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Necrotizing non-granulomatous lymphadenitis: a clinicopathologic study of 40 Thai patients
Anapat Sanpavat1, Pongsak Wannakrairot, Thamathorn Assanasen
1Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Necrotizing non-granulomatous lymphadenitis in Thai patients can indicate Kikuchi-Fujimoto disease, tuberculosis, or systemic lupus erythematosus. Histopathological evaluation is crucial for accurate diagnosis and treatment of these diverse conditions.
Area of Science:
- Pathology
- Histopathology
- Oncology
Background:
- Necrotizing non-granulomatous lymphadenitis is a histological pattern observed in various conditions.
- Distinguishing between causes is essential for appropriate patient management.
Purpose of the Study:
- To describe the clinicopathological features of necrotizing non-granulomatous lymphadenitis in Thai patients.
- To identify common causes and diagnostic challenges associated with this condition.
Main Methods:
- Retrospective review of 40 Thai patient cases diagnosed with necrotizing non-granulomatous lymphadenitis.
- Evaluation of clinical features, histomorphology, and special stains from pathology records (2001-2003).
Main Results:
- Kikuchi-Fujimoto disease (KFD) accounted for 42.5% of cases, tuberculosis (TB) lymphadenitis for 20%, and systemic lupus erythematosus (SLE) with lymphadenitis for 2.5%.
- 35% of cases lacked a specific diagnosis due to insufficient follow-up data.
- Distinct histopathological features were identified for KFD, TB lymphadenitis, and SLE-associated lymphadenitis.
Conclusions:
- Necrotizing non-granulomatous lymphadenitis is not disease-specific but a common histological change.
- Accurate diagnosis requires further investigation beyond initial histopathology, considering KFD, TB, and SLE.
- Definitive diagnosis is critical for guiding appropriate treatment strategies.
Abstract:
The purpose of this study was to describe the clinicopathological features of 40 cases of necrotizing non-granulomatous lymphadenitis in Thai patients. The clinical features, histomorphology and special stains were evaluated in 40 Thai patients from the pathology records of King Chulalongkorn Memorial Hospital from January 2001 to December 2003 in those diagnosed as having necrotizing non-granulomatous lymphadenitis. Of the 40 patients, 17 cases (42.5%) had Kikuchi-Fujimoto disease (KFD), 8 cases (20%) had tuberculosis (TB) lymphadenitis and 1 case (2.5%) had systemic lupus erythematosus (SLE) with associated lymphadenitis. Fourteen cases (35%) did not have a specific diagnosis due to a lack of follow-up data. KFD most commonly occurs in young women, and is characterized by the presence of coagulative necrosis and karyorrhexis often centered in the paracortex, an absence of neutrophils and plasma cells, proliferation of various cells composed of lymphocytes, histiocytes, immunoblasts and plasmacytoid monocytes and the absence of a granuloma. Tuberculous lymphadenitis usually occurs in women with a mean age of 34.25 years. The lymph nodes reveal extensive coagulative necrosis involving the cortex, paracortex and medulla, proliferation of mixed inflammatory cells, including neutrophils, lymphocytes and plasma cells in the necrotic area and the presence of proliferating histiocytes at the periphery of the necrotic area. The lymph nodes of SLE-associated lymphadenitis reveal large numbers of plasma cells and hematoxylin bodies. We suggest that necrotizing non-granulomatous lymphadenitis is not specific for any disease, but rather a common histologic change found in diseases, such as TB, SLE, and KFD. Further investigation to obtain a definite diagnosis should be done for appropriate treatment.