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Kikuchi's disease, necrotizing lymphadenitis (3350)
Kikuchi's disease, necrotizing lymphadenitisclosed
Subtitle: lymphnode
Type:
HEMATO
Sender:
ugnius
2007-07-04 09:39
INCTR - EBMWG Hematopathology Online
32 yrs old male with disseminated lymhadenopathy and suspition of lymphoma. Lateral neck lymph node was taken.  
HISTO: The pale nodules with histyocytic infiltrates, coalescent nodules of acellular necrosis, crescentic histiocytes MPO+/CD68+, predominating CD8+ cells around. Some T salt'n'pepper nodules and reactive follicles are present.  
BUT... Some nodules with HL like giant cells CD30+ CD15-. Some large perinecrotic cells CD15+ CD30-(maybe histiocytic? granuliocytic?).  
IH: Giant cells: CD30+ CD15- ALK1- EBVLMP1-; PALE AREAS (PRENECROTIC/HISTIOCYTIC): CD8 slightly >CD4 (mixture), CD68+/MPO+ histyocytes.  
 
PROPOSAL: Necrotic/Kikuchi lymphadenitis with HL like cells.  
Thank you for your attention.
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Mueller-Hermelink
2007-07-04 12:14
I like the diagnosis of KiKuchi very much - but we have to consider several points: male sex and generalized lymphadenopathy is not typical( although not exclusive). The MPO reaction is very strong- is it really just the macrophages or are there also granulocytes( I got in the CD 15 stain the impression that there are also some granulocytes in the necrosis)?Proliferating cells in Kikuchi are mainly CD8 cells ( this should be shown , whereas HD has a background od CD4+ cells) LMP1 stain may also be helpful to exclude HD like cells in an acute Mononucleosis which , in my view , is the most important differential diagnosis , since cortical necrosis is a typical feature in that disease( and it would help , at least in aq formal way to deal with these unusual CD30 / CD15 double positive cells. There are still some questions open - please look for the answers.
ugnius
2007-07-04 13:23
Thank you Prof.Mueller-Hermelink for urgent comment. Some pictures are placed in. EBV LMP1 (-). The paracortical CD30+ cells seems to be CD30+ only. I've requested some DOUBLE stains for better visualisation. CD4/CD8 ratio is 1/2, so T populations seems to be mixed.
Mueller-Hermelink
2007-07-04 13:48
I am convinced- This is really Kikuchi Lymphadenitis. An interesting and nice case !
ugnius
2007-07-07 18:40
Thank a lot for your comments. Double CD4/CD8 and CD3/CD30 stain once more reveal admixture of CD4 and CD8+ cells and some CD30+ cells mainly "mononuclear". The phots are not added due to insufficient quality.
ugnius
2007-07-09 08:43
FINAL DIAGNOSIS was issued: NECROTIC LYMPHADENOPATHY: KIKUCHI DISEASE. The 1 problem left: the pulmonary infiltrate was detected, but still I have any data about origin of it.  
A lot of thanks to Prof.Mueller-Hermelink and Prof.N.Hurwitz for continuing support and consulting.
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Last modified: 2007-07-04 09:39:38