Journal of Pathology and Translational Medicine

Original Article

Fine Needle Aspiration Cytology of Kikuchi's Lymphadenitis: with Emphasis on Differential Diagnosis with Tuberculosis.: Kang Min Han, Jai Hyang Go, Na Hye Myong, Wonae Lee; Korean J Pathol. 2011;45(6):626-631.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.626

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BACKGROUND
Although Kikuchi's lymphadenitis (KL) has been known to have characteristic cytological features, pathologists encounter difficulties in making a diagnosis with fine needle aspiration cytology (FNAC). The objective of this study was to assess the diagnostic pitfalls of KL with FNAC, particularly with emphasis on differential diagnosis with tuberculosis.
METHODS
FNAC of 10 patients with a histological diagnosis of KL and tuberculosis was reviewed.
RESULTS
Acidophilic cells were observed in all the 10 KL cases, even if the smears were insufficient. Crescentic histiocytes were seen in 8, granular background in 7, and karyorrhectic debris in 3 cases. Epithelioid histiocytes or neutrophils were not seen in any of the KL cases. Of the 10 cases of tuberculosis, acidophilic cells were observed in 6 cases, crescentic histiocytes in none of them, cheese-like background in 9, karyorrhectic debris in 8, epithelioid histiocytes in 4, and neutrophils in 8 cases.
CONCLUSIONS
The acidophilic cell could be the most sensitive but not the specific marker of KL with FNAC. The crescentic histiocytes might be the sensitive and considerably specific marker of KL. The cytological features distinguishing tuberculosis from KL may be cheese-like necrosis admixed with neutrophils and epithelioid histiocytes.

Citations

Citations to this article as recorded by

Kikuchi–Fujimoto disease in the Eastern Mediterranean zone
Abdel Rahman Al Manasra, Hamzeh Al-Domaidat, Mohd Asim Aideh, Doaa Al Qaoud, Majd Al Shalakhti, Sohaib Al khatib, Jehad Fataftah, Raed Al-Taher, Mohammad Nofal
Scientific Reports.2022;[Epub] CrossRef
The fine-needle aspiration cytology and clinical findings of Kikuchi–Fujimoto disease in pediatric patients: a retrospective clinical study
Yuto Naoi, Tomoyasu Tachibana, Yoji Wani, Machiko Hotta, Katsuya Haruna, Yasutoshi Komatsubara, Kazunori Kuroda, Soichiro Fushimi, Tami Nagatani, Yuko Kataoka, Kazunori Nishizaki, Yasuharu Sato, Mizuo Ando
Acta Oto-Laryngologica.2022; 142(3-4): 340. CrossRef
Identification of Torque Teno Virus/Torque Teno-Like Minivirus in the Cervical Lymph Nodes of Kikuchi-Fujimoto Lymphadenitis Patients (Histiocytic Necrotizing Lymphadenitis): A Possible Key to Idiopathic Disease
Yosep Chong, Ji Young Lee, Chang Suk Kang, Eun Jung Lee
Biomedicine Hub.2020; 5(1): 1. CrossRef
Morphology quiz: Enigma of a cervical lymph node
Sudha Sharma
Cytopathology.2019; 30(6): 676. CrossRef
Kikuchis lymphadenitis: Is biopsy necessary in managing these patients
Hemalatha Anantharamaiah, Sagayaraj Arokiyaswamy, ChinaiahS. B. R. Prasad
International Journal of Medicine and Public Health.2015; 5(1): 115. CrossRef
Causative agents of Kikuchi–Fujimoto disease (histiocytic necrotizing lymphadenitis): A meta-analysis
Yosep Chong, Chang Suk Kang
International Journal of Pediatric Otorhinolaryngology.2014; 78(11): 1890. CrossRef

Case Reports

Mesenteric Lymphadenitis Due to Yersinia enterocolitica: A case report.: Hyang Mi Shin, Hwa Sook Jeong, Hyun Dug Wang, Young Don Lee, Ro Hyun Sung; Korean J Pathol. 2000;34(12):1022-1024.

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Abstract PDF: Mesenteric lymphadenitis due to Yersinia enterocolitica infection is not common in Korea. Although most cases of Yersinia enterocolitica-induced mesenteric adenitis are self limited, cardinal features of Yersinia enterocolitica-induced mesenteric adenitis are so similar to those of acute appendicitis that some of the patients undergo laparotomy with suspected appendicitis. The findings on laparotomy in such patients are usually enlarged mesenteric nodes with a normal or slightly inflamed appendix. Because histologic examination of the removed mesenteric lymph nodes reveals reactive hyperplasia in most cases, it is usually difficult to suspect Yersinia enterocolitica infection on morphology of the resected nodes. But suppurative granulomata of mesenteric lymph nodes, uncommonly encountered in Yersinia enterocolitica infection, strongly suggest yersinial infection. We report a case of mesenteric lymphadenitis in a 10-year-old boy, who underwent laparotomy with suspected acute appendicitis. The removed lymph node showed several suppurative granulomata in the cortex, suggesting yersinial infection. Serologic study confirmed Yersinia enterocolitica serotype O:3 infection.

Fine Needle Aspiration Cytology of Subacute Necrotizing Lymphadenitis: Three Cases Report.: Soo Yeon Cho, Min Sun Cho, Sung Sook Kim, Hye Soo Koo, Woon Sub Han, Sung Min Chung; Korean J Cytopathol. 1994;5(1):23-27.

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Abstract PDF: Three cases of subacute necrotizing lymphadenitis diagnosed by fine needle aspiration(FNA) of enlarged lymph nodes are reported. The FNA smears contained randomly activated lymphoid cells, necrotic debris and histiocytes. The same patterns were found in subsequently examined excised lymph nodes from these cases. The differential diagnosis of this entity is discussed and the value of preparing FNA cell blocks and accompanying AFB stain with culture is emphasized.

Fine Needle Aspiration Cytologic Findings of Kikuchi's Lymphadenitis: Analysis of 30 cases.: Hyun Ju Yoo, Hye Je Cho, Ill Hyang Ko; Korean J Cytopathol. 1994;5(2):113-119.

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Abstract PDF: Thirty cases of kikuchi's lymphadenitis, diagnosed by fine needle aspiration cytology, were reviewed to determine the main cytologic features helpful in reaching a diagnosis. The patients(mean age 26.6 years. male: female=1:3.8) presented with lymphadenopathy(cervical 24, submandibular 3, and axillary 1) with or without fever and local tenderness. Excisional biopsy was done for confirmation in 5 cases and the remaining 25 cases showed the similar cytologic and clinical features. In the aspiration smears of all cases. there was a heterogenous cellular mixture including frequent extracellular karyorrhectic nuclear debris, phagocytic histiocytes, plasmacy toid monocytes, and a variable number of polymorphous lymphocytes such as immunoblasts. activated large lymphocytes, and small mature lymphocytes, The characteristic cytologic features of kikuchi's lymphadenitis were the following: (1) frequent extracelluar karyorrhectic nuclear debris in the background: (2) phagocytic histiocytes with eccentrically placed crescentic nuclei and abundant pale cytoplasm containing phagocytized karyorrhectic debris: (3) plasmacytoid monocytes, which were medium-sized cells with eccentrically placed round nuclei and amphophilic cytoplasm: (4) no neutrophilic background.

Fine Needle Aspiration Cytology of Kimura's Lymphadenitis with Characteristic Warthin-Finkeldey Type Polykaryocytes: A Case Report.: Yeon Mee Kim, Hye Je Cho; Korean J Cytopathol. 1995;6(1):48-53.

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Abstract PDF: Kimura's disease is a chronic inflammatory disorder of unknown etiology, presenting usually as a painless subcutaneous swelling in the head and neck region or in the lymph nodes. We experienced a case of Kimura's lymphadenitis with characteristic Warthin-Finkeldey type polykaryocytes by fine needle aspiration cytology. The patient was a 10 - year old male, with two enlarged lymph nodes in the postauricular area. Fine needle aspiration cytology from the lymph nodes disclosed hypercellular smears with some scattered eosinophils and polykaryocytes in a polymorphous lymphoid background. There were also fragmented vessel walls and activated endothelial cell clusters in the slightly necrotic background. The Warthin-Finkeldey type polykaryocytes had three to thirty nuclei and prominent nucleoli with ill defined cytoplasmic borders. Their nuclei were arranged in grapevine or ring shaped clusters. As these polykaryocytes could also be found in lymph nodes and extranodal tissues of both reactive and neoplastic lymphoid disorders, polykaryocytes themselves are clinically nonspecific. However, the morphologic features of the Warthin-Finkeldey type giant cells are quite different from the foreign body type or Langhans' type giant cells. When the characteristic cytologic features of Kimura's disease such as significant number of eosinophils in a background of lymphoid cells asd proliferation of vessels and endothelial cells are also observed in the smear, it is possible to suggest this diagnosis in the appropriate clinical setting.

Cytologic Findings of Infectious Mononucleosis Lymphadenitis: A Report of Four Cases .: Jin Hee Sohn, Eun Ha Jung, Hye Rim Park; Korean J Cytopathol. 1998;9(2):227-232.

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Abstract PDF: Infectious mononucleosis(IM) is an acute self-limiting lymphoproliferative disorder associated with infection by the Epstein-Barr Virus(EBV), with the characteristic triad of fever, sore throat, and cervical or generalized lymphadenopathy. And also there are atypical lymphocytes in the peripheral blood. Cytological findings of IM lymphadenitis are characterized by a florid immunoblastic and atypical lymphoid cell proliferation. However, the small number of cases were studied by fineneedle aspiration cytology(FNAC) even though there was a complexity of lymph node pathology. It is important to recognize the reactive pattern of IM that would initiate EBV study and to avoid unnecessary biopsy. We studied findings of lymph node FNAC from 4 patients with EBV infection confirmed by EBV-specific serologic studies. All of the cases were positive for viral capsid antigen(VCA) and one case was positive for anti-EBV nuclear antigen(EBNA). Cytologically, all of the cases exhibited high cellularity and atypia with great numbers of large immunoblastic lymphocytes.

Toxoplasmic Lymphadenitis with Toxoplasma Bradyzoites: A Case Report.: Hwa Eun Oh, Insun Kim; Korean J Pathol. 2004;38(5):330-332.

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Abstract PDF: Toxoplasmic lymphadenitis is the most frequently observed clinical form of acquired toxoplasmosis. It is diagnosed by observing the characteristic histopathology, performing serologic tests and demonstrating the organisms. However, detection of the organisms in lymph node section is rarely accomplished. We demonstrate a case of a toxoplasmic lymphadenitis of a 40-year-old man with bradyzoites. The histopathologic findings of the lymph nodes showed reactive follicular hyperplasia associated with the presence of irregular clusters of epithelioid histiocytes, usually located in the cortical and paracortical zones, and monocytoid B cell proliferation. We demonstrated the bradyzoites of Toxoplasma gondii with periodic acid-Schiff (PAS)-stain, and serologic testing showed positive Ig-G and Ig-M toxoplasma antibodies.

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