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From the Departments of Malignant Hematology (DD, LS) and Address correspondence to Darcie Deaver, PhD, Celgene
Hematopathology and Laboratory Medicine (PH) at the H. Lee Moffitt Corporation, 1503 Foppiano Loop, Round Rock, TX 78665.
Cancer Center & Research Institute, Tampa, Florida, and IHCFLOW E-mail: darciemarie2@hotmail.com
(HC), Lutz, Florida. No significant relationships exist between the authors and the com-
Dr Deaver is now affiliated with Celgene Corporation. panies/organizations whose products or services may be referenced
Submitted February 18, 2014; accepted July 2, 2014. in this article.
Cytomorphology Immunohistochemistry
Kikuchi–Fujimoto Disease Distorted nodal architecture with cortical and paracortical CD68 +
Systemic Lupus Erythematosus Moderate reactive follicular hyperplasia, scattered plasma CD4+ with predominance over CD8+ T cells
cells and immunoblasts, with increased vascularity or varying Lymphoid follicles are mixture of small-
degrees of coagulative necrosis with Azzopardi phenomenon and medium-sized lymphocytes
and presence of hematoxylin bodies
Germinal centers of the B cell are BCL2–
A B
C D
Fig 1 A-D. — (A) Low power view of a lymph node with involvement by Kikuchi histiocytic necrotizing nonsuppurative lymphadenitis. The pathognomonic
pale foci are clues to the collection of histiocytes located in the center between the benign germinal centers located on the left and right sides of the image.
(B) Medium power view showing necrosis and pink debris among histiocytes with round- to sickle-shaped nuclei. Well-formed granulomas are not typically
seen. (C) Oil magnification showing sheets of pale histiocytic nuclei with violaceous hue and pink cytoplasm showing early findings of the disease with
crescentic histiocytes appearing as tingible bodies. This stage is the most often histological appearance mistaken for large cell lymphoma because of the
solid appearance of these large cells. Most of these are plasmacytoid monocytes that derive from plasmacytoid dendritic cells. (D) A more advanced stage of
Kikuchi–Fujimoto lymphadenitis recognized by pathologists that shows the typical pink necrotizing nodules composed of histiocytic debris. Note the absence
of neutrophils or suppurative abscess, which is a hallmark distinguishing this process from the class of suppurative granulomas.
FDG/PET avid Yes/High Yes/High Yes/Low, if active disease Yes/Low, if active disease
Asymptomatic Symptomatic
Nonsteroidal
Observation Glucocorticoids Hydroxychloroquine
anti-inflammatories
Negative Positive