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Case Reports
. 2015 Apr 28:15:50.
doi: 10.1186/s12893-015-0036-y.

Kikuchi-Fujimoto lymphadenitis imitating metastatic melanoma on positron emission tomography: a case report

Peter Urbanellis  1   2 , Laura Chin-Lenn  2 , Carolin J Teman  3 , J Gregory McKinnon  4
Affiliations
Case Reports

Kikuchi-Fujimoto lymphadenitis imitating metastatic melanoma on positron emission tomography: a case report

Peter Urbanellis et al. BMC Surg. .

Abstract

Background: Accurate staging is critical for decision-making for the treatment of malignant conditions. Fluoro-deoxy-glucose positron emission tomography-computed tomography (FDG PET-CT) is a highly sensitive imaging modality for the assessment of distant metastases; however false positive results are possible due to its lower specificity with detection of other hypermetabolic pathologies.

Case presentation: A patient with high-risk thigh melanoma was staged with FDG PET-CT. Four ipsilateral inguinal nodes (three superficial, one deep) demonstrated intense hypermetabolic activity. Metastatic melanoma was confirmed in the largest superficial inguinal node with ultrasound-guided fine needle aspiration. Histopathology demonstrated metastatic melanoma in one superficial node and histiocytic necrotizing lymphadenitis, also known as Kikuchi-Fujimoto disease in five deep inguinal nodes.

Conclusion: This case illustrates a false positive FDG PET-CT due to coincidental, synchronous melanoma and Kikuchi-Fujimoto disease in the same draining lymph node basin.

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Figures

Figure 1
Figure 1
FDG PET and CT images (A) Axial FDG PET and CT images demonstrating intense avidity in a left superficial inguinal lymph node; (B) Whole body FDG PET demonstrating intense avidity in three inguinal superficial lymph nodes (black arrow) and left deep inguinal (external iliac) lymph node (red arrow). Hypermetabolism is seen in the left thigh biopsy site and likely physiologic changes in the right and left adnexae. (C) Axial FDG PET and CT images demonstrating the avid left deep inguinal lymph node.
Figure 2
Figure 2
Kikuchi-Fujimoto disease histopathology A Sheet-like lymphohistiocytic infiltrate with crescentic histiocytes and abundant karyorrhectic debris (hematoxylin-eosin, 400x magnification). B Histiocytes are highlighted by CD68 (400x magnification). C Histiocytes co-express myeloperoxidase (400x magnification). D High proliferative index is highlighted by Ki-67 (400x magnification).
See this image and copyright information in PMC

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