Spontaneous regression of Kikuchi lymphadenopathy with oligoclonal T-cell populations favors a benign immune reaction over a T-cell lymphoma.
To aid in the initial diagnosis of Kikuchi lymphadenitis and to assess whether the composition of the T cells might shed light on the pathogenesis, we used nested polymerase chain reaction tests followed by high-resolution gel electrophoresis to determine the pattern of T-cell antigen receptor rearrangement in 56 consecutive cases. Except for 1 unusual case with recurrent lymphadenopathy, none had a monoclonal beta or gamma rearrangement. Eight cases had a polyclonal pattern at both beta and gamma loci, 20 cases had a mixed polyclonal beta and oligoclonal gamma pattern, and 27 cases had an oligoclonal pattern at both loci. The high frequency of oligoclonality did not indicate an early-stage T-cell lymphoma in evolution, as confirmed by spontaneous resolution of the lymphadenopathy in all cases within 6 months. Rather, it is consistent with reports of oligoclonal T cells in a variety of immune reactions. We conclude that, in the vast majority of cases, absence of a monoclonal T-cell receptor rearrangement excludes the possibility of T-cell lymphoma, and the presence of an oligoclonal pattern implies a benign immune reaction.
Lin
Chung-Wu
CW
Department of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei.
Chang
Chia-Liang
CL
Li
Chi-Cheng
CC
Chen
Yue-hua
YH
Lee
Wei-Hsiang
WH
Hsu
Su-Ming
SM
D000293:Adolescent; D000328:Adult; D002648:Child; D017931:DNA Primers; D004586:Electrophoresis; D005260:Female; D015329:Gene Rearrangement, T-Lymphocyte; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D020042:Histiocytic Necrotizing Lymphadenitis / Q000175:diagnosis* / Q000276:immunology* / Q000473:pathology; D006801:Humans; D016399:Lymphoma, T-Cell / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction
D017931:DNA Primers