This case study details the case of a 50-year-old white Hispanic male from Puerto Padre, Las Tunas, Cuba, who presented with a Left-sided Cervical mass characterized by prominent lymphadenopathy, low-grade fever of short duration, and no significant systemic symptoms or weight loss. Initial diagnostic workup included general hematologic studies, cervical imaging, two Fine Needle Aspiration biopsies of a Submandibular lymph node, and histopathological examination following a left-sided Supraomohyoid functional neck dissection. Both Fine Needle Aspirations were interpreted as positive for Metastatic Carcinoma with Sarcomatous Features. Autoimmune and collagen vascular disorders were considered, and Tuberculosis was excluded. The patient was managed presumptively for Metastatic Lymphadenopathy of Unknown Primary Origin. However, final histopathologic and inmuno histochemical evaluation of the surgical specimen revealed abundant histiocytic infiltration (CD68+), along with reactive T-cell (CD3+) and B-cell (CD20+) populations, consistent with a diagnosis of Necrotizing Histiocytic Lymphadenitis (Kikuchi-Fujimoto Disease). The patient’s clinical course was favorable, with complete resolution of symptoms (1-2).
Table of Contents
1. Abstract
2. Case Presentation
3. Discussion
4. Conclusion
Objectives and Topics
This case study aims to highlight the diagnostic challenges associated with Kikuchi-Fujimoto Disease (KFD), particularly when clinical and initial cytological findings mimic malignancy. It details the journey of a patient who underwent unnecessary surgical intervention due to misinterpretation of Fine Needle Aspiration (FNA) results, emphasizing the critical role of comprehensive histopathological and immunohistochemical analysis for accurate diagnosis.
- Clinical presentation and diagnostic workup of cervical lymphadenopathy.
- The risks of misinterpreting FNA cytology as metastatic carcinoma.
- The importance of histopathological and immunohistochemical markers (CD68+, CD3+, CD20+).
- Management strategies for rare, self-limiting diseases in atypical demographics.
- The value of multidisciplinary evaluation in complex head and neck cases.
Excerpt from the Book
Case Presentation:
A 50-year-old Caucasian male with a medical history significant for type 1 Diabetes Mellitus managed with Glibenclamide and a history of tobacco use presented with a six-month history of progressive, non-tender swelling on the left side of the Neck. The patient reported intermittent low-grade fevers and vague constitutional symptoms, including fatigue and general malaise, but denied weight loss, night sweats, or respiratory complaints. Physical examination revealed firm, non-fluctuant lymphadenopathy in the left submandibular and upper cervical region, without overlying skin changes or signs of acute infection. Initial Cervical Soft Tissue Ultrasonography imaging revealed a heterogeneous, enlarged Left Submandibular Gland containing a Cystic lesion measuring 7 × 11 mm with internal echogenic components. The Left Parotid Gland was also enlarged, demonstrating a Complex Hypoechoic Lesion measuring 18 × 25 mm with irregular contours and associated Lymphadenopathy Posterior to the Sternocleidomastoid Muscle.
A contrast-enhanced CT scan of the Neck confirmed Enlargement of the Left Parotid Gland but did not reveal any definitive mass or features consistent with Primary Tumor. Fine needle aspiration (FNA) biopsies of a level II cervical lymph node were performed twice, and both cytology reports indicated the presence of Atypical Cells consistent with Metastatic Carcinoma of Sarcomatous Morphology. Given the Cytological findings and absence of a Known Primary Lesion, a provisional diagnosis of Metastatic Cervical Lymphadenopathy of unknown origin was made. The patient subsequently underwent a left-sided Supraomohyoid Neck Dissection (SOHND) for both therapeutic and diagnostic purposes. Histopathological analysis of the resected specimen demonstrated Salivary Gland and Skeletal muscle with Preserved architecture alongside multiple lymph nodes showing reactive follicular hyperplasia. One lymph node exhibited Granulomatous Inflammation with Multinucleated Giant Cells and Central Necrosis, raising initial concern for Tuberculous Lymphadenitis.
Chapter Summaries
Abstract: Provides a concise overview of the case study regarding a patient misdiagnosed with metastatic carcinoma who was ultimately found to have Kikuchi-Fujimoto Disease.
Case Presentation: Details the patient's medical history, clinical symptoms, initial diagnostic imaging, misleading FNA results, and the subsequent surgical intervention that led to the final diagnosis.
Discussion: Explains the pathophysiology of Kikuchi-Fujimoto Disease, its typical and atypical presentations, and why it is frequently misdiagnosed as malignancy.
Conclusion: Summarizes the importance of thorough histopathological assessment and multidisciplinary collaboration to avoid unnecessary surgeries in patients with cervical lymphadenopathy.
Keywords
Kikuchi-Fujimoto Disease, Necrotizing Histiocytic Lymphadenitis, Cervical Lymphadenopathy, Fine Needle Aspiration, Metastatic Carcinoma, Histopathology, Immunohistochemistry, CD68, CD3, CD20, Diagnostic Challenge, Multidisciplinary Evaluation, Lymph Nodes, Differential Diagnosis, Surgical Intervention
Frequently Asked Questions
What is the primary focus of this medical case study?
The study focuses on a specific patient case of cervical lymphadenopathy that was initially misdiagnosed as metastatic carcinoma but was later confirmed to be Kikuchi-Fujimoto Disease.
What are the central thematic areas discussed in the paper?
The core themes include diagnostic difficulties in head and neck pathology, the limitations of fine needle aspiration (FNA), the necessity of histopathological verification, and the clinical management of Kikuchi-Fujimoto Disease.
What is the primary research question or clinical objective?
The objective is to demonstrate how clinical and cytological discordance can lead to misdiagnosis and to advocate for the use of advanced histopathological and immunohistochemical assessment to ensure accurate diagnosis.
Which scientific methods were utilized in this study?
The study employed clinical physical examination, soft tissue ultrasonography, contrast-enhanced CT scans, repeated fine needle aspiration biopsies, and post-surgical histopathological and immunohistochemical (CD68, CD3, CD20 staining) analysis.
What is covered in the main body of the paper?
The main body details the patient's presentation, the initial misleading diagnostic results, the surgical procedure (SOHND), the subsequent findings that confirmed the actual diagnosis, and a discussion of the disease's clinical behavior.
Which keywords best characterize this work?
Key terms include Kikuchi-Fujimoto Disease, Necrotizing Histiocytic Lymphadenitis, Cervical Lymphadenopathy, FNA, and histopathological diagnosis.
Why was the patient's age and sex significant in this case?
The patient was a 50-year-old male, which is considered atypical as Kikuchi-Fujimoto Disease typically affects young women under 40, highlighting why the condition might not have been initially suspected.
What role did the surgical specimen play in the diagnosis?
The surgical specimen was crucial; it allowed for a comprehensive histopathological and immunophenotypic analysis that correctly identified the disease after the non-invasive cytology had proven misleading.
- Citation du texte
- Manuel Suárez (Auteur), Amanda Menendez Soler (Auteur), Manuel J. Medina Rodriguez (Auteur), Helen Aguila Cid (Auteur), Lizander Verges Acosta (Auteur), Israel Borrajero (Auteur), 2025, Misleading Cytology in Cervical Lymphadenopathy, Munich, GRIN Verlag, https://www.grin.com/document/1596449
