Kikuchi-Fujimoto Lymphadenitis

Related Cases: HP-007; HP-196; HP-284; HP-300

  • Also called “histiocytic necrotizing lymphadenitis”

  • Typically young Asian women, most lack antinuclear antibodies

  • Often unilateral cervical lymphadenopathy, fever and leukopenia

  • Usually resolves spontaneously within several months

  • Proliferative Stage:

    • Paracortical, patchy proliferation of medium to large lymphoid cells, histiocytes, and plasmacytoid dendritic cells

    • Histiocytes with irregular nuclear and bland chromatin

    • Plasmacytoid dendritic cells tend to cluster

    • Neutrophils, eosinophils, plasma cells rare

  • Necrotic stage:

    • Patchy necrosis in paracortex, focal to extensive geographic, mostly irregular

    • Abundant karyorrhectic debris in the center of necrosis

    • Mixed immunoblasts, crescentic histiocytes and plasmacytoid dendritic cells

    • Lack of neutrophils and plasma cells

  • Resolution stage:

    •  Large number of foamy macrophages

  • IHC:

  • T cells: abundant, CD8+ > CD4+

  • Histiocytes: CD68+ and MPO+

  • Plasmacytoid dendritic cells, CD68+, CD4+, CD43+, CD123+, CD56-

  • Rare B cells

  • May be associated with SLE

  • DDX: Lupus lymphadenitis

    • Positive ANA and other autoantibodies

    • Lymph node with extensive necrosis and neutrophils

    • Hematoxylin bodies along the vessels or necrotic areas

    • Frequent plasma cells in the follicles and interfollicular regions

Last update: 05/19/15