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.

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound‐cytology‐estradiol (UCE) triad was sufficient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty‐two ultrasound‐diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age >40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery. Diagn. Cytopathol. 2000;22:70–80. © 2000 Wiley‐Liss, Inc.

This study was designed to assess if cytology was accurate for an appropriate diagnosis of ovarian and paraovarian cysts, and if the ultrasound-cytology-estradiol (UCE) triad was suffıcient to discriminate functional vs. nonfunctional cysts, the latter requiring surgical resection. One hundred twenty-two ultrasound-diagnosed adnexal cysts were punctured and surgically removed, and then subjected to cytologic and histologic examinations; 90 of these fluids were assayed for estradiol. Histologically, 30 cysts were functional and 92 were nonfunctional. A correct discrimination between functional and nonfunctional origin was obtained in 54.9% of cases with cytology, in 94.4% with estradiol assay, in 50.8% with ultrasonography, and in 97.8% with these three examinations combined (UCE triad). Among the 34 patients with no criteria of neoplastic origin (age Ͼ40, ultrasonographic findings), the UCE triad diagnosed six functional cysts. Therefore, 17.6% (6/34) of these young women could have avoided unnecessary surgery.Ovarian and paraovarian cysts are divided into two physiopathologic categories: functional and nonfunctional. The first kind of cyst is derived from abnormal folliculogenesis during sexual activity, and even in the absence of spontaneous regression, this kind does not require surgical resection, whereas the second kind, including true neoplasms and tumor-like lesions, is more frequent after age 40 and does require surgical removal because of potential malignant transformation. This study was performed 1) to define precise and reliable cytologic criteria for diagnosing ovarian and paraovarian cysts, 2) to assess the value of the ultrasoundcytology-estradiol (UCE) triad in discriminating functional from nonfunctional cysts, and 3) to determine indications and benefits of ultrasound-guided fine-needle puncture as a first-intention examination. Materials and Methods Patient SelectionDuring a 10-yr period, 119 women were investigated at the Department of Obstetrics and Gynecology of Roanne Hospital for a diagnosis of ovarian or paraovarian cyst(s) persisting after failure of a 3-mo hormonal therapeutic test. Every ovarian and paraovarian lesion with an ultrasonographic cystic component was included in the study. The age ranged from 10-92 yr (median, 38.7 yr). The main complaints were chronic pelvic pain and irregular bleeding. In 52 cases, the diagnosis was established during infertility investigation. Ultrasonography and Puncture ProcedureTransvaginal or transabdominal ultrasonographic examination was performed by gynecologists. Ultrasonographic criteria of nonfunctional origin were a size greater than 7 cm, multiple (Ͼ2) locules, irregularity of contour, echogenic content, thick septa, intra-or extracystic vegetations, and associated signs such as ascitis or lymph nodes. 1-3 The cysts were surgically removed by laparotomy or laparoscopy and submitted for cytologic and histologic examination, and for estradiol level measurement. The puncture was made with a 19-gauge needle, either by transabdominal or transvagi...