Inset: necrotic areas are mainly composed of abundant karyorrhectic debris, fibrin deposits, and histiocytes (H&E stain, × 100).Į. The histologic section of the celiac lymph node shows extensive necrosis, particularly in the paracortical area (H&E stain, × 20). The anterior maximum intensity projection image of 18F-FDG PET/CT shows multiple hypermetabolic lymph nodes in the neck, bilateral supraclavicular, bilateral axillary, retro-pancreatic, mesenteric, left paraaortic, aortocaval, bilateral iliac, and bilateral inguinal areas (arrows).ĭ. Enlarged lymph nodes in the left paraaortic and aortocaval spaces (arrowheads) are hypoechoic on transverse US (left), hyperdense on contrast-enhanced abdominal CT (middle), and hypermetabolic on 18F-FDG PET/CT (right).Ĭ. Multiple enlarged lymph nodes near the celiac trunk (arrowheads) and in the left paraaortic space (arrows) are hypoechoic on transverse US (left), homogeneously hyperdense with perinodal infiltration on contrast-enhanced abdominal CT (middle) and hypermetabolic on 18F-FDG PET/CT (right).ī. Kikuchi disease in a 15-year-old girl manifesting as multifocal lymphadenopathy and splenomegaly mimicking lymphoma. After the administration of a low dose corticosteroid, the patient became afebrile and was discharged without any complications. The bone marrow biopsy showed a normal complement of precursor cells with normal cellularity. 1E) and CD68, indicating a predominance of T lymphoid cells and histiocytes, and negative results for CD20, CD79a, CD5, cyclin D1, BCL2, BCL6, CD10, C138, MUM-1, CD30, ALK, MPO, Ki-67, EBER, and AFB, consistent with histiocytic necrotizing lymphadenitis, also known as KFD ( Fig. In addition, immunohistochemical staining of the paraffin blocks revealed strong positivity for CD3 ( Fig. There were collections of transformed lymphocytes, histiocytes, and plasmacytoid monocytes in the cortical areas around the germinal centers ( Fig. Histopathologic evaluation of the resected lymph node revealed extensive necrosis, especially in the paracortical areas. Therefore, for accurate diagnosis, laparoscopic excision of the celiac lymph nodes and bone marrow biopsy were performed to exclude malignancy. Although the lymph nodes in both neck also showed FDG uptake, those were not significantly large in size. With the suspicion of lymphoma, the patient underwent 18F-FDG PET/CT that demonstrated an increased FDG uptake on the enlarged lymph nodes in both neck, both supraclavicular, both axillary, retro-pancreatic, mesenteric, left para-aortic, aortocaval, both iliac, and both inguinal areas, with a maximum standardized uptake value (SUVmax) of 10 ( Fig. The abdominal CT scan showed similar findings with US that the enlarged lymph nodes showed homogeneous density without internal necrotic foci, but with only mild perinodal infiltration. The abdominal ultrasonography (US) revealed mild splenomegaly, measuring 12 cm on the long axis and multiple enlarged homogeneously hypoechoic lymph nodes near the celiac axis and para-aortic space, measuring up to 1.3 cm on the short axis ( Fig. Chest and abdominal plain radiographs were unremarkable. Serologic and microbiologic tests for tuberculosis, systemic lupus erythematosus, and infectious mononucleosis were all negative. ![]() Lactate dehydrogenase, C-reactive protein, and erythrocyte sedimentation rate were elevated (413 IU/L, 0.890 mg/dL, and 76 mm/h, respectively). The patient's serum electrolytes, liver function test, and routine urinalysis were also within normal limits. The patient's hemoglobin count was 9.5 g/dL, which is lower than normal range, but leukocyte and platelet counts were within normal range (leukocyte count 4.43 × 10 3/µL with distribution of lymphocyte 36.8%, monocyte 4.1%, and eosinophil 0.7% and platelet count 203 × 10 3/µL). The patient had a fever (38.7℃), but her other vital signs were within the normal range (pulse rate 90 beats/min, blood pressure 130/80 mm Hg, and respiratory rate 18 breaths/min). Physical examination revealed no palpable mass in neck and no abnormalities in other parts of the body. There was no headache, cough, abdominal pain, dysuria, vomiting, loose stools or weight loss and no previous history of similar complaints. A 15-year-old girl presented with a 2-week history of fever, chills, and sweating. Our Institutional Review Board approved this case report, and informed consent was waived because of the retrospective nature of this report.
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