Journal List > Pediatr Allergy Respir Dis > v.21(4) > 1033145

TOOLS
Chung, Kwon, Jang, Baek, Jang, Park, Park, Oh, and Lee: Discrimination Between Childhood Subacute Necrotizing Lymphadenitis and Nonspecific Cervical Lymph Hyperplasia for Earlier Diagnosis
Abstract

Pediatr Allergy Respir Dis 2011;21(4):326-333.

Published online: 20 January 2011

DOI: https://doi.org/10.7581/pard.2011.21.4.326

Discrimination Between Childhood Subacute Necrotizing Lymphadenitis and Nonspecific Cervical Lymph Hyperplasia for Earlier Diagnosis

Eun-Jin Chung, MD1, Young-Hee Kwon, MD1, Yeo Sun Jang, MD1, Hey-Sung Baek, MD, PhD2, Ki-Seok Jang, MD3, Chan Kum Park, MD, PhD3, Jeong Seon Park, MD, PhD4, Jae Won Oh, MD, PhD1, Ha-Baik Lee, MD, PhD1,

1Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea

2Department of Pediatrics, Gangdong Sacred Heart Hospital, Hallym University College, Seoul, Korea

3Department of Pathology and of Medicine, Seoul, Korea

4Department of Radiology, Hanyang University College, Seoul, Korea

책임저자:이하백, 서울시 성동구 행당동 17 한양대학교 의과대학 소아과학교실 Tel: 02)2290-8385 Fax: 02)2297-2380 E-mail: hablee@hanyang.ac.kr

Received 26 August 2011       Revised 20 September 2011       Accepted 26 September 2011

Copyright © 2011 The Korean Academy of Pediatric Allergy and Respiratory Disease

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We conducted this research to make an earlier diagnosis and identify better treatment for Kikuchi-Fujimoto disease (KFD) by comparing clinical findings with nonspecifically enlarged cervical lymph nodes in children.

Methods

Nineteen patients were diagnosed with KFD by tissue pathology from a fine needle aspiration biopsy and/or excisional biopsy and were compared with the clinical, radiological, and pathological findings of reactive hyperplasia.

Results

The average onset age of onset for patients with KFD was 11.8 3.61 years, and the ± male to female ratio was 1:1.1, whereas patients with reactive hyperplasia were 11.8 5.96 years, ± and the male to female ratio was 1.7:1. Patients with KFD suffered more from fever than patients with reactive hyperplasia (68% vs. 13%,P=0.002). Patients with KFD showed perinodal infiltration (P=0.001) and necrosis on computed tomography, whereas patients with reactive hyperplasia did not show any of these findings. Ultrasonographic findings were similar between the two study groups. In contrast, the histopathological examinations of biopsied cervical lymph nodes were enormously helpful for distinguishing the findings of KFD from those of patients with reactive hyperplasia.

Conclusion

We recommend a histopathological examination to distinguish KFD from reactive hyperplasia in children with significantly enlarged cervical lymph nodes.

Keywords: Kikuchi-Fujimoto disease, Subacute necrotizing lymphadenitis, Reactive hyperplasia

References

1. Famularo G, Giustiniani MC, Marasco A, Mini-sola G, Nicotra GC, De Simone C. Kikuchi Fujimoto lymphadenitis: case report and literature review. Am J Hematol. 2003; 74:60–3.
crossref
2. Kikuchi M. Lymphadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytosis. Nippon Kesueki Gakkai Zasshi. 1972; 35:375–80.
3. Fujimoto Y, Kozima Y, Yamaguchi K. Cervical subacute necrotizing lymphadenitis: a new clinicopathological entity. Naika. 1972; 30:920–7.
4. Turner RR, Martin J, Dorfman RF. Necrotizing lymphadenitis. A study of 30 cases. Am J Surg Pathol. 1983; 7:115–23.
5. Tsang WY, Chan JK, Ng CS. Kikuchi's lymphadenitis. A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol. 1994; 18:219–31.
6. Debley JS, Rozansky DJ, Miller ML, Katz BZ, Greene ME. Histiocytic necrotizing lymphadenitis with autoimmune phenomena and meningitis in a 14-year-old girl. Pediatrics. 1996; 98:130–3.
crossref
7. Park HS, Sung MJ, Park SE, Lim YT. Kikuchi-Fujimoto disease of 16 children in a single center of Korea. Pediatr Allergy Immunol. 2007; 18:174–8.
crossref
8. Rosenberg HK, Markowitz RI, Kolberg H, Park C, Hubbard A, Bellah RD. Normal splenic size in infants and children: sonographic measurements. AJR Am J Roentgenol. 1991; 157:119–21.
crossref
9. Som PM. Lymph nodes of the neck. Radiology. 1987; 165:593–600.
crossref
10. Dorfman RF, Berry GJ. Kikuchi's histiocytic necrotizing lymphadenitis: an analysis of 108 cases with emphasis on differential diagnosis. Semin Diagn Pathol. 1988; 5:329–45.
11. Mahadeva U, Allport T, Bain B, Chan WK. Haemophagocytic syndrome and histiocytic necrotising lymphadenitis (Kikuchi's disease). J Clin Pathol. 2000; 53:636–8.
crossref
12. Chen JS, Chang KC, Cheng CN, Tsai WH, Su IJ. Childhood hemophagocytic syndrome associated with Kikuchi's disease. Haematologica. 2000; 85:998–1000.
13. O'Neill D, O'Grady J, Variend S. Child fatality associated with pathological features of histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease). Pediatr Pathol Lab Med. 1998; 18:79–88.
14. Kim KH, Jung SH, Park C, Choi IJ. Subacute necrotizing lymphadenitis–a collective clinicopathological and immunohistochemical study. Yonsei Med J. 1992; 33:32–40.
15. 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; 128:650–3.
crossref
16. Lee SM, Oh YJ, Jun YH, Hong YJ, Son BK, Kim SK, et al. Fine needle aspiration cytology of enlarged lymph nodes in children and adole-scents. Korean J Pediatr. 2006; 49:167–72.
crossref
17. Kikuchi M, Yoshizumi T, Nakamura H. Necrotizing lymphadenitis: possible acute toxoplasmic infection. Virchows Arch A Pathol Anat Histol. 1977; 376:247–53.
crossref
18. Feller AC, Lennert K, Stein H, Bruhn HD, Wuthe HH. Immunohistology and aetiology of histiocytic necrotizing lymphadenitis. Report of three instructive cases. Histopathology. 1983; 7:825–39.
crossref
19. Krueger GR, Klueppelberg U, Hoffmann A, Ablashi DV. Clinical correlates of infection with human herpesvirus-6. In Vivo. 1994; 8:457–85.
20. Hollingsworth HC, Peiper SC, Weiss LM, Raf-feld M, Jaffe ES. An investigation of the viral pathogenesis of Kikuchi-Fujimoto disease. Lack of evidence for Epstein-Barr virus or human herpesvirus type 6 as the causative agents. Arch Pathol Lab Med. 1994; 118:134–40.
21. Liu Q, Ohshima K, Shinohara T, Kikuchi M. Apoptosis in histiocytic necrotizing lymphadenitis. Pathol Int. 1995; 45:729–34.
crossref
22. Ohta A, Matsumoto Y, Ohta T, Kaneoka H, Yamaguchi M. Still's disease associated with necrotizing lymphadenitis (Kikuchi's disease): report of 3 cases. J Rheumatol. 1988; 15:981–3.
23. Gourley I, Bell AL, Biggart D. Kikuchi's disease as a presenting feature of mixed connective tissue disease. Clin Rheumatol. 1995; 14:104–7.
crossref
24. Rubio SI, Plewinsky TS, Sabatini M, Poretsky L. Kikuchi's disease associated with Hashimoto's thyroiditis. J Endocrinol Invest. 1996; 19:136–7.
crossref
25. Ahn CY, Oh MG, Ha JH, Kim SH, Hur JA. A case of systemic lupus erythematosus associated with Kikuchi-Fujimoto's disease. J Korean Rheum Assoc. 2007; 14:297–301.
crossref
26. Kikuchi M, Takeshita M, Eimoto T, Iwasaki H, Minamishima Y, Maeda Y. Histiocytic necrotizing lymphadenitis: clinicopathologic, immunologic, and HLA typing study. Hanaoka M, Kadin ME, Mikata A, Watanabe S, editors. editors.Lymphoid Malignancy: Immunocytology and Cytogenetics. New York: Field and Wood Medical Pub;1990. p. 251–7.
27. Imamura M, Ueno H, Matsuura A, Kamiya H, Suzuki T, Kikuchi K, et al. An ultrastructural study of subacute necrotizing lymphadenitis. Am J Pathol. 1982; 107:292–9.
28. Sumiyoshi Y, Kikuchi M, Takeshita M, Ohshima K, Masuda Y. Alpha-interferon in Kikuchi's disease. Virchows Arch B Cell Pathol Incl Mol Pathol. 1991; 61:201–7.
crossref
29. Eimoto T, Kikuchi M, Mitsui T. Histiocytic necrotizing lymphadenitis. An ultrastructural study in comparison with other types of lymphadenitis. Acta Pathol Jpn. 1983; 33:863–79.
30. Naito Y, Okamura S, Iwata Y, Niho Y, Otsuka T, Yamano Y, et al. Granulocytopenia in histiocytic necrotizing lymphadenitis without granulocytic infiltration: decreased CFU-C and an inhibitory effect of the serum. Nihon Ketsueki Gakkai Zasshi. 1985; 48:1053–8.
31. Ahuja AT, Ying M. Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 2005; 184:1691–9.
crossref
32. Kwon SY, Kim TK, Kim YS, Lee KY, Lee NJ, Seol HY. CT findings in Kikuchi disease: analysis of 96 cases. AJNR Am J Neuroradiol. 2004; 25:1099–102.
33. Martin HE, Ellis EB. Biopsy by needle puncture and aspiration. Ann Surg. 1930; 92:169–81.
crossref
34. Koh YH, Choi IJ, Lee YB. Subacute necrotizing lymphadenitis. Korean J Pathol. 1983; 17:257–62.
35. Tong TR, Chan OW, Lee KC. Diagnosing Kikuchi disease on fine needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology. Acta Cytol. 2001; 45:953–7.
36. Greenberg ML, Cartwright L, McDonald DA. Histiocytic necrotizing lymphadenitis (Kikuchi's disease): cytologic diagnosis by fine-needle biopsy. Diagn Cytopathol. 1993; 9:444–7.
crossref
37. Piccirillo JF, Lanza DC, Stasio EA, Moloy PJ. Histiocytic necrotizing lymphadenitis (Kikuchi's disease). Arch Otolaryngol Head Neck Surg. 1991; 117:800–2.
crossref
38. Chiu CF, Chow KC, Lin TY, Tsai MH, Shih CM, Chen LM. Virus infection in patients with histiocytic necrotizing lymphadenitis in Taiwan. Detection of Epstein-Barr virus, type I human T-cell lymphotropic virus, and parvovirus B19. Am J Clin Pathol. 2000; 113:774–81.

Table 1.
Clinical Differences between KFD and Reactive Hyperplasia
Symptoms and signs KFD Reactive hyperplasia P -value
Neck mass 18 (95) 16 (100) >0.05
With pain 6 (33) 2 (13)  
Without pain 12 (67) 14 (87)  
Fever 13 (68) 2 (13) 0.002
Splenomegaly 7 (36) 1 (6) 0.047
Chill 2 (10) 0 (0) >0.05
Mesenteric LAP 2 (10) 0 (0) >0.05
Sore throat 2 (10) 1 (6) >0.05
Abdominal pain 2 (10) 0 (0) >0.05
Cough 1 (5) 1 (6) >0.05
Headache 1 (5) 0 (0) >0.05
Location of LN
  Cervical 18 (95) 16 (100) >0.05
    Both 9 (50) 11 (69) >0.05
    Right 5 (28) 3 (19) >0.05
    Left 4 (22) 2 (12) >0.05
  Abdominal 2 (10) 0 (0) >0.05
  Axillary 1 (5) 0 (0) >0.05
Total 19 (100) 16 (100)  

Values are presented as number (%).

KFD, Kikuchi-Fujimoto disease; LAP, lymphadenopathy; LN, lymph node.

Table 2.
Comparison of Laboratory and Radiologic Findings between KFD and Reactive Hyperplasia
　 KFD Reactive hyperplasia P −value
Laboratory findings      
  WBC     0.002
    <4,500/mm3 14 (78) 3 (19)  
    4,500–10,000/mm3 3 (17) 11 (69)  
    >10,000/mm3 1 (5) 2 (12)  
  Platelet     >0.05
    <150,000/mm3 3 (17) 0 (0)  
    >150,000/mm3 15 (83) 16 (100)  
  ESR     0.001
    >20 mm/hr 11 (85) 1 (25)  
  AST/ALT     >0.05
    Normal 11 (61) 14 (87)  
    High 7 (39) 2 (13)  
  LDH     >0.05
    >200 7 (100) ) 5 (83)  
  ASO     0.043
    >200 U/mL 10 (83) 1 (50)  
Radiologic findings      
  Involved lesion     >0.05
    Bilateral 8 (50) 11 (69)  
    Ipsilateral 8 (50) 5 (31)  
  Enhanced pattern     >0.05
    Well-enhanced 13 (81) 8 (50)  
    Not enhanced 3 (19) 8 (50)  
  Necrosis     >0.05
    Present 4 (25) 2 (13)  
    Absent 12 (75) 14 (87)  
  Perinodal infiltration     0.001
    Present 9 (56) 0 (0)  
    Absent 7 (44) 16 (100)  

Values are presented as number (%).

KFD, Kikuchi-Fujimoto disease; WBC, white blood cell; ESR, erythrocyte sedimentation rate; AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactate dehydrogenase; ASO, anti-streptolysin O.

TOOLS
Similar articles