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Case 196 - Discussion

Hematopathology Case

 

Kikuchi-Fujimoto Lymphadenitis

§     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:

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

o    Histiocytes with irregular nuclear and bland chromatin

o    Plasmacytoid dendritic cells tend to cluster

o    Neutrophils, eosinophils, plasma cells rare

§     Necrotic stage:

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

o    Abundant karyorrhectic debris in the center of necrosis

o    Mixed immunoblasts, crescentic histiocytes and plasmacytoid dendritic cells

o    Lack of neutrophils and plasma cells

§     Resolution stage:

o    Large number of foamy macrophages

§     IHC:

o    T cells: abundant, CD8+ > CD4+

o    Histiocytes: CD68+ and MPO+

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

o    Rare B cells

§     May be associated with SLE

§     DDX: Lupus lymphadenitis - extensive necrosis, hematoxylin bodies, and plasma cells or neutrophils