Figure 1.
Sonographic presentation and USCB of KFD.
a. Multiple lymph nodes with heterogeneous echogenicity and well-defined margins. b. Color duplex mode showed central lymphatic hilus in the enlarged nodes. c. A core needle (arrow) was inserted into the lymph nodes for tissue harvest. d. The inner needle (arrow) was pushed forward to expose the notch for harvesting tissue specimens within the lymph nodes.
Table 1.
Demographic and clinical features of patients.
Table 2.
Comparison of the specimens harvested by USCB or Open Biopsy.
Figure 2.
Representative photographs of an open biopsy specimen (400x).
a. Necrosis, usually with blurred cell shadow, was mixed with karyorrhexis and histiocytes. b. Numerous histiocytes engulfed karyorrhectic debris. c. Foamy histiocytes were identified. d. Immunohistochemical stain for CD123 highlighted plasmacytoid dendritic cells. Hematoxylin counterstain revealed abundant karyorrhexis around the plasmacytoid dendritic cells.
Table 3.
Pathological presentation in the specimens harvested from OB.
Figure 3.
Variable pathological presentations of KFD were shown within one lymph node.
The left panel is the scanning view of a bisected lymph node. (Scale bar: 1 mm). The high power view of areas b, c, and d were shown in the right panels (Scale bar: 200 µm). Area b showed nonspecific reactive lymphoid hyperplasia. Area c showed necrosis with karyorrhexis. Area d showed. histiocytic infiltration with karyorrhexis. It demonstrated the possibility of sampling bias if distinct sites of the lesion were harvested.
Figure 4.
Variable pathological presentations of KFD among different lymph nodes obtained from a surgical biopsy.
a. One lymph node showed reactive follicular hyperplasia without evidence of KFD. b. The other lymph node showed specific features of KFD with paracortical necrosis and histiocytic infiltration. (Scale bar: 1 mm).
Figure 5.
Representative photographs of a USCB specimen.
a. Necrosis was mixed with karyorrhexis and histiocytes (H&E, 400x). b. Conspicuous karyorrhexis accompanied by histiocyte aggregation (H&E, 400x). c. Clustered plasmacytoid dendritic cells highlighted by CD123 (200x). d. Increased histiocytes were observed (H&E, 400x).
Table 4.
Demographic data and pathological presentation in the specimens harvested from USCB.
Figure 6.
A case of KFD diagnosed by the specimens harvested from USCB instead of OB.
a, b. Specimens of USCB. A focus of necrosis mixed with karyorrhexis, histiocytes and immunoblasts (H&E. a, 100x b, 400x). c, d. Specimens of OB. Nonspecific reactive lymphoid hyperplasia with occasional fibrovascular organization (c, 40x). There was only one small focus of aggregated histiocytes accompanied by karyorrhexis (d, x400).
Figure 7.
A case of KFD diagnosed by the specimens harvested from OB rather than USCB.
a, b. Specimens of USCB. Reactive lymphoid follicles with tingible bodies (a, 200x). Mildly increased histiocytes were noted between follicles, but no karyorrhexis was seen (b, 200x). c, d. Specimens of OB. Distinctive histology with necrosis and karyorrhexis was prominent (c, 400x). Reactive follicular hyperplasia was observed in the viable parts (d, 200x).