Pathological Study of Subacute Necrotizing Lymphadenitis

The histopathological features of necrotizing lymphadenitis in 36 patients are described. This disease occurs predominantly in the second and third decades of life. In our study the onset of the disease had no relation to seasons and sex. Most of them (33 patients, 91.7%) had enlarged cervical lymph nodes. Their other lymph nodes rarely showed abnormalities. Patients had pain and/or tenderness in their cervical lymph nodes. There patients were often feverish. Moreover, there were many patients (17 patients, 47.2%), who complained of headache and/or sore throat. Aseptic meningitis was found in the two of these patients. At the onset of the disease, the white blood cell count in the peripheral blood was low, and serum leucine aminopeptidase (substrate: leucine amide) activity and serum lactic dehydrogenase activity were high. In the later phase, serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase were elevated. In the electron microscopic study of the lymph nodes, one of the characteristic features of the disease was the presence of lymphocytes in various stages of coagulative necrosis. Another characteristic feature was the infiltration of histiocytes which were phagocytosing necrotic debris. Neither neutrophils nor eosinophils were found in any materials. Tubuloreticular structures (TRS) and Intracytoplasmic rodlets (ICR) in the cytoplasm were characteristic of necrotizing lymphadenitis. The TRS were irregularly branched tubuli of 20〜30nm diameter and present in the endoplasmic reticulum of immunoblasts and histiocytes. The TRS were found in 6 of 8 patients in our study. The diameter of all rodlets was 12〜18nm. The ICR, found in the cells which contained TRS, were found in only two patients in our study. Other authors of medical reserch have proposed various ideas on the etiology of this disease, but we could get no single definite etiology which was common to our all patients. The necrotizing lymphadenitis is benign, since the lymphadenopathy usually resolves spontaneously within 3〜6 months. In our studies, there have been no patients of associated cancer.