Two Cases of an Enigmatic Entity: Kikuchi’s Disease

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Professor, Consultant Pathologist, American Board Certified Pathologist, Fellow College of American Pathologists. Areas of interest Fine Needle Aspiration Cytology, Cytology, Cancer, Ethics, Islam, Humanity

Two Cases of an Enigmatic Entity: Kikuchi’s Disease

Sevinç Şahin, Selda Seçkin

Department of Pathology, Bozok University School of Medicine, Yozgat, Turkey

 

Background: Kikuchi’s disease [KD] is a self-limited rare disorder characterized by necrotizing lymphadenopathy in especially women with a mean age of 27.4 years. It mostly arises in the posterior cervical triangle. Lympadenopathy may be accompanied by fever, chills, myalgias, arthralgias, splenomegaly, hepatomegaly and/or skin rashes. KD’s etiology is unknown, and it is commonly misdiagnosed as lymphoma. Herein, we present two cases of KD consulted to our institute in two weeks period.

Case Presentations:  The first case was a 41 year-old male presented with a posterior cervical lymphadenopathy of 2×1.7×1 cm in size. The second case was a 33 year-old female presented  with a left axillary lymphadenopathy of 1.5x1x1 cm in size. The paraffin blocks of lymph node biopsies were evaluated. Similar findings were detected in both cases, and the diagnoses of KD were reached microscopically. There were multiple foci of patchy necrosis. Necrotic foci were composed of nuclear dusts phagocytosed by numerous histiocytes with crescentic nuclei that were positive for myeloperoxidase immunohistochemically. Numerous immunoblasts with atypical nuclei were detected.

Discussion: It should be noted that discriminating KD from systemic lupus erytematosus [SLE], cat-scratch disease, and particularly some lymphomas showing necrosis in the lymph nodes is usually difficult. A brief summary about the clinicopathological characteristics and clues about the differential diagnosis of KD are given in this report with two demonstrative cases in order to contribute a better understanding of this rare enigmatic entity.

Key Words: Kikuchi’s disease”, “lymphadenopathy”, “lymphadenitis”, “necrosis”.

         

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