What is the role of biopsy in the workup of Kikuchi disease?

Updated: Nov 13, 2020
  • Author: John Boone, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Answer

A definitive diagnosis of Kikuchi disease can be made only by tissue evaluation. Cytologic examination by fine needle aspiration (FNA) can suggest the diagnosis of Kikuchi disease, especially when supported by typical clinical findings, but excisional biopsy of an involved lymph node is needed to confirm the diagnosis in doubtful cases.

FNA characteristics include the following:

  • FNA findings are most often nonspecific; some authors believe that the diagnosis can be confirmed when supported by typical clinical findings, but most authors recommend confirmation by excisional biopsy

  • In a retrospective study of 44 patients, FNA had an overall accuracy of 56.75% in diagnosing Kikuchi disease [31]

  • Characteristic cytologic findings in Kikuchi disease include crescentic histiocytes, plasmacytoid monocytes, and extracellular debris

  • Definitive diagnosis by FNA is uncommon; prudent pathologists are likely to report results as "suggestive of" or "compatible with" Kikuchi disease

  • Confirm the diagnosis of Kikuchi disease by excisional biopsy in doubtful cases

Excisional lymph node biopsy can reveal histologic findings consistent with Kikuchi disease, as follows:

  • Paracortical necrosis may be patchy or confluent, and the degree of necrosis varies considerably from patient to patient

  • Histocytes – Crescent-shaped nuclei (crescentic nuclei)

  • Other cells – Lymphocytes, plasmacytoid monocytes, macrophages, and immunoblasts (predominantly T cells)

  • Karyorrhexis – Histiocytes and macrophages containing phagocytized debris from degenerated lymphocytes

  • Absent or rare features in Kikuchi disease include neutrophils, granulomas, and plasma cells


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