Haematopathology 2016 Craig Soderquist MD and Vinodh Pillai MD PhD Kikuchi disease presenting as abdominal mass Case number Clinical History 8 year old African female Adopted from Ghana no known family history ID: 927642
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Slide1
European Association for Haematopathology 2016
Craig Soderquist, MD and Vinodh Pillai, MD, PhD
Kikuchi disease presenting as abdominal mass
Case number
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Slide2Clinical History8 year old African female Adopted from Ghana, no known family historyNo past medical history
Chief Complaint: Intermittent fever of 1-2 month duration Unintentional 8 pound (~10%) weight loss
Slide3Clinical HistoryCBC: WBC: 3.5 K/µl, Hgb
10.2 g/dl, Platelet 226KLabs:Negative infectious workupNegative autoimmune workupTreatment:Antibiotics (cefnidir, amoxicillin, doxycycline)NaproxenPrednisone taper
Slide4Clinical HistoryImaging: Mesenteric mass (5 cm) abutting the inferior vena cava
Abdominal mass resection highlighted in the following slides
Slide5Abdominal mass biopsy, H&E, 5x
Slide6Abdominal mass
biopsy, H&E, 10x
Slide7Abdominal mass
biopsy, H&E, 40x
Slide8Abdominal mass
biopsy, IHC, 10xClusters of plasmacytoid dendritic cells adjacent to necrosis CD123
Slide9Abdominal mass
biopsy, IHC, 20xClusters of plasmacytoid dendritic cells adjacent to necrosis CD123
Slide10Abdominal mass
biopsy, IHC, 5xMPO positive histiocytes adjacent to necrosis MPO
Slide11Abdominal mass
biopsy, IHC, 10xMPO positive histiocytes adjacent to necrosis MPO
Slide12Abdominal mass
biopsy, IHC, 20xMPO positive histiocytes adjacent to necrosis MPO
Slide13Abdominal mass
biopsy, IHC, 10xCD15 highlights maturing myelomonocytic cells CD15
Slide14Abdominal mass
biopsy, IHC, 40xCD15 highlights histiocytes
CD15
Slide15Ancillary StudiesImmunohistochemistry- Unremarkable B and T cells, EBER and ALK-1 are negative.
Flow cytometry Polytypic mature B cells and unremarkable T cells with no aberrant antigen expression or lossCytogenetics and SNP arraysUnremarkableIGH and TCR rearrangement studies: Negative for a clonal population
Slide16Interesting Features of CaseLarge 5cm mesenteric mass
Significant systemic symptoms for 2 monthsResection showed histiocytic necrotizing lymphadenitisOverall morphological and immunophenotypic features favor kikuchi-fujimoto lymphadentitis
Histiocytic disorder of unknown etiology
Slide17Proposed DiagnosisHistiocytic necrotizing lymphadenitis, favor kikuchi-fujimoto lymphadenitis