Background
: Determining the etiology of enlargement of the cervical lymph nodes is a common diagnostic challenge for clinicians. Necortizing lymphadenopathy was first described by Kikuchi in 1972, as a benign disease of which cervical lymphadenopathy with or without fever is characteristic. It has, on occasion, been misdiagnosed as tuberculosis lymphadenopathy or malignant lymphoma etc. It is resolved spontaneously without specific treatment within 1 to 4 months. So, we should consider this disease at the stage of presumptive diagnosis of the patient with cervical lymphadenopathy to avoid the unnecessary treatment of laboratory tests. Recently, in Korea, the cases with necrotizing lymphadenitis have been reported and studied, but the entity of this disease is not known to most of physicians of primary care. Therefore, we analyzed the clinical features of 39 cases which were diagnosed as necrotizing lymphadenitis by pathologist and reviewed the pertinent literature.

Methods : Thirty nine cases diagnosed as necrotizing lymphadenitis or subacute necrotizing lymphadenitis were selected from the files of the Department of Pathology, Kyung Hee University Medical Center, from 1985 through 1991.

Results : The age of 39 patients ranged form 5 to 58 years old with 89.7% below the 4th decades. Females were slightly more frequently encountered than males in the ratio of 22:17. The most common chief manifestations were neck mass only in 20 patients(51.3%). Cervical lymphadenopathy was multiple in 23 patients(60.5%) and tender in one half. The duration of the symptoms ranged from 1 week to 4 years and was within 3 months in the most of cases. At the first visit, the presumptive diagnosis were tuberculosis lymphadenitis in 23(59.0%), fever unknown origin in 6(15.4%), nonspecific lymphadenitis in 3(7.7%), malignant lymphomas in 3(7.7%), systemic lupus erythematosus in 1(2.6%), typhoid fever in 1(2.6%), lipoma in 1(2.6%), acute appendicitis 1 patient(2.6%). Three patients were relapsed.

Conclusion : At the diagnosis of cervical lymphadenopathy, the clinical and epidemiologic features of the enlarged lymph nodes are often useful in determining the diagnostic tests that are required and the type of initial therapy to be administered, also pathologic examination of excisional lymph node should be performed to prevent patients who have necrotizing lymphadenitis from unnecessary treatment or laboratory tests.