case_images: PMC5094917_01
case_images: (A) Contrast-enhanced computed tomography of the neck showed enlarged right cervical lymph nodes (arrow). (B) Lymph node biopsy demonstrated mixed inflammatory cells including histiocytes and plasmacytoid monocytes with necrotic fibrin debris and karyorrhexis (H&E, x400).
case_images: kjim-2014-395f1.jpg
case_images: PMC5094917_01_kjim-2014-395f1.jpg
case_images: f1-kjim-2014-395
case_images: Computed tomography (CT) scan of the neck revealed multiple enlarged lymph nodes at all cervical levels on the right side without evidence of abscess formation (Fig. 1A). Pathologic findings from ultrasound-guided core needle biopsies of nodes revealed necrotizing lymphadenitis, which was histologically compatible with KD (Fig. 1B) and polymerase chain reaction was negative for Mycobacterium.
case_images: (A) Ultrasonography of the right thyroid lobe revealed a 7-mm hypoechoic nodule (arrow). (B) Surgical section of medullary thyroid cancer (MTC) with polygonal or spindle cells in nests or follicle formation. Tumor cells displayed granular cytoplasm with oval nuclei. The stroma contained amyloid deposits (H&E, x200). (C) Congo red staining of MTC showed apple green birefringence (arrowheads, x100). C, carotid artery; T, trachea.
case_images: kjim-2014-395f2.jpg
case_images: PMC5094917_01_kjim-2014-395f2.jpg
case_images: f2-kjim-2014-395
case_images: Thyroid ultrasonography during work-up of KD revealed a 7-mm hypoechoic nodule in the right lobe (Fig. 2A). Histopathology (Fig. 2B and 2C) confirmed a 5-mm medullary thyroid cancer (MTC) via positive immunohistochemical staining of chromogranin A, thyroid transcription factor-1, and synaptophysin and by staining of deposited stromal amyloid with Congo red.