Differential Diagnosis of Necrotic Lymph Node Tissue on Histopathology
Single Most Likely Diagnosis
- Metastatic carcinoma: This is often the most common cause of necrotic lymph node tissue, especially in the context of a known primary malignancy. The necrosis can be due to rapid growth of the tumor outpacing its blood supply, leading to ischemia and necrosis.
Other Likely Diagnoses
- Lymphoma: Certain types of lymphoma, such as diffuse large B-cell lymphoma or Hodgkin lymphoma, can present with necrotic lymph node tissue. The necrosis may be due to tumor lysis or ischemia.
- Infectious lymphadenitis: Bacterial, fungal, or parasitic infections can cause necrotic lymphadenitis, especially in immunocompromised individuals. Examples include tuberculosis, cat-scratch disease, and histoplasmosis.
- Kikuchi-Fujimoto disease: This is a rare, self-limiting condition characterized by necrotizing lymphadenitis, often affecting the cervical lymph nodes.
Do Not Miss Diagnoses
- Cat-scratch disease: Although not the most common cause, cat-scratch disease can cause severe necrotizing lymphadenitis and should not be missed due to its potential for serious complications if left untreated.
- Tuberculosis: TB can cause necrotic lymphadenitis, and it is essential to consider this diagnosis, especially in high-risk populations or areas with high TB prevalence, due to its public health implications and the need for prompt treatment.
- Malignant histiocytosis: This rare condition can mimic lymphoma or other malignancies and requires prompt diagnosis and treatment to improve outcomes.
Rare Diagnoses
- Kimura disease: A rare, chronic inflammatory disorder that can cause necrotic lymphadenitis, often accompanied by eosinophilia and IgE elevation.
- Rosai-Dorfman disease: A rare histiocytic disorder that can cause necrotic lymphadenitis, often accompanied by systemic symptoms such as fever and weight loss.
- Castleman disease: A rare lymphoproliferative disorder that can cause necrotic lymphadenitis, often accompanied by systemic symptoms such as fever, weight loss, and fatigue.