Kikuchi Disease Mimicking Metastatic Lymphadenopathy on 18F-FDG PET/CT in Patients with Breast Cancer

Abstract

Kikuchi disease is a rare benign lesion usually affecting the lymph nodes of the whole body, and its hypermetabolic features on 18 F-FDG PET/CT may be confused with those of infection, metastasis or primary malignancy. I report a case of Kikuchi disease of the axillary lymph node (LN) showing increased FDG uptake on 18 F-FDG PET/CT mimicking a metastatic lymphadenopathy (LAP) in a 40-year-old patient with right breast cancer (Fig. 1).A 40-year-old female had been diagnosed with intraductal carcinoma of the right breast and successfully treated with chemotherapy and surgical resection 5 years ago. She had no complaints of pain, fever or palpation of a mass in her right axilla after surgery.An 18 F-FDG PET/CT scan (Biograph 2, Siemens, Germany) was performed after the injection of 351.5 MBq (9.5 mCi) of 18 F-FDG with a blood glucose level of 88 mg/dl for restaging. 18 F-FDG PET/CT showed an increased FDG uptake of the enlarged LN in the right axilla with a maximum standardized value (SUVmax) of 4.0, which could not exclude ipsilateral metastatic LAP. The chest CT images revealed an enhancing LAP in the right axilla that appeared to be a metastatic LAP. Because the imaging studies failed to demonstrate

Kikuchi-Fujimoto disease associated with primary Sjögren’s syndrome – literature review based on a case report

“…Kikuchi-Fujimoto disease can be confused with malignancy but is rarely associated with solid tumors. The case reports available in the literature present examples of KFD comorbidity with breast, [27] tongue, [33], stomach, [34] thyroid, [35] but no renal carcinoma.…”

“…In some cases there is mild anemia, leukopenia (20–58% of cases) or leukocytosis (2–5% of cases), elevated erythrocyte sedimentation rate, increased lactate dehydrogenase (LDH), increased C-reactive protein and elevated transaminases [ 9 , 21 – 23 ]. Its recognition is crucial because it can be mistaken for malignancies, especially lymphomas, which is even more important in pSS patients, who are more susceptible to lymphoma evaluation [ 7 , 27 ].…”