Histiocytic necrotizing lymphadenitis is an uncommon autoimmune condition characterized by fever, leukopenia, and neck swelling. Diagnostic imaging, including ultrasound and CT, typically demonstrates conglomerates of enlarged cervical lymph nodes with hypervascular cortices and areas of necrosis. Ultimately, the diagnosis is confirmed with the histopathologic findings of paracortical coagulative necrosis with karyorrhectic debris, abundant histiocytes, and absence of neutrophils. Other potential etiologies, such as other causes of infectious lymphadenitis, tuberculosis, lymphoma, and systemic lupus erythematosus, must be excluded. These features are exemplified in this sine qua non radiology–pathology correlation article. Keywords Histiocytic necrotizing lymphadenitis · Neck · Lymph node · Radiology · Pathology History Radiographic Features The patient was a 14-year-old male who presented with Ultrasound performed in the right cervical region showed fever, neck pain, and fatigue for several weeks. Physical multiple enlarged, hypervascular lymph nodes (Fig. 1). CT exam demonstrated diffuse swelling and tenderness to pal- of the neck with contrast was also performed, which revealed pation in right lateral neck without overlying skin changes. numerous enlarged right cervical lymph nodes involving lev- A complete blood count revealed leukopenia with a white els 2B, 3, and 5A. The lymph nodes generally displayed blood cell count of 3.0 × 10 per microliter and mild anemia cortical hyperenhancement
Head and Neck Pathology – Springer Journals
Published: Jun 1, 2018
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