소아 아급성 괴사성 림프절염의 조기 진단을 위한 비특이적 경부 림프절 종대와의 감별
Discrimination Between Childhood Subacute Necrotizing Lymphadenitis and Nonspecific Cervical Lymph Hyperplasia for Earlier Diagnosis
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목 적:지속되는 발열과 중등도 이상 경부 림프절 종대를 동반한 소아에서 Kikuchi-Fujimoto disease (KFD)로 조기에 감별진단하고 치료경과에 도움이 되고자 본 연구를 진행하였다. 방 법:경부 림프절 세침흡인세포검사나 절제생검에 의해서 KFD로 진단된 19례와 대조군으로 동일한 연령군이며 조직생검으로 확인된 비특이적 반응성 경부 림프절 종대환아 16명의 임상 소견을 후향적으로 비교하였다. 결 과:KFD 환아들의 발병 당시 나이는 평균 11.8± 3.61세였고, 남녀비는 1:1.1로 큰 차이가 없었고, 반응성 림프절 종대로 진단된 환아의 평균 나이는 11.1±5.96세였으며 남녀비는 1.7:1로 남자에서 더 많은 빈도를 보였다. 주된 증상으로 KFD 환아는 경부 종물 18례(94.7%), 발열 13례(68.4%)순이었고, 반응성 림프절 종대 환아들은 경부 종물(100%), 발열 2례(13%)였다. CT 소견상 KFD 환아에서 피막주위 침범 소견은 9례(56%), 괴사 부위는 4례(25%)에서 동반하였고 반응성 림프절 종대로 진단받은 환아는 괴사 부위나 피막주위 침범이 된 예는 없었다. 초음파 검사를 시행한 KFD 환아 5례에서 모두 다발성의 커져 있는 림프절을 확인할 수 있었고, 3례(60%)에서 피막주위 침범소견을 보였으며 괴사 소견은 관찰할 수 없었다. 반면, 반응성 림프절 종대의 경우 KFD와 유사한 소견을 보였다. 결 론:지속되는 발열과 중등도 이상 경부 림프절 종대를 동반한 소아에서 KFD의 초음파검사 소견은 반응성 림프절과 유사하게 보이며 CT상 악성종양, 감염, 혈관염, 결체조직 질환 등에서 보이는 림프절 병변과 유사하므로 방사선학적으로 구분하기 어렵기 때문에 경부 림프절 종대가 있는 환아에서 임상 소견이나 검사 소견을 종합하여도 진단이 되지 않은 경우는 절제생검이 진단을 내리는데 도움이 될 수 있다고 생각한다.
Abstract
Purpose:We conducted this research to make an earlier diagnosis and identify better treatment for Kikuchi-Fujimoto disease (KFD) by comparing clinical findings with nonspecifically enlarged cervical lymph nodes in children. Methods:Nineteen patients were diagnosed with KFD by tissue pathology from a fine needle aspiration biopsy and/or excisional biopsy and were compared with the clinical, radiological, and pathological findings of reactive hyperplasia. Results:The average onset age of onset for patients with KFD was 11.8±3.61 years, and the male to female ratio was 1:1.1, whereas patients with reactive hyperplasia were 11.8±5.96 years, and the male to female ratio was 1.7:1. Patients with KFD suffered more from fever than patients with reactive hyperplasia (68% vs. 13%, P=0.002). Patients with KFD showed perinodal infiltration (P=0.001) and necrosis on computed tomography, whereas patients with reactive hyperplasia did not show any of these findings. Ultrasonographic findings were similar between the two study groups. In contrast, the histopathological examinations of biopsied cervical lymph nodes were enormously helpful for distinguishing the findings of KFD from those of patients with reactive hyperplasia. Conclusion:We recommend a histopathological examination to distinguish KFD from reactive hyperplasia in children with significantly enlarged cervical lymph nodes.
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