Pathological significance of plasma cell infiltration in diagnosing lymph node diseases / 中华病理学杂志

Objective: To investigate the value of plasma cells for diagnosing lymph node diseases. Methods: Common lymphadenopathy (except plasma cell neoplasms) diagnosed from September 2012 to August 2022 were selected from the pathological records of Changhai Hospital, Shanghai, China. Morphological and immunohistochemical features were analyzed to examine the infiltration pattern, clonality, and IgG and IgG4 expression of plasma cells in these lymphadenopathies, and to summarize the differential diagnoses of plasma cell infiltration in common lymphadenopathies. Results: A total of 236 cases of lymphadenopathies with various degrees of plasma cell infiltration were included in the study. There were 58 cases of Castleman's disease, 55 cases of IgG4-related lymphadenopathy, 14 cases of syphilitic lymphadenitis, 2 cases of rheumatoid lymphadenitis, 18 cases of Rosai-Dorfman disease, 23 cases of Kimura's disease, 13 cases of dermal lymphadenitis and 53 cases of angioimmunoblastic T-cell lymphoma (AITL). The main features of these lymphadenopathies were lymph node enlargement with various degrees of plasm cell infiltration. A panel of immunohistochemical antibodies were used to examine the distribution of plasma cells and the expression of IgG and IgG4. The presence of lymph node architecture could help determine benign and malignant lesions. The preliminary classification of these lymphadenopathies was based on the infiltration features of plasma cells. The evaluation of IgG and IgG4 as a routine means could exclude the lymph nodes involvement of IgG4-related dieases (IgG4-RD), and whether it was accompanied by autoimmune diseases or multiple-organ diseases, which were of critical evidence for the differential diagnosis. For common lesions of lymphadenopathies, such as Castleman's disease, Kimura's disease, Rosai-Dorfman's disease and dermal lymphadenitis, the expression ratio of IgG4/IgG (>40%) as detected using immunhistochemistry and serum IgG4 levels should be considered as a standard for the possibility of IgG4-RD. The differential diagnosis of multicentric Castleman's diseases and IgG4-RD should be also considered. Conclusions: Infiltration of plasma cells and IgG4-positive plasma cells may be detected in some types of lymphadenopathies and lymphomas in clinicopathological daily practice, but not all of them are related to IgG4-RD. It should be emphasized that the characteristics of plasma cell infiltration and the ratio of IgG4/IgG (>40%) should be considered for further differential diagnosis and avoiding misclassification of lymphadenopathies.

De la escrófula a la linfoadenitis micobacteriana / From scrophula to mycobacterial lymphadenitis

Resumen En el siglo XIX se pensaba que la tuberculosis y la tumefacción ganglionar cervical llamada escrófula afectaban a individuos predispuestos por una "constitución diatésica" heredada. En 1882 Robert Koch demostró que lesiones tuberculosas y escrofulosas humanas eran causadas por el bacilo Mycobacterium tuberculosis. A principios del siglo XX se estableció que Mycobacterium bovis, bacilo de la tuberculosis del ganado, podía también causar linfoadenitis cervical en humanos, especialmente en niños, por la ingestión de leche de vacas enfermas. La condición disminuyó después que se controló la infección en el ganado y se introdujo la pasteurización de la leche. En 1956 se describió la linfoadenitis cervicofacial granulomatosa necrosante y supurada causada por micobacterias no tuberculosas. Afecta principalmente a niños bajo los cinco años, especialmente en países sin endemia de tuberculosis. Las linfoadenitis cervicales tuberculosas predominan en adultos jóvenes en países con tuberculosis endémica y en individuos infectados por VIH.

In the 19th century it was widely believed that both tuberculosis and cervical lymph node swelling, known as scrophula, affected individuals predisposed to an inherited "diathetic constitution". In 1882 Robert Koch proved that human tuberculosis and scrophulous lesions were caused by the bacillus Mycobacterium tuberculosis. In the early twentieth century it was stated that Mycobacterium bovis, the bacillus of cattle tuberculosis, could also cause cervical lymphoadenitis in humans, especially in children, by the intake of milk from sick cows. The incidence of this condition decreased after the infection was controlled in cattle and pasteurization of the milk was introduced. A type of granulomatous necrotizing and suppurative cervico-facial lymphadenitis associated to non-tuberculous mycobacteria was described in 1956. It mainly affects children younger than 5 years old, particularly those born in countries with non-endemic tuberculosis. Tuberculous cervical lymphadenitis is prevalent in young adults from tuberculosis-endemic countries and in HIV-infected subjects. Infectious etiology displaced the importance of a personal disposition in the development of scrophula. Nevertheless, mutations that confer susceptibility to mycobacterial infection are currently investigated.

Bacillus Calmette-Guerin lymphadenitis: A 6-year experience in two Saudi hospitals.

Background : The World Health Organization (WHO) has recommended Bacillus Calmette-Guerin (BCG) vaccination as a part of the global expanded program for immunization. Although the BCG vaccine is usually a safe vaccine, a number of complications with lymphadenitis being the most common complication, can occur. Aim : We evaluated the frequency, the clinical presentation and treatment modalities of lymphadenitis after BCG vaccine in Saudi children. Results : A total of 145 patients with BCG lymphadenitis presented between January 2005 and December 2010. In the majority (103) of the cases, the lymphadenitis involved ipsilateral left axillary nodes. Other sites of involvement included the left supraclavicular lymph nodes in 26 (18%) patients, and both the left axillary and supraclavicular lymph nodes were involved in 7 cases (4.8%). A total of 75 patients (65%) were given antituberculous medication. Eight (27%) patients had positive acid-fast bacilli and positive cultures for Mycobacterium bovis. Conclusion : In light of the findings of this study, it would be advisable to administer the BCG vaccine in Saudi Arabia at a time later than at birth, as the younger children are commonly affected.

Linfadenitis por mycobacterium incluyendo pacientes infectados por el virus de inmunodeficiencia humana / Mycobacterium lymphadenitis including patients infected with human inmunodefi

El género Mycobacterium provoca infecciones pulmonares y extrapulmonares, de estas últimas predomina la infección ganglionar. Mientras Mycobacterium tuberculosis es el agente causal más importante, en las últimas décadas aumenta la incidencia de otras especies micobacterianas que se han hecho prevalentes en los pacientes positivos al virus de la inmunodeficiencia humana (VIH +) tanto en países desarrollados como en vías de desarrollo. Durante el período enero 2007 hasta diciembre 2009 se procesó en nuestro laboratorio 6540 muestras, 210 muestras fueron obtenidas por biopsia ganglionar, precisamente este constituyó nuestro universo de estudio, 190 (90.4%) muestras se obtuvieron por exéresis quirúrgica, 20 (9.5%) por punción espirativa;17 procedían de pacientes VIH– (8.1%) y 193 procedentes de pacientes VIH+(91.9%). En solo 16 muestras (7.6%) el cultivo BAAR fue positivo; 4 procedentes de pacientes VIH– (25%) y 12 VIH+(75%). La clasificación e identificación micobacteriana demostró la presencia de Mycobacterium tuberculosis en 13 de los casos (81.25%), mientras Mycobacterium avium-intracellulare fue aislado en 3 (18.7%). En los pacientes inmunodeprimidos con linfadenopatía incluidos los pacientes VIH/sida, es muy importante la búsqueda activa de la presencia de BAAR como coinfección oportunista, donde Mycobacterium tuberculosis se mantiene como el agente infeccioso más frecuente, sin embargo la posibilidad de que otras especies micobacterianas también estén presentes no se debe descartar. Nuestro objetivo en este estudio como Laboratorio Nacional de Referencia de TB- Micobacterias fue lograr la caracterización etiológica de linfadenopatías en pacientes en que se sospechaba clínicamente la participación del género Mycobacterium.

Mycobacterium tuberculosis is the most important etiological agent producing pulmonary as well as extrapulmonary infection. During these last decades, the increase in the incidence of infection due to other mycobacteria species is evident. Lymphadenopathy is the most frequent extrapulmonary presentation form of Mycobacterium Genera infection among HIV positive patients either in developed or underdeveloped countries. The aim of this work is to analyze the results obtained during January 2007 - December 2009 in our laboratory. Two hundred ten tissue samples were studied; 190 (90.4%) samples were lymph node biopsied tissues and 20 (9.5%) samples were obtained by fine needle aspiration; 17 were from HIV - patients (8.1%) and 193 from HIV + (91.9%). A total of 16 (7.6%) samples produced a positive culture for BAAR, 4 VIH- (25%) and 12 VIH+ (75%). Classification and identification for mycobacteria confirmed Mycobacterium tuberculosis in 13 of the cases (81.25%), and Mycobacterium avium-intracellulare in three patients (18.7%). The present study once again confirms that BAAR culture has more sensitivity and specificity than histopathologhic studies have. Lymphadenopathy in immunosuppressed patients should by studied for the presence of an BAAR coinfection where M. tuberculosis is still the agent most frequently found, nevertheless, other species of Mycobacteria may be causing infection and should be searched for. Our objective as National Reference Laboratory of Tuberculosis and Mycobacterial was to obtain the etiological characterization of Mycobacterium lymphadenopathy in clinically suspect patients.

Linfadenite caseosa em ovinos deslanados abatidos em um frigorífico da Paraíba / Caseous lymphadenitis in slaughtered hair sheep in northeastern Brazil

Este trabalho teve como objetivo determinar a prevalência e distribuição de lesões da linfadenite caseosa em ovinos deslanados abatidos no município de Mulungu, Paraíba. Dos 1466 ovinos abatidos, 236 (15,9%) apresentaram lesões macroscópicas semelhantes à linfadenite caseosa. A prevalência foi maior em fêmeas, 17.9% (135/754) que em machos, 13,8% (101/732). As principais lesões estavam localizadas nos linfonodos pré-escapulares em 36,3% (97/268) dos ovinos, nos parotídeos em 22,4% (60/268) e no pré-crural em 20,9% (56/268). Somente 70 (26,1%) de um total de 268 lesões foram detectadas no exame ante mortem. Foram encontradas lesões em todos os lotes provenientes de diversos municípios da Paraíba, Pernambuco e Bahia. Das 51 amostras em que foi feito o cultivo bacteriológico, em 74,5% (43/51) foi isolado Corynebacterium pseudotuberculosis. Em 7,8% (4/51) foi isolado Staphylococcus aureus, em 2% (1/51) Escherichiacoli e 5,9% (3/51) amostras foram negativas. No exame histológico, em 11 linfonodos havia lesões da linfadenite caseosa caracterizadas por área de necrose central formada por lamelas concêntricas, com presença de grandes colônias bacterianas e focos de mineralização, rodeada por uma faixa de infiltrado inflamatório com macrófagos epitelióides e poucos neutrófilos. Na camada adjacente observaram-se linfócitos e plasmócitos e toda a lesão era delimitada por tecido conjuntivo fibroso. Nas outras 32 amostras foram observadas a maioria, mas não todas as lesões características da doença. Em 21 amostras foram encontradas células gigantes. As lesões histológicas dos linfonodos que foi isolado S. aureus foram semelhantes as da linfadenite caseosa. Conclui-se que as lesões histológicas de linfadenite caseosa são características, mas não patognomônicas, pois podem ser confundidas com lesões causadas por outros organismos piógenos e com tuberculose; portanto o isolamento bacteriológico é imprescindível para o diagnóstico definitivo da linfadenite caseosa.

The objective of this paper is to report the prevalence and distribution of lesions of caseous lymphadenitis (CL) in hair sheep slaughtered in an abattoir in the state of Paraíba, northeastern Brazil. From 1,466 sheep slaughtered, 236 (15.9%) had gross lesions similar to that of CL. The prevalence was higher in females, 17.9% (135/754), than in males, 13.8% (101/732). Ninety seven (36.3%) out of 268 lesions were localized in the prescapular lymph node, 22.4% (60/268) in the parotideal, and 20.9% (56/268) in the prefemoral. Only 70 (26.1%) out of 268 lesions suggestive of CL were detected during ante mortem examination. Caseous lymphadenitis-like lesions were observed in all flocks examined from different municipalities in the states of Paraíba, Pernambuco and Bahia. Cultures and histologic examination were performed in samples from 51 lesions. Corynebacterium pseudotuberculosis was isolated in 74.5% (43/51) samples, Staphylococcus aureus in 7.8% (4/51) samples, Escherichia coli in 2% (1/51), and in 5.9% (3/51) samples cultures were negative. Histologic findings in 11 lymph nodes showed all characteristic lesions of caseous lymphadenitis: central area of necrosis formed by concentric lamellae, with large bacterial colonies and mineralization, surrounded by an inflammatory exudate with epithelioid macrophages and few neutrophils; lymphocytes and plasma cells were observed in the next layer, and fibrous tissue was surrounding the whole lesion. Lesions in the other 32 lymph nodes showed most, but not all lesions characteristic of the disease. Giant cells were observed in 21 lymph nodes. Histologic lesions in lymph nodes from which S. aureus was isolated were similar as those of CL. These findings suggest that CL lesions are characteristic, but not pathognogmonic, because they can be confused with lesions caused by other pyogenic bacteria or tuberculosis; therefore bacteriologic examination is necessary for the diagnosis of the disease.

Fine needle aspiration cytology in the diagnosis of superficial lymphadenopathy in children and adolescents: an analysis of 869 cases

Fine needle aspiration cytology [FNAC] in children has gained acceptance gradually and is currently used extensively as an initial diagnostic tool. This study was undertaken to determine the value of FANC in peripheral lymphadenopathy in pediatric and adolescent patients in Kuwait. Retrospective. Mubarak Al-Kabeer Hospital, Kuwait. Eight hundred and sixty-nine children and adolescents [ranging from five months to 20 years] from January 2000 to September 2009. FNAC. The spectrum of disease of lymph nodes in pediatric and adolescent age groups, using FNAC. Out of the 4116 lymph node aspirates performed, the cytology reports of 869 [21.1%] pediatric aspirates were reviewed. There were 409 [51.3%] male and 388 [48.7%] female patients. Seventy-two [8.3%] were considered unsatisfactory. Out of the 797 [91.7%] satisfactory aspirates, reactive lymphoid tissue was reported in 616 cases [77.3%], lymphadenitis in 115 [14.4%], atypical cytology in 18 [2.3%], lymphoreticular malignancy in 46 [5.7%] and metastatic tumor in 2 [0.3%]. The lymphadenitis included 8, 66, 23 and 18 cases of necrosis only, granulomatous lymphadenitis, necrotizing granulomatous lymphadenitis and tuberculous lymphadenitis [where acid fast bacilli were detected respectively. FNAC of lymph nodes in children and adolescents is feasible and reliable. Majority of the nodes revealed reactive lymphoid tissue and helped allay the fears of parents thereby preventing unnecessary surgery

Pseudoglandular pattern of basaloid cells in pilomatrixoma in the needle aspiration cytology: a case report.

A varied cytomorphology of pilomatrixoma often results in diagnostic dilemma. Here, we report a case of pilomatrixoma that presented with prominent gland like arrangement of basaloid cells on cytologic smears causing diagnostic problem. Clinical diagnosis in the present case was cervical lymphadenitis and the cytologic smears showed a strikingly varied morphology with few loose clusters of basaloid cells exhibiting pseudoglandular pattern. A possibility of metastatic carcinoma was considered. However, following histopathologic diagnosis of pilomatrixoma, when cytologic smears were reviewed, it was realized that the ghost cells were overlooked as anucleate squames. Our case highlights the importance of careful clinical and cytologic interpretation of pilomatrixoma. Awareness of the cytomorphologic characteristics of ghost cells and their identification in cytologic smears is highly criticalfor an accurate diagnosis. A prominent basaloid cell component of pilomatrixoma with a pseudoglandular pattern, which has not been described earlier, may easily lead to a false positive diagnosis.

TBC extrapulmonar (ganglionar): a propósito de un caso / Extrapulmonary TBC (ganglionic): a purpose of a case

La tuberculosis es una enfermedad infectocontagiosa producida por bacilos aerobios que pertenecen al complejo mycobacterium tuberculosis, enfermedad, que afecta habitualmente a los pulmones, aunque en la tercera parte de los casos existe también afectación de otros órganos denominándose TBC extrapulmonar, su transmisión se produce habitualmente por la desiminación a través del aire de pequeñas gotas respiratorias producidas por los pacientes con tuberculosis pulmonar infecciosa. Actualmente la mayoría de las adenitis tuberculosas son manifestación postprimaria de la infección por este agente, ya sea por una diseminación linfática o hematógena; apareciendo como tumefacción indolora y unilateral de los ganglios con afectación más frecuente a nivel cervical, así como regiones parotídeas, submandibular, supraclavicular, axilar; puede ser confundida con diversos procesos infecciosos y enfermedades neoplásicas como linfomas o carcinoma metastásico; los que se utilizan en el tratamiento son la isoniciada, rifampicina, estambutol, pirazinamida y estreptomicina. El caso que se presenta a continuación es un paciente masculino de 17 años quien consulta a especialista por presentar de 1 año de evolución aumento de volumen en región axilar izquierda, no teniendo antecedentes personales ni familiares importantes, el cual fue tratado al ingreso como lipoma axilar por lo que fue intervenido para su exéresis, al momento de su intervención se evidencia ocupación de toda la cadena ganglionar axilar izquierda estableciéndose otros diagnósticos diferenciales como Linfoma Tipo Hodgkin y TBC ganglionar, lo cual se comprobó por prueba PPD positiva y con la biopsia que reporto: granulomas de TBC ganglionar de ganglio axilar izquierdo. Por lo cual se mantiene bajo control en la consulta de neumotisiología iniciando tratamiento antituberculoso en 2 esquemas y luego de la segunda fase cumplida se decide alta médica por mejoría clínica.

Correlación entre ploidia y fase S, y características morfológicas y receptores hormonales en el cáncer de mama: estudio de 402 casos / Correlation between ploidy and S phase faction and morphological characteristic and hormonal recepyor in breast cancer: study of 402 cases

Con la finalidad de establecer la relación entre ploidia, fase S y las características morfológicas del carcinoma de mama se estudiaron 402 muestras de material en fresco. No se encontro ninguna relación entre ploidia y fase S, y el status de los ganglios linfáticos y la edad de los pacientes. Las lesiones aneuploides resultaron de mayor tamaño que los tumores diploides y usualmente no expresaban receptores hormonales. Los carcinomas ductales infiltrantes (322/402) mostraron mayor porcentaje de lesiones aneuploides y una fase S más elevada en relación con el incremento del grado histológico, la formación de túbulos, el pleomorfismo nuclear y el índice mitótico. En el análisis multivariante, el plemorfismo nuclear y el tamaño tumoral constituyeron las únicas variables independientes y con valor de predicción para la aneuploidia. El patrón de ADN y la fase S constituyen variables que se correlacionan con los cambios morfológicos y así proporcionan información objetiva y reproducible

report of two patients with kikuchi's disease

Two cases of Pakistani women presenting with fever along with cervical lymphadenopathy which showed a histiocytic nercotizing picture on histology, and diagnosis as Kikuchi's disease are being reported

Biopsia por Aspiración con Aguja fina en el Síndrome Adénico Cervical Crónico / Fine needle aspiration biopsy in the chronic adenic cervical syndrome

Con el objetivo de determinar en nuestro medio el valor de la citología aspirativa con aguja fina, al evaluar una linfadenopatía cervical asintomática, como procedimiento diagnóstico preliminar, se realizó un estudio de 40 pacientes que acudieron a la consulta de otorrinolaringología del Hospital Clinicoquirúrgico Docente "Joaquín Albarrán", durante el año 1994, en los cuales se practicó primero biopsia aspirativa con aguja fina y posteriormente la extirpación quirúrica de los ganglios afectados para evaluar los diagnósticos citopatológicos realizados. El 72,5 por ciento de los pacientes tenían más de 50 años y el 62,5 por ciento era del sexo masculino. Se diagnosticaron lesiones metastásicas en el 45 por ciento, tumores primarios en el 20 por ciento, adenitis aguda en 7,5 por ciento. En la correlación se encontraron 2 falsos positivos (5 por ciento) e igual número de falsos negativos. La eficacia del método fue de 90 por ciento, sensibilidad de 92,3 por ciento y especialidad de 85,75 por ciento. Los índices predictivos positivos y negativos fueron 92,3 y 85,7 por ciento

Poliadenopatías cervicales por enfermedad de Kikuchi y Fujimoto / Cervical polyadenopathies by Kikuchi's and Fujimoto's diseases

Kikuchi and Fujimoto disease is a benign subacute necrotizing lymphadenitis, probably associated to a viral infection, that affects mostly young Asian women. We report a 19 years old woman, with a vast familiar history of thyroid disease (3 uncles with papillary thyroid carcinoma and one with Hashimoto thyroiditis). After an upper respiratory infection, she presented with painless cervical adenopathies. Cervical ultrasound examination detected an 8 mm thyroidal nodule. She was operated with the diagnosis of thyroidal cancer. The pathological examination confirmed that the nodule was papillary thyroidal cancer, but the study of the resected lymph nodes, revealed a Kikuchi and Fujimoto disease

Infección por bartonella henselae en pacientes inmunocompetentes: enfermedad por arañazo de gato / Infection by bartonella henselae in immunocompetent patients: cat scratch disease

Ten children (7 males), aged between 6 and 13 years old, with histologically or serologically confirmed cat scratch disease are reported. Lympadenopathy location was pre auricular in four cases, axillary in two, inguinal in 2 and epitrochlear in 2. Three children had fever over 39ºC and 2 had a Parinaud syndrome. Nine children had a history of cat scratch and one of a cat byte. Six had an arythrocyte sedimentation rate over 40. Lymph node ultrasound examination was a useful diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies were obtained in 4 cases, showing a suppurative granulomatous lymphadenitis in all and positive Warthin-Starry stain in 2. Serology, done in patients without histological confirmation was positive with titles ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with regression of lymphadenopathy. Infection by bartonella henselae occur in the Chilean population and must be considered in the differential diagnosis of regional lymph node enlargement

Histiocytic necrotizing lymphadenitis: A clinico-pathologic study of 45 cases with in situ hybridization for Epstein-Barr virus and hepatitis B virus

Forty-five cases of histiocytic necrotizing lymphadenitis (HNL) or Kikuchi-Fujimoto disease were reviewed clinico-pathologically and studied for Epstein-Barr virus (EBV) and hepatitis B virus (HBV) by in situ hybridization to assess their causative role. Histologically, the lymph nodes typically showed relatively well defined paracortical lesions composed of large atypical mononuclear cells, histiocytes, and karyorrhectic nuclear debris. Mild to moderate degree of coagulation type necrosis was present in 24 cases. Clinical features did not vary greatly from previously described female preponderance, young age onset, subacute cervical lymphadenopathy, and frequent leukopenia, except for a few cases with recurrent disease over 8-9 years. Serologic tests revealed EBV IgG antibody in one case, HBV surface antibody in 11 cases and HBV surface antigen in 2 cases. In situ hybridization was performed on 41 cases using internal repeat 1 fragment DNA and EBV-coded small RNA (EBER-1) for EBV, and pan-HBV DNA probe for HBV detection, and showed that all cases were negative for EBV or HBV genome. Our results suggest EBV or HBV may not have causative role in the pathogenesis of HNL.

A punçåo aspirativa no diagnóstico das linfadenopatias: citomorfologia e imunocitoquímica / Aspiration biopsy in the diagnosis of lymphadenopathies: cytomorphology and immunocytochemistry

A fim de avaliar a eficácia da punçåo aspirativa no diagnóstico das linfadenopatias, utilizando conjuntamente a citomorfologia e imunocitoquímica, foi examinado o material aspirado, com agulha fina, de lifonodos aumentados em 75 pacientes. Os resultados obtidos foram comparados com o estudo histológico e imunohistoquímica e descritos os aspectos citólogicos encontrados nas diversas linfadenopatias. A punçåo aspirativa fez o diagnóstico em 29 neoplasias metastáticas, 13 linfomas nåo Hodgkin, três casos de doença de Hodgkin, 10 linfadenites reacionais, 15 linfadenites granulomatosas e dois casos de doença de Rosai-Dorfman. Um caso de linfoma de células T, de baixo grau, e dois casos de doença de Rosai-Dorfman. Um caso de linfoma de células T, de baixo grau, e dois casos de histiocitoses maligna nåo foram diagnosticados. Obteve-se uma sensibilidade de 93 por cento e uma especificidade de 100 por cento. A associaçåo da citomorfologia com a imunocitoquímica melhorou a acurácia da punçåo aspirativa no diagnóstico das linfadenites reacionais e linfomas nåo Hodgkin. Conclui-se que a punçåo aspirativa pode contribuir para uma maior eficiência e rapidez de diagnóstico nas linfadenopatias, reduzindo a necessidade de biópsia e diminuindo os custos da avaliaçåo diagnóstica

Histiocytic necrotizing lymphadenitis without granulocytic infiltration (Kikuchi's disease). A case report.

Clinical and pathological findings in a case of necrotizing lymphadenitis are described. Histologically the necrotic areas show striking karyorrhexis, absence of polymorphonuclear granulocytes and surrounding zones of large reactive lymphoid cells. The disorder must be carefully distinguished from a lymphoma which it may resemble closely.