Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma
Aim: Kikuchi — Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma. Patient: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma. Results: On immunohistopathologic examination diag...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
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| Zitieren: | Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma / Y. Urun, G. Utkan, D. Kankaya, M. Dogan, B. Yalcin, F. Icli // Experimental Oncology. — 2011. — Т. 33, № 4. — С. 242-244. — Бібліогр.: 4 назв. — англ. |
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Urun, Y. Utkan, G. Kankaya, D. Dogan, M. Yalcin, B. Icli, F. 2018-06-19T11:21:50Z 2018-06-19T11:21:50Z 2011 Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma / Y. Urun, G. Utkan, D. Kankaya, M. Dogan, B. Yalcin, F. Icli // Experimental Oncology. — 2011. — Т. 33, № 4. — С. 242-244. — Бібліогр.: 4 назв. — англ. 1812-9269 https://nasplib.isofts.kiev.ua/handle/123456789/138669 Aim: Kikuchi — Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma. Patient: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma. Results: On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment. Conclusion: Patient’s lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical lymphadenopathy KFD should be considered in the differential diagnosis. en Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України Experimental Oncology Short communications Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma Article published earlier |
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| title |
Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
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Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma Urun, Y. Utkan, G. Kankaya, D. Dogan, M. Yalcin, B. Icli, F. Short communications |
| title_short |
Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
| title_full |
Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
| title_fullStr |
Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
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Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
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kikuchi — fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma |
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Urun, Y. Utkan, G. Kankaya, D. Dogan, M. Yalcin, B. Icli, F. |
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Urun, Y. Utkan, G. Kankaya, D. Dogan, M. Yalcin, B. Icli, F. |
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Short communications |
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Short communications |
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2011 |
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English |
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Experimental Oncology |
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Article |
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Aim: Kikuchi — Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lymphoma. Patient: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma. Results: On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment. Conclusion: Patient’s lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical lymphadenopathy KFD should be considered in the differential diagnosis.
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1812-9269 |
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https://nasplib.isofts.kiev.ua/handle/123456789/138669 |
| citation_txt |
Kikuchi — Fujimoto disease: cervical lymphadenopathy suggestive of relapsing lymphoma in patient with lymphoblastic lymphoma / Y. Urun, G. Utkan, D. Kankaya, M. Dogan, B. Yalcin, F. Icli // Experimental Oncology. — 2011. — Т. 33, № 4. — С. 242-244. — Бібліогр.: 4 назв. — англ. |
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| fulltext |
242 Experimental Oncology 33, 242–244, 2011 (December)
KIKUCHI — FUJIMOTO DISEASE: CERVICAL LYMPHADENOPATHY
SUGGESTIVE OF RELAPSING LYMPHOMA IN PATIENT
WITH LYMPHOBLASTIC LYMPHOMA
Y. Urun1,*, G. Utkan1, D. Kankaya2 , M. Dogan1, B. Yalcin2, F. İcli1
1Department of Medical Oncology, Ankara University Faculty of Medicine,Cebeci Hospital, Ankara,
Turkey
2Department of Medical Oncology,Yildirim Beyazit University Faculty of Medicine, Ankara Atatürk
Research and Training Hospital, Ankara,Turkey
Aim: Kikuchi — Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare disorder and often confused with lym-
phoma. Patient: There is presented a case of 28-year-old patient with cervical lymphadenopathy, who had history of lymphoma.
Results: On immunohistopathologic examination diagnosis of KFD was made and patient followed without any treatment. Conclusion:
Patient’s lymphadenopathy had almost resolved and he was completely asymptomatic after three months. In patient with cervical
lymphadenopathy KFD should be considered in the differential diagnosis.
Key Words: lymphoma, cervical lymphadenopathy, Kikuchi — Fujimoto disease.
KFD or histiocytic necrotizing lymphadenitis
is a rare disorder. Although it is primarily affecting
young adults of Asian descent, KFD is being increas-
ingly reported in other areas [1–3]. It is generally
a self-limiting benign condition and is characterized
by patients presenting with cervical lymphadenopathy,
fevers and malaise. The clinical features can also
be consistent with malign lymphomatous disorders
[4]. The clinician being referred patients with cervical
lumps should be aware of this condition as part of their
clinical assessment. Histological examination is the
only means of definitive diagnosis, so the provision
of clear clinical information and adequate biopsy ma-
terial to the pathologist is critical.
Case report. A 28-year-old man recently present-
ed with a 1-month history of palpable lump in the left
posterior cervical region at October 2009. The lumps
were increasing in size and were tender. He denied any
fever, weight loss or night sweats. He has been follow-
ing with diagnosis of lymphoblastic lymphoma which
was in complete remission since April 1999.
On examination there were no abnormalities in the
ears, oral cavity, oropharynx or larynx. In the left poste-
rior cervical region lymph nodes could be palpated and
the largest lymph node measured 2 cm in dia meter. The
rest of examination was normal. In laboratory examina-
tion of complete blood count and bioche mistrical pa-
rameter there weren’t any abnormality except slightly
elevated lactate dehydrogenase. The erythrocyte
sedimentation rate was 54 mm/h and C-reactive pro-
tein 15 mg/L. Neck ultrasonography (USG) revealed
multiple nodal enlargements in left postrerior cervical
region (the biggest one to be 20×11 mm). Neck, thorax,
and abdominopelvic computerize tomographiic (CT)
scan were done. Neck CT revealed multiple nodal en-
largements in left posterior cervical region (the biggest
one to be 20×10 mm). Thorax and abdominopelvic
CT were normal.
A provisional diagnosis of relapsing lymphoma
was suspected. Ultrasonographically guided needle
biopsy was done.
On histopathologic examination, the lymph node
architecture was effaced by paracortical expansion
composed of necrotic areas with extensive apoptotic
bodies, abundant karyorrhectic debris and numer-
ous histiocytes (Fig. 1). Neutrophils and eosinophils
were absent. Immunohistochemical examination
Received: August 24, 2011.
*Correspondence: Fax: +903123192283
E-mail: yukselurun@gmail.com
Abbreviation: KFD — Kikuchi-Fujimoto disease.
Exp Oncol 2011
33, 4, 242–244
a
b
Fig. 1. Expansion of paracortical areas with necrosis (HE×4)
(a). Necrotic areas with extensive apoptotic bodies, abundant
karyorrhectic debris and numerous histiocytes (HE×40) (b)
Experimental Oncology 33, 242–244, 2011 (December)33, 242–244, 2011 (December) (December) 243
revealed that histiocytic cells in the necrotic areas
stained positively for antibodies against CD68 (Fig. 2,
a) and myeloperoxidase (MPO) (Fig. 2, b). The lym-
phocytes in the involved zones were predominantly
T cells (CD3+), whereas B cells (CD20+) were very
few (Fig. 2, c, d). The majority of T cells were CD8+
cytotoxic cells and CD4+ T helper cells were scattered
in the periphe ral zones of necrotic areas (Fig. 2, e, f).
Finally KFD (histiocytic necrotizing lymphadenitis) was
diagnosed by the combination of histopathological and
immunohistochemical findings.
After the diagnosis of KFD was made patient fol-
lowed without any treatment. On review at 1 month,
the patient’s lymphadenopathy had almost resolved
and at 3 months he was completely asymptomatic.
All physical and laboratory examination were in nor-
mal limit.
Kikuchi’s disease was first described indepen-
dently in 1972 by Kikuchi and Fujimoto et al. The cause
remains unclear although infections particularly with
Epstein — Barr virus, paramyxovirus and Toxoplasma
have been suggested as possible triggers. The dif-
ferential diagnosis includes malignant lymphoma,
systemic lupus erythematosus, metastatic carcinoma,
AIDS and infectious mononucleosis [4].
The most common site of cervical lymphadenopa-
thy is the posterior triangle and both sides of the neck
can be involved. The involved lymph nodes are usually
tender. Malaise, fever and leucopenia are common
presenting symptoms. Less common symptoms in-
clude nausea, vomiting and diarrhea [1, 4].
An excisional lymph node biopsy and histological
examination is the optimal method of ensuring an ac-
curate diagnosis, as there are no specific laboratory
tests available for KFD. This does, however, come
with the proviso that there is close clinical liaison with
the pathologist. Histological features that exclude
malignancy include the absence of abnormal mitosis
and the preservation of the sinusoidal pattern on in-
tervening areas.
a
c
b
d
e f
Fig. 2. CD68 and MPO positivity of histiocytic cells, respectively (a, b) (×20). CD3+ T cells predominated in the necrotic zones,
in despite of very few CD20+ B cells (c, d) (×10, ×4). CD8 positivity of the majority of T cells and very few number of CD4+ T helper
cells, scattered in the peripheral zones of necrotic areas (e, f) (×4)
244 Experimental Oncology 33, 242–244, 2011 (December)
Most patients have spontaneous resolution
of their symptoms within 6 months and treatment tends
to be symptomatic. All patients require medical follow
up as a small percentage can go to develop systemic
lupus erythematosus, which can coincide or precede the
Kikuchi’s manifestations. As KFD is a generally benign self-
limiting condition, it is important to establish the correct
diagnosis quickly by biopsy and histopathology and it de-
serves more recognition among those specialists who are
regularly referred patients with cervical lymphadenopathy.
REFERENCES
1. Hutchinson CB, Wang E. Kikuchi — Fujimoto disease.
Arch Pathol Lab Med 2010; 134: 289–93.
2. Koybasi S, Saydam L, Gungen Y. Histiocytic necrotizing
lymphadenitis of the neck. Am J Otolaryngol 2003; 24: 344–7.
3. Primrose WJ, Napier SS, Primrose AJ. Kikuchi —
Fugimoto disease (cervical subacute necrotising lymphad-
enitis): an important benign disease often masquerading
as lymphoma. Ulster Med J 2009; 78: 134–6.
4. Chan JK, Kwong YL. Common misdiagnoses in lympho-
mas and avoidance strategies. Lancet Oncol 2010; 11: 579–88.
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