KCP 808 울산의대 서울아산병원 전공의 안소연

Patient history 34 yrs old, female CC: Rt neck mass with fever & tenderness Onset: 5 days ago On neck US –Multiple enlarged LNs in Rt neck

Differential diagnosis Malignancy –Metastasis –Malignant lymphoma -Hodgkin lymphoma, no RS cell/Hodgkin cell, no eosinophil Inflammation –Acute lymphadenitis –Subacute or chronic lymphadenitis Kikuchi-Fujimoto disease Other diseases associated with sinus histiocytosis Tuberculous lymphadenitis Lupus lymphadenitis

Differential diagnosis Other diseases associated with sinus histiocytosis –Rosai-Dorfman disease 7 plasma cells(-) emperipolesis(-) Tuberculous lymphadenitis –Epithelioid histiocytes/granuloma, plasma cells, neutrophils, variable necrosis, crescentic histiocytes. 8 Lupus lymphadenitis –Variable histiocytes, immunoblasts, KFD-like necrosis, abundant plasma cells, hematoxylin bodies, few neutrophils –SLE can follow KFD or coexist. 4

Kikuchi-Fujimoto disease 1-3 This case Clinical features Young Asian women (mean: 30yrs, ) 34yrs, woman Acute or subacute (2-3wks) Lymphadenopathy with tenderness(cervical, m/c) Onset: 5days ago Rt cervical LN enlargement with tenderness Sx: fever, URS, nausea, vomiting, weight loss Sx: fever Cytologic features Polymorphous lymphoid cell population Crescentic histiocytes Plasmacytoid monocytes Absence of neutrophils or plasma cells Apoptotic cells or karyorrhectic debris Lack of apoptotic cells or karyorrhectic debris 6 Differential diagnosis

Diagnosis Kikuchi-Fujimoto disease

References [1] Das DK, Mallik MK, Dashti HA, Sathar SA, Jaragh M, Junaid TA: Kikuchi-Fujimoto disease in fine-needle aspiration smears: a clinico-cytologic study of 76 cases of KFD and 684 cases of reactive hyperplasia of the lymph node. Diagnostic cytopathology 2013, 41: [2] Sivakumar S, Ramamoorthy R: Fine needle aspiration cytology of Kikuchi-Fujimoto's disease: a report of 2 cases with emphasis on cytologic features and differential diagnosis. Acta cytologica 2012, 56: [3] Bosch X, Guilabert A: Kikuchi-Fujimoto disease. Orphanet journal of rare diseases 2006, 1:18. [4] Rao GS, Vohra D, Kuruvilla M: Is Kikuchi-Fujimoto disease a manifestation of systemic lupus erythematosus? International journal of dermatology 2006, 45: [5] Nayak S, Puranik SC, Deshmukh SD, Mani R, Bhore AV, Bollinger RC: Fine-needle aspiration cytology in tuberculous lymphadenitis of patients with and without HIV infection. Diagnostic cytopathology 2004, 31: [6] Osborn M, Aqel N, Levine TS: The fine needle aspiration appearances of Kikuchi's lymphadenitis. Cytopathology : official journal of the British Society for Clinical Cytology 2009, 20: [7] Vemuganti GK, Naik MN, Honavar SG: Rosai dorfman disease of the orbit. Journal of hematology & oncology 2008, 1:7. [8] 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 cytologica 2001, 45:953-7.