This case study details the case of a 50-year-old white Hispanic male from Puerto Padre, Las Tunas, Cuba, who presented with a Left-sided Cervical mass characterized by prominent lymphadenopathy, low-grade fever of short duration, and no significant systemic symptoms or weight loss. Initial diagnostic workup included general hematologic studies, cervical imaging, two Fine Needle Aspiration biopsies of a Submandibular lymph node, and histopathological examination following a left-sided Supraomohyoid functional neck dissection. Both Fine Needle Aspirations were interpreted as positive for Metastatic Carcinoma with Sarcomatous Features. Autoimmune and collagen vascular disorders were considered, and Tuberculosis was excluded. The patient was managed presumptively for Metastatic Lymphadenopathy of Unknown Primary Origin. However, final histopathologic and inmuno histochemical evaluation of the surgical specimen revealed abundant histiocytic infiltration (CD68+), along with reactive T-cell (CD3+) and B-cell (CD20+) populations, consistent with a diagnosis of Necrotizing Histiocytic Lymphadenitis (Kikuchi-Fujimoto Disease). The patient’s clinical course was favorable, with complete resolution of symptoms (1-2).
Table of Contents
- Case Presentation
- However, special stains for Acid-Fast Bacilli were Negative. Immunohistochemical evaluation
- Discussion
Objectives and Key Themes
This case study aims to illustrate the diagnostic challenges posed by Kikuchi-Fujimoto Disease (KFD), highlighting the potential for misleading cytological findings and the importance of comprehensive diagnostic workup. The case emphasizes the need for a multidisciplinary approach when initial findings are inconclusive.
- Diagnostic challenges in differentiating KFD from malignancy
- Limitations of fine needle aspiration (FNA) cytology in KFD diagnosis
- Importance of histopathological analysis and immunohistochemistry in confirming KFD
- Clinical presentation and atypical demographics of KFD
- Role of multidisciplinary evaluation in resolving diagnostic discrepancies
Chapter Summaries
Case Presentation: This section details the case of a 50-year-old male who presented with a left-sided cervical mass, low-grade fever, and fatigue. Initial FNA biopsies were misinterpreted as metastatic carcinoma with sarcomatous features. Imaging revealed enlarged submandibular and parotid glands with associated lymphadenopathy. The patient's history included type 1 diabetes and tobacco use. A provisional diagnosis of metastatic cervical lymphadenopathy of unknown origin was made, leading to a left-sided Supraomohyoid Neck Dissection (SOHND).
However, special stains for Acid-Fast Bacilli were Negative. Immunohistochemical evaluation: Histopathological examination of the surgical specimen revealed normal salivary gland and muscle architecture, with multiple lymph nodes showing reactive follicular hyperplasia. One lymph node showed granulomatous inflammation, initially suggesting tuberculosis, but acid-fast bacilli stains were negative. Immunohistochemical evaluation revealed abundant CD68-positive histiocytes, CD3-positive T-cells, and CD20-positive B-cells, leading to a definitive diagnosis of Kikuchi-Fujimoto Disease (KFD). The patient experienced a favorable postoperative course with symptom resolution.
Discussion: This section provides background information on KFD, a rare, benign, self-limiting lymphadenopathy. It discusses the typical demographic presentation (young women under 40, Asian descent), the etiology (potentially viral or autoimmune), and the clinical presentation (tender cervical lymphadenopathy, fever, fatigue). The discussion highlights the challenges in diagnosing KFD, particularly when FNA yields atypical results, emphasizing the importance of excisional biopsy and histopathological analysis as the gold standard. The section emphasizes the role of immunohistochemistry in distinguishing KFD from other conditions. This case is discussed as an example of an atypical presentation (older male patient) and the diagnostic challenges it presented. The authors stress the importance of multidisciplinary evaluation when cytology and clinical presentation are discordant.
Keywords
Kikuchi-Fujimoto Disease, Necrotizing Histiocytic Lymphadenitis, Cervical Lymphadenopathy, Fine Needle Aspiration, Misdiagnosis, Histopathology, Immunohistochemistry, CD68, CD3, CD20, Metastatic Carcinoma, Diagnostic Challenges, Multidisciplinary Approach.
Frequently asked questions
What is the Kikuchi-Fujimoto Disease (KFD) Case Study about?
This case study discusses a specific instance of Kikuchi-Fujimoto Disease (KFD) in a 50-year-old male, highlighting the diagnostic challenges and the importance of a comprehensive diagnostic workup to avoid misdiagnosis.
What are the key objectives of this case study?
The case study aims to illustrate the difficulties in distinguishing KFD from malignancy, the limitations of fine needle aspiration (FNA) cytology in diagnosing KFD, the importance of histopathological analysis and immunohistochemistry in confirming KFD, the atypical clinical presentation of KFD, and the role of multidisciplinary evaluation in resolving diagnostic discrepancies.
What is Kikuchi-Fujimoto Disease (KFD)?
Kikuchi-Fujimoto Disease (KFD) is a rare, benign, and self-limiting lymphadenopathy, typically affecting young women under 40 of Asian descent. It can be caused by viral or autoimmune etiologies. It usually presents with tender cervical lymphadenopathy, fever, and fatigue.
What were the initial findings in the case presentation?
The patient, a 50-year-old male, presented with a left-sided cervical mass, low-grade fever, and fatigue. Initial FNA biopsies were misinterpreted as metastatic carcinoma with sarcomatous features. Imaging revealed enlarged submandibular and parotid glands with associated lymphadenopathy. The patient's history included type 1 diabetes and tobacco use.
Why was the initial FNA misdiagnosis a problem?
The initial FNA misdiagnosis led to an incorrect provisional diagnosis of metastatic cervical lymphadenopathy of unknown origin, which in turn led to a left-sided Supraomohyoid Neck Dissection (SOHND).
What role did special stains and immunohistochemistry play in the correct diagnosis?
Special stains for Acid-Fast Bacilli were negative, ruling out tuberculosis. Immunohistochemical evaluation revealed abundant CD68-positive histiocytes, CD3-positive T-cells, and CD20-positive B-cells, which led to the definitive diagnosis of Kikuchi-Fujimoto Disease (KFD).
Why is histopathological analysis so important in diagnosing KFD?
Histopathological analysis, specifically excisional biopsy, is considered the gold standard for diagnosing KFD. It allows for a more accurate assessment of the lymph node architecture and cellular composition, compared to FNA.
What are the keywords associated with this case study?
The keywords associated with this case study are: Kikuchi-Fujimoto Disease, Necrotizing Histiocytic Lymphadenitis, Cervical Lymphadenopathy, Fine Needle Aspiration, Misdiagnosis, Histopathology, Immunohistochemistry, CD68, CD3, CD20, Metastatic Carcinoma, Diagnostic Challenges, Multidisciplinary Approach.
What is the significance of this case study's emphasis on a multidisciplinary approach?
The case emphasizes that reliance on single diagnostic tool (like FNA) can lead to misdiagnosis. A multidisciplinary approach (radiology, histopathology, immunohistochemistry, clinical history) is crucial for accurate diagnosis, especially in atypical presentations of KFD.
Why is this case presentation considered atypical?
This case is atypical because it involves an older male patient, while KFD more commonly affects young women of Asian descent.
- Quote paper
- Manuel Suárez (Author), Amanda Menendez Soler (Author), Manuel J. Medina Rodriguez (Author), Helen Aguila Cid (Author), Lizander Verges Acosta (Author), Israel Borrajero (Author), 2025, Misleading Cytology in Cervical Lymphadenopathy, Munich, GRIN Verlag, https://www.hausarbeiten.de/document/1596449
