Reşit Doğan KÖSEOĞLU, Onuk Nurper FİLİZ, Mehmet GÜVEN

Bir nekrotizan lenfadenitis nedeni: Kikuchi-Fujimoto hastalığı

Farklı nedenlerden kaynaklanan nekrotizan lenfadenopatiler ile patoloji rutin pratiğinde karşılaşılmaktadır. Ülkemizde nadir olarak görülen bir nekrotizan lenfadenitis olan Kikuchi-Fujimoto Hastalığı (KFH)'na daha çok Uzak Doğu Asya'da rastlanılmaktadır. Kadınlarda 2 kat daha sık görüldüğü rapor edilen KFH daha çok servikal lenfadenomegali ve üst solunum yolu enfeksiyonu belirtileri ile kendisini belli etmektedir. Lökopeni, karaciğer fonksiyon testlerinde bozulma ve sedimentasyon yüksekliği laboratuar bulgularıdır. Onbeş gündür ateş, halsizlik, boğaz ve eklem ağrıları ile merkezimize başvuran 38 yaşında erkek hastamızda sedimentasyon 40mm/saat ve karaciğer fonksiyon testlerinde yükseklik saptandı. Ayrıca fi zik muayenede sol servikal bölgede multiple lenfadenopatilerin varlığı nedeni ile lenf düğümü insizyonel biyopsi işlemi yapıldı. Biyopsinin değerlendirilmesinde yaygın nekroz alanları ile lenfoblastik ve histiositik hücre infi ltrasyon alanları ve yaygın nekrotik debris izlendi. Polimorfonükleer lökositik infi ltrasyon görülmedi. Bu bulgular temelinde olgumuz nekrotizan lenfadenitis-KFH hastalığı ile uyumlu olarak rapor edildi. Etiyolojisi bilinmeyen, kendi kendini sınırlayan bu hastalık, histopatolojik incelemede lenfoma ile karışabilir. Bu nedenle benign lenfadenopatilerin ayırıcı tanısında KFH'nın hatırlanması gerekir.

A cause of necrotizing lymphadenitis Kikuchi Fujimoto disease

Necrotizing lymphadenopathies arised from the different causes could be encountered in the routine surgical histopathology practice. Kikuchi-Fujimoto disease (KFD) rarely seen in our country is a necrotizing lymphadenitis and frequently encountered in Far East Asia. The women are affected by KFD, two times more frequently. KFD are clinically presented with lymphadenomegaly and findings of upper respiratory tract infection. Leukopenia, elevated liver function tests and high erythrocyte sedimentation rate are laboratory findings of KFD. A thirty-eight years old male patient was admitted to our center with fever, weakness, sore throat and arthralgia during the previous fifteen days. Erythrocyte sedimentation rate was 40 mm/h and liver function tests were in high values. The lymph node inscional biopsy was performed due to the presence of multiple lymphadenopathies in the left cervical region on physical examination. In evaluating of the biopsy, extensive necrosis areas, lymphoblastic and histiocytic cell infiltrations were observed. Polymorphonuclear leukocyte infiltration was seen. On the basis of these histopathological findings, our case was reported as "necrotizing lymhadenitis"-KFD. This self limited disorder with unknown etiology could be misdiagnosed as lymphoma on histopathological examination. For this reason, KFD should be kept in mind in differential diagnosis of benign lymphadenopathies.

PDF

___

1. Kikuchi M. Lymadenitis showing focal reticulum cell hyperplasia with nuclear debris and phagocytes: a clinicopathological study. Acta Hematol Jpn 1972;35:379-380.
2. Fujimoto Y, Kozimo Y, Yamaguchi K. Cervical subacute necrotizing lymphadenitis: a new clinicopathologic entity. Naika 1972;20:20-27.
3. Huh J, Chi HS, Kim SS et al. A study of the viral etiology of histiocytic necrotizing lympadenitis (Kikuchi-Fujimoto disease). J Korean Med Sci 1998;13:27-30.
4. Bosch X, Guilabert A. Kikuchi-Fujimoto disease. Orphanet J Rare Dis. 2006 May 23;1(1):18.
5. Çoşkun U, Yıldırım Y, Ceyhan K ve ark. T. Klin Tıp Bilimleri 2004;24:106-108.
6. Takakuwa T, Ohnuma S, Koike J et al. Involvement of cell mediated killing in apoptosis in histiocytic necrotizing lymphadenitis (Kikuchi-Fuchimoto disease). Histopathology 1996;28:41-8.
7. Sumiyoshi Y, Kikuchi M, Takeshita M et al. Alpha-interferon in Kikuchi’s disease. Virchows Archiv. B, Cell Pathol Incl Mol Pathol 1991;61:201-207.
8. Hirai M, Tanaka K, Hasuike T et al. Detected Epstein-Barr virus genome using polymerase chain reaction in peripheral mononuclear cells-subacute necrotizing lympadenitis (Japanese) Rinsho Byori- Japanese J Clinical Pathol 1995;43:181-186.
9. Pileri AS, Pileri A, Yasukawa K et al. Th a Karma of Kikuchi’s disease. Clin Immunol 2005;114:27-29.
10. Meyer O, Kahn MF, Grossin M et al. Parvovirus B19 infection can induce histiocytic necrotizing lymphadenitis (Kikuchi’s disease) associated with systemic lupus erythematosus. Sarcoidosis 1991;8:170-171.
11. Dorfman RF. Histioytic necrotizing lymphadenitis of Kikuchi and Fujimoto. Arch Pathol Lab Med 1987;111:1026-1029.
12. Imamura M, Ueno H, Matsuura A et al. An ultrastructural tudy of subacute necrtizing lymphadenitis. Am J Pathol 1982;107:292-299.
13. Oshima K, Shimazaki K, Kume T et al. Perforin and Fas pathways of cytotoxic T-cells in histiocytic necrotizing lymphadenitis. Histopathology 1998;33:471-478.
14. Bosch X, Guilabert A, Miquel R et al. Enigmatic Kikuchi-Fujimoto disease: a comprehensive review. Am J Clin Pathol 2004;122:141-152.
15. Lin HC, Su CY, Huang CC et al. Kikuchi’s disease. A review and analysis of 61 cases. Otolaryngol Head Neck Surg 2003;128:650-563.
16. Ramiraz AL, Johnson J, Murr AH. Kikuchi-Fujimoto’s Disease: An easily misdiagnosed clinical entity. Otolaryngol Head Neck Surg 2001;125:651-653.
17. Sun-wing Tong TR, Chan OW, Lee K. Diagnosing Kikuchi Disease on fi ne needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and by histopathology. Acta Cytologica 2001;45:953-957.
18. Lin CW, Chang CL, Li CC, Chen Y, Lee WH, Hsu SH. Spontaneous regression of Kikuchi lymphadenopahty with oligoclonal T-cell populations favors a benign immune reaction over a T-cell lymphoma. Am J Clin Pathol 2002;117:627-635.