RESUMO
OBJECTIVE: To evaluate the cosmetic benefit of neck skin-lifting surgery for the removal of nonthyroidal neck masses. STUDY DESIGN AND SETTING: Fifty patients with neck masses were divided into the following 2 surgical groups that were matched in age, sex, and the size, location, and pathology of lesions: skin lifting (n = 25) and conventional (n = 25). The operation time, hospital stay, complications, and subjective satisfaction with the incision scar as assessed on a visual analogue scale (VAS) were compared between the 2 groups. RESULTS: All but 2 lesions (lymphomas) were benign and were removed completely, drained, or biopsied. The surgery time, hospital stay, and complication rates did not differ significantly between the groups. The mean satisfaction score of the patients was 8.2 +/- 1.1 in the skin-lifting surgery group and 4.8 +/- 2.5 in the controls (P < 0.001). The incision scars were commonly hidden by natural hair or collars in the patients who received skin-lifting surgery. CONCLUSION: This surgical technique can be safely applied to most benign masses in the entire neck excluding the thyroid region, especially in patients who prefer neck scars to be invisible. EBM RATING: B-2b.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Estética , Pescoço/cirurgia , Retalhos Cirúrgicos , Abscesso/cirurgia , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Cicatriz/etiologia , Cicatriz/psicologia , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/cirurgia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Complicações Pós-Operatórias , Fatores de Tempo , Resultado do Tratamento , Tuberculose dos Linfonodos/cirurgiaRESUMO
Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a rare disorder that typically affects the cervical lymph nodes. The disease usually occurs in women in their late 20s or early 30s. Reports in the pediatric literature are sparse. Most authors consider Kikuchi-Fujimoto disease as a self-limiting disorder that requires no specific management but long-term follow-up. The clinical features of Kikuchi-Fujimoto disease are easily confused with other less-benign conditions. Thus, an early biopsy is instrumental in making definite diagnosis and preventing unnecessary investigations. We describe a case of Kikuchi-Fujimoto disease in an 8-year-old boy which presenting as a submandibular gland tumor. The case illustrates the clinical features of this unusual condition and emphasizes the potential confusion with other diagnoses.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Neoplasias da Glândula Submandibular/diagnóstico , Biópsia , Criança , Diagnóstico Diferencial , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Linfonodos/patologia , Masculino , Pescoço , Neoplasias da Glândula Submandibular/patologiaRESUMO
Kikuchi-Fujimoto disease, or histiocytic necrotising lymphadenopathy of unknown aetiology, is a rare, benign and self-limiting cause of lymphadenopathy often involving the cervical nodes, and rarely presenting with mesenteric lymphadenopathy. We present a 26-year-old Caucasian male, who presented with right iliac fossa pain and low grade pyrexia, mimicking acute appendicitis. He underwent a laparatomy and an extended right hemi-colectomy for a caecal mass. Histology of the specimen showed lymph nodes with extensive areas of necrosis, with abnormal architecture suggesting Kikuchi-Fujimoto lymphadenopathy. This was further confirmed by immunohistochemistry. In this context maintenance of a high index of suspicion of this condition can avoid major surgical interventions. We describe the management of our case of Kikuchi-Fujimoto's disease involving the mesenteric nodes and provide an up to date review of the pertinent literature on this subject.
Assuntos
Apendicite/diagnóstico , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Mesentérica/diagnóstico , Adulto , Diagnóstico Diferencial , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Masculino , Linfadenite Mesentérica/cirurgiaRESUMO
BACKGROUND: Kikuchi-Fujimoto disease is a self-limited condition, characterized by benign lymphadenopathy. METHODS AND RESULTS: We describe a case of a 56-year-old male who presented with a node growth in the left axilla, without referring any other symptoms. The patient underwent excision and biopsy of the node and the histological examination established the diagnosis of Kikuchi-Fujimoto disease. After 3 days of hospitalization, the patient was released in a perfect condition and no medical treatment was prescribed. In a regular follow-up of 3 years the patient remains asymptomatic. CONCLUSIONS: Kikuchi-Fujimoto disease is an uncommon clinicopathological entity in Greece and it should always been taken under consideration in the differential diagnosis in patients presenting with lymphadenopathy. Surgical excision is the treatment of choice and the course of the disease is usually the spontaneous resolution.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Doenças Linfáticas , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
An adolescent boy underwent laparoscopic evaluation with persisting fever associated with colicky abdominal pain of about 3 weeks duration after a CT study of his abdomen revealed mesenteric adenopathy. Histopathological evaluation of the excised mesenteric nodes showed features of histiocytic necrotising lymphadenopathy suggestive of Kikuchi-Fujimoto lymphadenopathy which was confirmed on immunehistochemistry staining. Kikuchi-Fujimoto's disease involving the mesenteric nodes is extremely unusual and can be confounding with a mistaken diagnosis of and prolonged treatment for tuberculosis. The authors present a case of Kikuchi-Fujimoto's disease involving the mesenteric lymph nodes and discuss the various aspects of diagnosis and management of the case along with a review of published literature.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Dor Abdominal/etiologia , Adolescente , Febre/etiologia , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Excisão de Linfonodo , Masculino , MesentérioRESUMO
OBJECTIVES: We describe a rare cause of posterior triangle cervical lymphadenopathy in a third decade female, outline the clinical and histopathological features and discuss excision biopsy as the investigation of choice in this age group, with lymphoma as the diagnosis of exclusion. CASE REPORT: A thirty-four year old female was referred to our Head and Neck clinic with a one-month history of left posterior triangle lymphadenopathy. She reported no other symptoms and haematological investigations were normal. She was "Red Flagged" as a possible lymphoma. Excision biopsy revealed extensive histiocytic necrotising lymphadenitis providing a diagnosis of Kikuchi-Fujimoto disease. CONCLUSIONS: Persistent posterior triangle lymphadenopathy in the 16-40 year old age group warrants "Red Flag" referral to rule out serious pathology such as HIV, metastatic cancer or lymphoma. When the ENT examination and haematological work up is negative, we advocate proceeding straight to excision biopsy as the quickest way to obtain a diagnosis, which sometimes comes up with the unexpected as in this rare case of Kikuchi-Fujimoto disease.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Adulto , Feminino , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Linfoma/diagnóstico , Linfoma/patologia , Linfoma/cirurgiaRESUMO
Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Linfoma/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Adulto JovemRESUMO
We report the case of a young woman, who presented a sus-clavicular adenopathy with fever and inflammatory syndrome. A cervico-thoracic scan reveals sus-clavicular and hilar adenopathies with central necrosis. Laboratory studies, including blood culture and viral serologies were negative, and excluded an infectious aetiology. Clinical features and anti-nuclear antibody tests were not compatible with an inflammatory autoimmune disease. Bone marrow examination and lymph node histology didn't show any malignant cell. Histology analysis of the lymph node showed a typical aspect of histiocytic necrotizing lymphadenitis. This is compatible with the diagnosis of Kikuchi's disease.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Doenças Linfáticas/etiologia , Adulto , Biópsia , Medula Óssea/patologia , Diagnóstico Diferencial , Feminino , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos/patologia , Doenças Linfáticas/patologia , Doenças Linfáticas/cirurgia , PescoçoRESUMO
The Kikuchi-Fujimoto disease, also known as histiocytic necrotizing lymphadenitis, is a self-limiting lesion of unknown cause first described in 1972 independently by Kikuchi and Fujimoto et al. This self-limiting disorder usually occurs in Asian women in their late 20s or early 30s. Typically, it runs a benign course and appears to resolve spontaneously 1 to 6 months after definite diagnosis. The Kikuchi-Fujimoto disease usually manifests as a localized cervical lymphadenopathy; therefore, most patients with this disease are seen in ears, nose, and throat practice. Nodal involvement other than in the neck area or extranodal involvement is rare. In this situation, however, the Kikuchi-Fujimoto disease is easily confused with other less-benign conditions. We describe a case of Kikuchi-Fujimoto disease in a 30-year-old man that presented as a parotid gland tumor. This is the third study to document intraparotid Kikuchi-Fujimoto disease in the English literature. Our report illustrates the clinical features of this unusual condition and emphasizes potential confusion with other diagnoses.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Masculino , Neoplasias Parotídeas/cirurgia , RadiografiaRESUMO
Kikuchi-Fujimoto disease, or necrotizing histiocyte lymphadenitis, is a rare anatomo-clinical entity of unknown cause. The patients present painful cervical lymph nodes, fever, and a flu-like syndrome, but the spontaneous course is usually favorable in six months. We observed two cases within six months in our unit. Both patients improved rapidly after diagnostic adenectomy.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Adenoidectomia , Adulto , Feminino , Febre/etiologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Linfonodos/patologia , Dor/patologiaRESUMO
Kikuchi-Fujimoto's disease (KFD) is a self-limiting condition usually presenting as cervical lymphadenopathy, with fever and leukopenia, in young adult females. No specific aetiology has been identified yet, although some authors believe that KFD is a 'forme fruste' of systemic lupus erythematosus. Certain human leucocyte antigen (HLA) types have also been associated with KFD. We herein report KFD in two non-twin sisters with HLA-identical phenotype, who presented 10 years apart. Neither patient had evidence of recent infection or connective tissue disease. The familial occurrence emphasizes the possibility of genetic predisposition and calls for a more extensive search for a specific cause of KFD.
Assuntos
Antígenos HLA/genética , Linfadenite Histiocítica Necrosante/genética , Núcleo Familiar , Adulto , Feminino , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , FenótipoRESUMO
A case of histiocytic necrotizing lymphadenitis involving a right submandibular lymph node is described in a 14-year-old Caucasian boy. The diagnosis was established on initial assessment by fine needle aspiration biopsy. Excisional biopsy, performed because the lymph node enlargement failed to regress, confirmed the cytological findings.
Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Linfonodos/patologia , Adolescente , Linfadenite Histiocítica Necrosante/cirurgia , Humanos , Linfonodos/cirurgia , Masculino , PescoçoRESUMO
The authors describe two children with Kikuchi necrotizing lymphadenitis, the main manifestations of which were cervical lymphadenopathy, fatigue, and fever. The diagnosis was based on histopathologic findings after open biopsy. Results of serologic studies, immunoperoxidase staining for Epstein-Barr virus (EBV) latent membrane protein, in situ hybridization for Epstein-Barr encoded RNAs, and polymerase chain reaction amplification of EBV Epstein-Barr nuclear antigen-1 (EBNA) DNA suggested that EBV was the causative agent in both patients. The disease was mild and subsided after complete surgical resection in one patient, with a follow-up of 1 year. In the other patient, a short course of corticosteroids led to complete clinical remission within 2 months, but the child still has biologic signs of persistent EBV infection. He experienced relapse with a large cervical mass and fever 28 months after the initial onset. Histologic findings were identical to those at initial presentation. Symptoms again resolved spontaneously within 2 weeks, but the follow-up was short (12 mos) and the child's EBNA antibodies are still absent. No evidence of immunodeficiency was found in either child. The cause of Kikuchi disease is unknown, but a viral or postviral hyperimmune reaction has been proposed. Malignant lymphoma and systemic lupus erythematosus are differential diagnoses. Early recognition of Kikuchi disease minimizes potentially harmful and unnecessary investigations and treatments. These findings add Kikuchi disease to the protean manifestations of chronic EBV infection.
Assuntos
Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/patogenicidade , Linfadenite Histiocítica Necrosante/etiologia , Adolescente , Biópsia , DNA Viral/isolamento & purificação , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Histiócitos/patologia , Linfadenite Histiocítica Necrosante/diagnóstico , Linfadenite Histiocítica Necrosante/patologia , Linfadenite Histiocítica Necrosante/cirurgia , Linfadenite Histiocítica Necrosante/virologia , Humanos , Linfonodos/patologia , Linfonodos/virologia , Linfoma/diagnóstico , Macrófagos/patologia , Masculino , Reação em Cadeia da Polimerase , Linfócitos T Citotóxicos/patologiaRESUMO
Histiocytic necrotizing lymphadenitis (HNL), also known as Kikuchi 5 disease is a rare condition of unknown etiology. Patients present with cervical lymph node enlargement, fever and malaise. The diagnosis is made by excision biopsy. However, this entity must be distinguished from both reactive processes and malignant tumors such as lymphoma. The clinical course is self limited with spontaneous resolution within a few months. We report three patients with the disease. A 37 year-old woman with a 4 months history of a painless submaxillary mass of 2.5 cm diameter, attached to the deep tissues of the neck. The mass was excised and the biopsy report was HNL. After 26 months of follow up, the patient is asymptomatic. A 30 year-old woman with a history of 2 months of a painless lateral cervical mass and aspiration biopsy was reported as suspicious for lymphoma. An excision biopsy was performed, that was reported as HNL. In both patients, lymphoma was ruled out by immunohistochemistry. A 33 year-old woman with a 3 weeks history of an asymptomatic lateral cervical mass. Biopsy was reported as HNL. This condition must be included in the differential diagnosis of cervical asymptomatic masses. The clinician must be aware of it to avoid long-term, costly treatments.