Enigmatic Kikuchi-Fujimoto Disease: A Comprehensive Review

Xavier Bosch, MD; Antonio Guilabert, MD; Rosa Miquel, MD; Elias Campo, MD

Disclosures

Am J Clin Pathol. 2004;122(1) 

In This Article

Diagnosis

KFD generally is diagnosed on the basis of an excisional biopsy of affected lymph nodes. This disorder does not have a characteristic appearance on ultrasonographic or computed tomographic (CT) examination. The findings of CT and magnetic resonance imaging of KFD can be variable and mimic not only lymphoma but also various nodal diseases with necrosis, including metastasis and tuberculosis.[93,94,95] By using CT and magnetic resonance imaging, Miller and Perez-Jaffe[96] found a distinctive lymphadenopathy pattern in patients with KFD consisting of many small clustered lymph nodes. However, these observations must be interpreted cautiously because the study was carried out with a small number of patients.[96]

The usefulness of fine-needle aspiration cytology (FNAC) to establish a cytologic diagnosis of KFD has been limited and, in general, it is less useful than excisional lymph node biopsy. It has been said, however, that surgical biopsy would be unnecessary if a firm diagnosis could be made by using FNAC.[97,98,99,100] Thus, the results from 2 studies including histologic sections and excisional biopsy specimens led to the conclusion that in patients with typical clinical features and characteristic cytologic findings in lymph node aspirates, FNAC alone would suffice for diagnosing KFD.[97,100] Nevertheless, the overall diagnostic accuracy of FNAC for KFD has been estimated at 56.3%.[101] Therefore excisional lymph node biopsy should be mandatory if clear-cut clinical and cytologic KFD findings are absent.

We speculate that KFD might be an underdiagnosed disorder. It is possible that some (or many) young patients with (a "minor form" of) KFD who have a short history of low-grade fever and small cervical lymphadenopathy are given a presumptive diagnosis of a viral process, especially when their physical examination findings are normal, atypical lymphocytes are seen in a peripheral blood smear, and no lymph node biopsy is available.

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