-slov. Patol., 48, 2012, No. 4, p. 198-206
Category:
Original Articles
Summary
Histiocytic necrotizing lymphadenitis / Kikuchi-Fujimoto disease (HNL/K-F) is being recognized with an increasing frequency not only in the East Asia but also on the American continents and in the Europe. Still the diagnostics of HNL/K-F is not easy and difficulties with its proper classification persist. In a group of 19 patients diagnosed primarily or as consults at our department there were 12 woman and 7 men. An average age at diagnosis was 28 years, median 25 years. Cervical lymph nodes were involved in 18 patients. Bilateral lymphadenopathy was present in one patient, the remaining 17 were unilateral. Inguinal lymph node was affected in one patient. In one other patient there were enlarged retroperitoneal lymph nodes simultaneously with a cervical lymphadenopathy. The size of the lymph nodes varied between 5 mm to 32 mm. The subclassification showed the necrotizing type in 14 patients, in one there was a predominant xanthomatous tissue reaction around the necrotic areas (xanthomatous type), and in 4 patients the disease was recognized as the proliferative type without necrosis (in two with a variously intense apoptosis of the proliferating lymphocytes).
Of 10 consult cases the tumor was primarily evaluated as B cell lymphoma not otherwise specified (1x), peripheral T cell lymphoma (1x), classical Hodgkin lymphoma of mixed cellularity (1x); two patients were submitted with a differential diagnosis between peripheral T cell lymphoma and HNL/K-F; in one diagnosis of probable EBV lymphadenitis and in one diagnosis HNL/K-F was made. There were no data submitted in the remaining three cases. The authors stress diagnostic features which should lead to the diagnosis of the disease and should prevent unnecessary oncological staging investigations and potential chemotherapy for a lymphoma. Among diagnostic features of HNL/K-F identification of the proliferating cells – CD8 activated lymphocytes with apoptotic decay prevail, there are frequent plasmacytoid monocytes and a striking reaction of macrophages which are CD68/myeloperoxidase positive. There are virtually no neutrophil granulocytes and there is a miminal participation of plasma cells. In case of necrotizing and xanthomatous type infectious causes are to be ruled out as well. In case we still need to distinguish HNL/K-F from a lymphoma PCR analysis of a rearrangement of the immunoreceptor gene in T cell population should be investigated.
Keywords:
Kikuchi-Fujimoto disease – histiocytic necrotizing lymphadenopathy – immunohistochemistry – PCR
Zdroje
1. Stejskal J. Measles lymphadenopathy. Ultrastruct Pathol 1980; 1(2): 243–247.
2. Kodetová D, Kodet R, Syrůček M, Trněný M. Sinusová histiocytóza s masivní lymfadenopatií – diseminovaná forma syndromu Rosai-Dorfman. Cesk Patol 1996; 32(2): 53–59.
3. Kikuchi M, Yoshizumi T, Nakamura H. Necrotizing lymphadenitis: possible acute toxoplasmic infection. Virchows Arch A Pathol Anat Histol 1977; 376(3): 247–253.
4. Pileri S, Kikuchi M, Helbron D, Lennert K. Histiocytic necrotizing lymphadenitis without granulocytic infiltration. Virchows Arch A Pathol Anat Histol 1982; 395(3): 257–271.
5. Ali MH, Horton LW. Necrotising lymphadenitis without granulocytic infiltration (Kikuchi’s disease). J Clin Pathol 1985; 38(11): 1252–1257.
6. Turner RR, Martin J, Dorfman RF. Necrotizing lymphadenitis. A study of 30 cases. Am J Surg Pathol 1983; 7(2): 115–123.
7. Dorfman RF, Berry GJ. Kikuchi’s histiocytic necrotizing lymphadenitis: an analysis of 108 cases with emphasis on differential diagnosis. Sem Diagn Pathol 1988; 5(4): 329–345.
8. Jun-Fen F, Chun-Lin W, Li L, et al. Kikuchi-Fujimoto disease manifesting as recurrent thrombocytopenia and Mobitz type II atrioventricular block in a 7-year-old girl: a case report and analysis of 138 Chinese childhood Kikuchi-Fujimoto cases with 10 years of follow-up in 97 patients. Acta Paediatr 2007; 96(12): 1844–1847.
9. Kuo T-T. Kikuchi’s disease (histiocytic necrotizing lymphadenitis): A clinicopathologic study of 79 cases with an anlysis of histologic subtypes, immunohistology, and DNA ploidy. Am J Surg Pathol 1995; 19: 798–809.
10. Chamulak GA, Brynes RK, Nathwani BN. Kikuchi-Fujimoto disease mimicking lymphoma. Am J Surg Pathol 1990; 14: 514–523.
11. Menasce LP, Banerjee SS, Edmondson D, Harris M. Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease): Continuing diagnostic difficulties. Histopathol 1998; 33: 248–254.
12. van Dongen JJ, Langerak AW, Bruggemann M, et al. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia 2003; 17(12): 2257–2317.
13. Olejárová M, Campr V, Pavelka K. Kikuchiho-Fujimotova nemoc (histiocytární nekrotizující lymfadenitida). Kazuistika a literární review. Vnitr Lek 2004; 50(10): 786–792.
14. Zhang WP, Wang JH, Wang WQ, et al. An association between parvovirus B19 and Kikuchi-Fujimoto disease. Viral Immunol 2007; 20(3): 421–428.
15. Hu S, Kuo TT, Hong HS. Lupus lymphadenitis simulating Kikuchi’s lymphadenitis in patients with systemic lupus erythematosus: a clinicopathological analysis of six cases and review of the literature. Pathol Int 2003; 53(4): 221–226.
16. Kim SK, Kang MS, Yoon BY, et al. Histiocytic necrotizing lymphadenitis in the context of systemic lupus erythematosus (SLE): Is histiocytic necrotizing lymphadenitis in SLE associated with skin lesions? Lupus 2011; 20(8): 809–819.
17. Wilkinson CE, Nichol F. Kikuchi-Fujimoto disease associated with polymyositis. Rheumatology (Oxford) 2000; 39(11): 1302–1304.
18. Ramanan AV, Wynn RF, Kelsey A, Baildam EM. Systemic juvenile idiopathic arthritis, Kikuchi’s disease and haemophagocytic lymphohistiocytosis—is there a link? Case report and literature review. Rheumatology (Oxford) 2003; 42(4): 596–598.
19. Shusang V, Marelli L, Beynon H, et al. Autoimmune hepatitis associated with Kikuchi-Fujimoto’s disease. Eur J Gastroenterol Hepatol 2008; 20(1): 79–82.
20. Tanaka T, Ohmori M, Yasunaga S, et al. DNA typing of HLA class II genes (HLA-DR, -DQ and -DP) in Japanese patients with histiocytic necrotizing lymphadenitis (Kikuchi’s disease). Tissue Antigens 1999; 54(3): 246–253.
21. Lin HC, Su CY, Huang CC, Hwang CF, Chien CY. Kikuchi’s disease: a review and analysis of 61 cases. Otolaryngol Head Neck Surg 2003; 128(5): 650–653.
22. Weisenburger DD, Savage KJ, Harris NL, et al. Peripheral T-cell lymphoma, not otherwise specified: a report of 340 cases from the International Peripheral T-cell Lymphoma Project. Blood 2011; 117(12): 3402–3408.
23. Tsang WYW, Chan JKC, Ng CS. Kikuchi’s lymphadenitis: A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol 1994; 18: 219–231.
24. Pileri SA, Facchetti F, Ascani S, et al. Myeloperoxidase expression by histiocytes in Kikuchi’s and Kikuchi-like lymphadenopathy. Am J Pathol 2001; 159(3): 915–924.
25. Nomura Y, Takeuchi M, Yoshida S, et al. Phenotype for activated tissue macrophages in histiocytic necrotizing lymphadenitis. Pathol Int 2009; 59(9): 631–635.
26. Facchetti F, de Wolf-Peeters C, Mason DY, et al. Plasmacytoid T cells. Immunohistochemical evidence for their monocyte/macrophage origin. Am J Pathol 1988; 133(1): 15–21.
27. Jegalian AG, Facchetti F, Jaffe ES. Plasmacytoid dendritic cells: physiologic roles and pathologic states. Adv Anat Pathol 2009; 16(6): 392–404.
28. Kishimoto K, Tate G, Kitamura T, Kojima M, Mitsuya T. Cytologic features and frequency of plasmacytoid dendritic cells in the lymph nodes of patients with histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease). Diagn Cytopathol 2010; 38(7): 521–526.
29. Herling M, Jones D. CD4+/CD56+ hematodermic tumor: the features of an evolving entity and its relationship to dendritic cells. Am J Clin Pathol 2007; 127(5): 687–700.
30. Cota C, Vale E, Viana I, et al. Cutaneous manifestations of blastic plasmacytoid dendritic cell neoplasm-morphologic and phenotypic variability in a series of 33 patients. Am J Surg Pathol 2010; 34(1): 75–87.
31. Quintas-Cardama A, Fraga M, Cozzi SN, et al. Fatal Kikuchi-Fujimoto disease: the lupus connection. Ann Hematol 2003; 82(3): 186–188.
Štítky
Anatomical pathology Forensic medical examiner ToxicologyČlánok vyšiel v časopise
Czecho-Slovak Pathology
2012 Číslo 4
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