Adult ; Diagnosis, Differential ; Exanthema ; etiology ; Histiocytic Necrotizing Lymphadenitis ; complications ; diagnosis ; Humans ; Lymphatic Diseases ; etiology ; Male

Adolescent ; Child ; Female ; Fever ; etiology ; Histiocytic Necrotizing Lymphadenitis ; classification ; complications ; diagnosis ; Humans ; Lymph Nodes ; pathology ; Male

A 13-yr-old female was admitted to our hospital with fever, seizure, and cervical lym-phadenopathy. Laboratory data showed pancytopenia, elevation of serum transaminase, lactate dehydrogenase, triglyceride, and ferritin levels. Lymph node biopsy revealed features of Kikuchi's disease and there were signs of histiocytosis and hemophagocytic phenomenon in bone marrow. She recovered after treatment with intravenous immunoglobulin and corticosteroids therapy. Hemophagocytic syndrome can be associated with Kikuchi's disease especially in childhood and seems to have a less aggressive clinical course and better prognosis.
Adolescent ; Adrenal Cortex Hormones/therapeutic use ; Biopsy ; Bone Marrow Cells/metabolism/pathology ; Female ; Ferritin/blood ; Histiocytic Necrotizing Lymphadenitis/*complications/*diagnosis ; Histiocytosis, Non-Langerhans-Cell/*complications/*diagnosis ; Human ; Immunoglobulins/metabolism/therapeutic use ; L-Lactate Dehydrogenase/blood ; Lymph Nodes/pathology ; Lymphatic Diseases/diagnosis ; Necrosis ; Pancytopenia/diagnosis ; Prognosis ; Transaminases/blood ; Triglycerides/blood

OBJECTIVETo study the clinical manifestation, pathologic features and immunophenotype of histiocytic necrotizing lymphadenitis (HNL).

METHODSThe clinicopathologic data of 84 patients with HNL from 2005 to 2014 were retrospectively studied. Immunohistochemical staining using EliVision method for CD20, PAX5, CD3, CD45RO, CD4, CD8, CD56, CD68, CD123, granzyme-B, TIA1 and MPO was carried out. In-situ hybridization for Epstein-Barr virus RNA was performed on archival lymph node biopsy tissue.

RESULTSImmunohistochemical study showed that the lesional cells were predominantly histiocytes (CD68+), plasmacytoid dendritic cells (CD123+) and T lymphocytes (CD3+ and CD45RO+). Clusters of CD68-positive cells with strong and diffuse MPO expression were identified. T lymphocytes with CD4 and CD8 positivity were noted. CD56+ natural killer cells and CD20+/PAX5 B cells were rare. Apoptosis-related markers, including TIA1 and granzyme B were expressed by T lymphocytes and histiocytes in lymph nodes of HNL. In-situ hybridization for Epstein-Barr virus RNA was positive in only 10.0% of the cases.

CONCLUSIONSHNL shows no specific clinical and laboratory findings. Recognition of the characteristic histopathologic changes in lymph node biopsy of HNL is the key to correct diagnosis. Immunohistochemical study using a panel of markers, including CD3, CD4, CD8, MPO, CD123, granzyme-B and TIA1, is helpful in the differential diagnosis of HNL.

Antigens, CD ; analysis ; Biomarkers ; Dendritic Cells ; pathology ; Diagnosis, Differential ; Granzymes ; analysis ; Herpesvirus 4, Human ; genetics ; Histiocytes ; pathology ; Histiocytic Necrotizing Lymphadenitis ; complications ; immunology ; pathology ; virology ; Humans ; Immunohistochemistry ; Immunophenotyping ; In Situ Hybridization ; methods ; Lymph Nodes ; RNA, Viral ; analysis ; Retrospective Studies ; T-Lymphocytes ; immunology ; pathology