Journal of Cytology
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 25  |  Issue : 1  |  Page : 36-37
Fine needle aspiration cytology of Kikuchi's lymphadenitis


1 Air Force Central Medical Establishment, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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How to cite this article:
Singh G, Iyer VK. Fine needle aspiration cytology of Kikuchi's lymphadenitis. J Cytol 2008;25:36-7

How to cite this URL:
Singh G, Iyer VK. Fine needle aspiration cytology of Kikuchi's lymphadenitis. J Cytol [serial online] 2008 [cited 2020 Sep 18];25:36-7. Available from: http://www.jcytol.org/text.asp?2008/25/1/36/40658


To the Editor,

Kikuchi's lymphadenitis also known as histiocytic necrotizing lymphadenitis, is an uncommon but well defined clinical entity that typically involves cervical lymph nodes of young adults. It is a benign, self-limited disease of unknown etiology. It is however, possible to miss the diagnosis on fine needle aspiration (FNA) cytology, if adequate attention is not given to the cytological features. We report here a case of Kikuchi's lymphadenitis, which showed features permitting cytological diagnosis.

A 25 year-old female patient presented to the All India Institute of Medical Sciences, New Delhi with fever of three months' duration with no localizing symptoms. Clinical examination revealed cervical lymphadenopathy. Four air-dried smears of an FNA procedure stained with May-Grünwald-Giemsa (MGG) were received for review. The smears were highly cellular and showed predominantly lymphoid tissue. However, numerous histiocytes were seen intricately admixed with the lymphoid cells. Karyorrhectic debris was seen focally. Some of the histiocytes in the areas of karyorrhexis had eccentrically placed, crescent-shaped nuclei [Figure - 1]. The karyorrhectic debris was present both extracellularly as well as within these histiocytes [Figure - 2]. No granulomas, neutrophils, or eosinophils were seen. A cytological diagnosis of necrotizing lymphadenitis was suspected. The patient underwent a cervical lymph node biopsy, which showed numerous similar histiocytes, including some with crescentic nucleus [Figure - 3]. A diagnosis of necrotizing lymphadenitis compatible with Kikuchi's disease was made.

The value of FNA in the diagnosis of lymph node disorders is well recognized. Kikuchi's lymphadenitis is one of the few reactive lymph node conditions in which characteristic cytological findings have been described. [1],[2],[3] The presence of abundant karyorrhectic debris in any lymph node aspirate should make one suspect this condition. In the present instance, this feature was only focally present. Identification of numerous nondescript histiocytes in lymph node FNA smears is another pointer toward this diagnosis, which has not been highlighted in previous reports. In the present instance, numerous such histiocyte were seen, which had no specific nuclear features and no phagocytosed material in the cytoplasm. The key to diagnosis is however the recognition of characteristic histiocytes having a crescent-shaped nucleus. These should not be mistaken for tingible body macrophages commonly found in reactive lymph node. These low and high power features should alert the cytopathologist to make a correct diagnosis for which awareness is essential.

 
   References Top

1.Tsang WY, Chan JK. Fine needle aspiration cytologic diagnosis of Kikuchi's lymphadenitis: a report of 27 cases. Am J Clin Pathol 1994;102:454-8.  Back to cited text no. 1  [PUBMED]  
2.Viguer JM, Jimenez-Heffernan JA, Perez P, Lopez-Ferrer P, Gonzalez-Peramato P, Vicandi B. Fine needle aspiration cytologic diagnosis of Kikuchi's lymphadenitis: a report of 10 cases. Diagn Cytopathol 2001;25:220-4.  Back to cited text no. 2    
3.Tong TR, Chan OW, Lee K. Diagnosing Kikuchi's lymphadenitis on fine needle aspiration biopsy: a retrospective study of 44 cases diagnosed by cytology and 8 by histopathology. Acta Cytol 2001;45:953-7.  Back to cited text no. 3    

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Correspondence Address:
Venkateswaran K Iyer
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.40658

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]

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