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Primary Bone Lesions in Rosai–Dorfman Disease, a Rare Case and Diagnostic Challenge—Case Report and Literature Review. Diagnostics (Basel) 2022; 12:diagnostics12040783. [PMID: 35453831 PMCID: PMC9032234 DOI: 10.3390/diagnostics12040783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/18/2022] Open
Abstract
Rosai–Dorfman Disease (RDD), also known as sinus histiocytosis, is included in the group of rare diseases, characterized by proliferation and accumulation of histiocytes in the lymph nodes (lymphadenopathy), most often involving the cervical ganglion chains (nodal form). RDD bone involvement is rare, estimated at 10% of cases, but primary bone involvement (extranodal form), is very rare—2–8%. Usually they are solitary lesions, with multifocal primary bone manifestations being extremely rare. Histopathological analysis is of high value for a correct diagnosis. We present the case of a Caucasian woman, 42 years old, initially treated in another clinic, for an osteolytic tumor formation in the right tibial shaft. An excisional biopsy with bone trepanation was performed, the histopathological diagnosis being the chronic inflammatory tissue. The evolution was atypical, with tumor growth, extraosseous, subcutaneous. A needle biopsy was repeated in our clinic, the result being similar to the original one. Evolution of the tumor, and the radiological and imaging aspect (periosteal reaction, eroded and thin bone cortex) suggested a more aggressive disease, these being in inconsistency with the result obtained. The biopsy was repeated, as an excision type this time. The histopathological result and immunohistochemistry indicated an RDD primary bone lesion. Based on this result, and corroborated with the data from the literature, we initiated the surgical treatment, curettage and grafting with bone substitute plus safety osteosynthesis with locked plaque, the patient registering a favorable evolution. RDD primary bone lesions are in fact an atypical manifestation of a rare disease. The correct diagnosis is very difficult due to the non-specific imaging aspect. Histopathological examination errors, especially in the case of needle biopsies can lead to errors in diagnosis and treatment with negative results for the patient.
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2
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NRAS Mutations May Be Involved in the Pathogenesis of Cutaneous Rosai Dorfman Disease: A Pilot Study. BIOLOGY 2021; 10:biology10050396. [PMID: 34063325 PMCID: PMC8147632 DOI: 10.3390/biology10050396] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
Background: Purely cutaneous Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder limited to the skin. To date, its pathogenesis remains unclear. Owing to recent findings of specific mutations in the mitogen-activated protein kinase/extracellular signal-regulated kinase (MAPK/ERK) pathway in histiocytic proliferative disorders, it provides a novel perspective on the pathomechanism of cutaneous RDD. We aim to investigate the genomic mutations in MAPK/ERK pathway in cutaneous RDD. Methods: We retrospectively recruited all cases of cutaneous RDD from two hospitals in Taiwan from January 2010 to March 2020 with the clinicopathologic features, immunohistochemistry, and treatment. Mutations of neuroblastoma RAS viral oncogene homolog (NRAS), Kirsten rat sarcoma 2 viral oncogene homolog (KRAS), and v-raf murine sarcoma viral oncogene homolog B1 (BRAF) in MAPK/ERK pathway were investigated by the highly sensitive polymerase chain reaction with Sanger sequencing. Results: Seven patients with cutaneous RDD were recruited with nine biopsy specimens. The median age was 46 years (range: 17–62 years). Four of seven patients (57.1%) received tumor excision, while the other three chose oral and/or topical or intralesional steroids. NRAS mutation was detected in 4 of 7 cases (4/7; 51.7%), and NRAS A146T was the most common mutant point (n = 4/7), followed by NRAS G13S (n = 2/7). There is no KRAS or BRAF mutation detected. Conclusions: We report the NRAS mutation is common in cutaneous RDD, and NRAS A146T was the most frequent mutation in this cohort. Mutations in the NRAS gene can activate the RAS/MAPK signaling and have been reported to be associated with various cancers. It indicates that NRAS mutation in MAPK/ERK pathway may involve the pathogenesis of cutaneous RDD.
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3
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El-Kamel MF, Selim MK, Gawad MMA. A new presentation of isolated cutaneous Rosai-Dorfman disease: Eruptive xanthoma-like lesions. Indian J Dermatol Venereol Leprol 2020; 86:158-161. [PMID: 30333358 DOI: 10.4103/ijdvl.ijdvl_540_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a benign lympho-histiocytic proliferative disorder initially described with bilateral painless lymphadenopathy (90 %), fever, leukocytosis, elevated ESR, anemia, and polyclonal hypergammaglobulinemia (90 %). Extranodal forms occur in 43% of cases, the skin being the most common site. Around 10% of patients have skin lesions and in 3%, the disease is limited exclusively to the skin. Here, we report a male patient who presented with pure cutaneous lesions which mimic eruptive xanthoma clinically. However, the diagnosis was established histo pathologically. So, high level of clinical suspension is critical to avoid missing such cases.
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Affiliation(s)
| | - Mohamed Khaled Selim
- Department of Dermatology, Andrology and STDs, Mansoura University, Mansoura, Egypt
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4
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Flowers TC, Raggio BS, Hasney C. Rosai-Dorfman Disease in the Parapharyngeal Space: The First Reported Case. EAR, NOSE & THROAT JOURNAL 2020; 100:NP466-NP468. [PMID: 32438847 DOI: 10.1177/0145561320928223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Thomas C Flowers
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Blake S Raggio
- Department of Otolaryngology, Tulane University Medical Center, New Orleans, LA, USA
| | - Christian Hasney
- Department of Otolaryngology, Ochsner Health System of New Orleans, New Orleans, LA, USA
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5
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Primary Rosai-Dorfman Disease of Bone: A Report of Two Cases. Case Rep Radiol 2019; 2019:1720131. [PMID: 30719368 PMCID: PMC6335665 DOI: 10.1155/2019/1720131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 11/30/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
Rosai-Dorfman disease (RDD), sometimes known as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic disorder that most commonly presents as painless, massive cervical lymphadenopathy in young adults. Extranodal disease can occur in up to 40% of patients but primary involvement of bone is rare. We present two cases of primary RDD of bone: one case of multifocal osseous RDD presenting as a painful lesion in the elbow, and one case of a solitary osseous lesion presenting as a painful lesion in the wrist.
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Abstract
In reviewing cutaneous manifestations of various hematologic malignancies, the authors focus on secondary cutaneous lymphomas and cutaneous manifestations of histiocyte disorders. Secondary cutaneous lymphomas are defined as skin lesions that develop secondary to infiltration by systemic lymphomas with predominantly extracutaneous involvement. In their review of histiocytic disorders with skin involvement, the authors focus on Langerhans cell histiocytosis and Rosai-Dorfman disease. Their review emphasizes the histology, pathophysiology, clinical presentation, prognosis, and treatments available for these diseases.
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7
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Lamant L. [Dermatopathology histoseminar. Case 6]. Ann Pathol 2018; 38:241-244. [PMID: 29980306 DOI: 10.1016/j.annpat.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Laurence Lamant
- Institut Universitaire du Cancer Toulouse Oncopole, avenue Hubert Curien, 31100 Toulouse, France.
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8
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Mavrogenis AF, Igoumenou VG, Antoniadou T, Megaloikonomos PD, Agrogiannis G, Foukas P, Papageorgiou SG. Rare diseases of bone: Erdheim-Chester and Rosai-Dorfman non-Langerhans cell histiocytoses. EFORT Open Rev 2018; 3:381-390. [PMID: 30034819 PMCID: PMC6026883 DOI: 10.1302/2058-5241.3.170047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Non-Langerhans cell histiocytosis (N-LCH) summarizes a group of rare diseases with different clinical presentations, pathogenesis and morphology. These include primary cutaneous N-LCH, cutaneous N-LCH with systemic involvement, and primary extracutaneous systemic forms with occasional cutaneous involvement. The juvenile (JXG) and non-juvenile xanthogranuloma (N-JXG) family of histiocytoses are N-LCH: the JXG family consisting of the JXG (cutaneous), xanthoma disseminatum (cutaneous and systemic) and Erdheim-Chester disease (ECD; systemic); and the N-JXG family consisting of the solitary reticulohistiocytoma (cutaneous), multicentric reticulohistiocytosis (cutaneous and systemic) and Rosai-Dorfman disease (RDD; systemic). ECD is a clonal disorder from the JXG family of N-LCH; RDD is a reactive proliferative entity from the non-juvenile xanthogranuloma family of N-LCH. ECD and RDD N-LCH are rare disorders, which are difficult to diagnose, with multi-organ involvement including bone and systemic symptoms, and which respond to therapy in an unpredictable way. The key to successful therapy is accurate identification at tissue level and appropriate staging. Patients should be observed and monitored in a long-term pattern. Prognosis depends on disease extent and the organs involved; it is generally good for RDD disease and variable for ECD.
Cite this article: EFORT Open Rev 2018;3:381-390. DOI: 10.1302/2058-5241.3.170047
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Thekla Antoniadou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - George Agrogiannis
- Second Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Periklis Foukas
- Second Department of Pathology, National and Kapodistrian University of Athens, School of Medicine, Greece
| | - Sotirios G Papageorgiou
- Second Department of Internal Medicine, Hematology Unit, National and Kapodistrian University of Athens, School of Medicine, Greece
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Eliassen E, Krueger G, Luppi M, Ablashi D. Lymphoproliferative Syndromes Associated with Human Herpesvirus-6A and Human Herpesvirus-6B. Mediterr J Hematol Infect Dis 2018; 10:e2018035. [PMID: 29755712 PMCID: PMC5937953 DOI: 10.4084/mjhid.2018.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022] Open
Abstract
Human herpesvirus 6A and 6B (HHV-6A and HHV-6B) have been noted since their discovery for their T-lymphotropism. Although it has proven difficult to determine the extent to which HHV-6A and HHV-6B are involved in the pathogenesis of many diseases, evidence suggests that primary infection and reactivation of both viruses may induce or contribute to the progression of several lymphoproliferative disorders, ranging from benign to malignant and including infectious mononucleosis-like illness, drug induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DIHS/DRESS), and nodular sclerosis Hodgkin's lymphoma. Herein, we discuss the conditions associated with the lymphoproliferative capacity of HHV-6, as well as the potential mechanisms behind them. Continued exploration on this topic may add to our understanding of the interactions between HHV-6 and the immune system and may open the doors to more accurate diagnosis and treatment of certain lymphoproliferative disorders.
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Affiliation(s)
- Eva Eliassen
- HHV-6 Foundation, Santa Barbara, California, USA
| | - Gerhard Krueger
- Department of Pathology and Laboratory Medicine, University of Texas, Houston, Texas, USA
| | - Mario Luppi
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Lee H, King G, Garg K, Pan Z, Tobin J, Robinson WA. Successful treatment of disseminated Rosai-Dorfman disease with siltuximab. Haematologica 2018; 103:e325-e328. [PMID: 29599203 DOI: 10.3324/haematol.2018.188441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Hannah Lee
- Department of Medicine, Internal Medicine Residency Training Program, University of Colorado School of Medicine, CO, USA
| | - Gentry King
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, CO, USA
| | - Kavita Garg
- Department of Radiology, University of Colorado School of Medicine, CO, USA
| | - Zenggang Pan
- Department of Pathology, University of Colorado School of Medicine, CO, USA
| | - Jennifer Tobin
- University of Colorado School of Pharmacy, Aurora, CO, USA
| | - William A Robinson
- Department of Medicine, Division of Hematology, University of Colorado School of Medicine, CO, USA
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Gameiro A, Gouveia M, Cardoso JC, Tellechea O. Histological variability and the importance of clinicopathological correlation in cutaneous Rosai-Dorfman disease. An Bras Dermatol 2017; 91:634-637. [PMID: 27828638 PMCID: PMC5087223 DOI: 10.1590/abd1806-4841.20164477] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022] Open
Abstract
Rosai-Dorfman disease is a benign histiocytic proliferative disorder of unknown
etiology. The disease mainly affects lymph node tissue, although it is rarely
confined to the skin. Here, we describe a 53-year-old woman with purely
cutaneous Rosai-Dorfman disease. The patient presented with a large pigmented
plaque on her left leg, and sparse erythematous papules on her face and arms. A
complete clinical response was achieved with thalidomide, followed by recurrence
at the initial site one year later. The histological examination displayed the
typical features of Rosai-Dorfman disease in the recent lesions but not in the
older lesions. In the setting of no lymphadenopathy, the histopathological
features of Rosai-Dorfman disease are commonly misinterpreted. Therefore,
awareness of the histological aspects present at different stages, not always
featuring the hallmark microscopic signs of Rosai-Dorfman disease, is
particularly important for a correct diagnosis of this rare disorder.
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Affiliation(s)
- Ana Gameiro
- Coimbra University Hospital - Coimbra, Portugal
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12
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Joshi SS, Joshi S, Muzumdar G, Turel KE, Shah RM, Ammbulkar I, Hussain MM, Choudhari KA. Cranio-spinal Rosai Dorfman disease: case series and literature review. Br J Neurosurg 2017; 33:176-183. [PMID: 28532172 DOI: 10.1080/02688697.2017.1329517] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Rosai-Dorfman disease (RDD) is a rare condition similar to lymphomas, presenting with cervical lymphadenopathy in young adults. Extra-nodal involvement is relatively common but involvement of the central nervous system (CNS) is rare. Cranial RDD presents with symptoms of raised intracranial pressure, focal or generalised seizures, while spinal RDD presents with pain, peripheral neurological deficits and radiculopathy. In contrast to other similar neoplastic or degenerative conditions affecting the CNS, RDD is a benign, non-infective, granulomatous disorder. Radiologically cranio-spinal RDD often mimics commoner dural-based lesions like meningioma, with only subtle radiological differentiating findings on Magnetic Resonance Imaging (MRI). The histopathology of RDD is diagnostic. Surgical excision is preferred modality of treatment. However, adjuvant therapies like steroids and radiation may help controlling residual or recurrent disease. There are multiple sporadic reports and short case publications in the literature, often focusing on a particular aspect of RDD. In this study, authors aim to present five cases of craniospinal RDD, and comprehensive review of literature and highlight neurological complications of systemic RDD.
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Affiliation(s)
- Shashank S Joshi
- a Department of Neurosurgery , Hindu Rhiday Samrat Balasaheb Thakare Medical College & Dr R N Cooper Hospital , Mumbai , Maharashtra , India.,b Department of Neurosurgery , Sevenhills Hospital , Mumbai , Maharashtra , India
| | - Shilpa Joshi
- c Department of CT and MRI , Fortis Hospitals , Mumbai , Maharashtra , India
| | - Girish Muzumdar
- d Department of Histopathology , Bombay Hospital Institute of Medical Sciences , Mumbai , Maharashtra , India
| | - Keki E Turel
- e Department of Neurosurgery , Bombay Hospital Institute of Medical Sciences , Mumbai , Maharashtra , India
| | - Rajan M Shah
- b Department of Neurosurgery , Sevenhills Hospital , Mumbai , Maharashtra , India.,e Department of Neurosurgery , Bombay Hospital Institute of Medical Sciences , Mumbai , Maharashtra , India
| | - Indoo Ammbulkar
- f Department of Medical Oncology , Sevenhills Hospital , Mumbai , Maharashtra , India
| | | | - Kishor A Choudhari
- h Department of Neurosurgery , Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield , UK
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Garza-Guajardo R, García-Labastida LE, Rodríguez-Sánchez IP, Gómez-Macías GS, Delgado-Enciso I, Chaparro MMS, Barboza-Quintana O. Cytological diagnosis of Rosai-Dorfman disease: A case report and revision of the literature. Biomed Rep 2016; 6:27-31. [PMID: 28123703 PMCID: PMC5244775 DOI: 10.3892/br.2016.814] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022] Open
Abstract
Rosai-Dorfman disease also known as sinus histiocytosis with massive lymphadenopathy (SHML) is characterized by distorted lymph node architecture with marked dilation of lymphatic sinuses occupied by numerous lymphocytes, as well as histiocytes with vesicular nucleus and abundant clear cytoplasm with phagocytized lymphocytes or plasma cells, also known as ‘emperipolesis’. This disease of unknown etiology progresses with a benign prognosis strictly and only when an early diagnosis and treatment is made. A late diagnosis and a generalized lymph node involvement contribute to a poor prognosis. In this study, we focussed on the cytological characteristics of the Rosai-Dorfman disease and differential diagnoses. We reported a case of a 61-year-old Mexican male with a 9-month history of painless bilateral cervical masses and low-grade fever with the final diagnosis of Rosai-Dorfman disease. The final diagnosis was made by fine needle aspiration (FNA) biopsy of parotid gland and cervical lymph node. In conclusion, FNA biopsy can be enough to make the diagnosis in most cases due to the distinct cytological features of SHML, thereby avoiding more invasive approaches that potentially are unnecessary.
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Affiliation(s)
- Raquel Garza-Guajardo
- Department of Pathological Anatomy and Cytopathology, University Hospital 'Dr José Eleuterio González', Autonomous University of Nuevo León, Monterrey, Nuevo Leon 64460, Mexico
| | - Laura Elvira García-Labastida
- Department of Pathological Anatomy and Cytopathology, University Hospital 'Dr José Eleuterio González', Autonomous University of Nuevo León, Monterrey, Nuevo Leon 64460, Mexico
| | - Iram Pablo Rodríguez-Sánchez
- Department of Genetics, School of Medicine, Autonomous University of Nuevo León, Monterrey, Nuevo Leon 64460, Mexico
| | - Gabriela Sofía Gómez-Macías
- Department of Pathological Anatomy and Cytopathology, University Hospital 'Dr José Eleuterio González', Autonomous University of Nuevo León, Monterrey, Nuevo Leon 64460, Mexico
| | | | - María Marisela Sánchez Chaparro
- Laboratory of Immunology and Virology, Faculty of Biological Sciences, Autonomous University of Nuevo León, San Nicolas de los Garza, Nuevo Leon 66420, Mexico
| | - Oralia Barboza-Quintana
- Department of Pathological Anatomy and Cytopathology, University Hospital 'Dr José Eleuterio González', Autonomous University of Nuevo León, Monterrey, Nuevo Leon 64460, Mexico
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15
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Kang KR, Jung SW, Koh SH. Cutaneous Rosai-Dorfman Disease Confused with Vascular Mass. Arch Craniofac Surg 2016; 17:31-34. [PMID: 28913250 PMCID: PMC5556720 DOI: 10.7181/acfs.2016.17.1.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/24/2015] [Accepted: 12/03/2015] [Indexed: 01/17/2023] Open
Abstract
Rosai-Dorfman disease is a rare histiocytic disorder, clinically characterized by massive, bilateral painless cervical lymphadenopathy with potential for extranodal manifestations. We report a 45-year-old male patient who presented with a slowly growing erythematous nodule of the left chin. The mass appeared non-vascular on computed tomography study, but ultrasonogram was suggestive of a vascular lesion. The lesion was excised with presumptive diagnosis of a hemangioma. However, histopathologic examination of the surgical biopsy revealed histiocytic infiltration with emperipolesis, which was pathognomic for Rosai-Dorfman disease. Additional imaging studies did not reveal lymph node enlargement or other extranodal manifestation. The patient was diagnosed with cutaneous form of the Rosai-Dorfman disease and was discharged home. He remains free of local recurrence at 8 months.
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Affiliation(s)
- Kwang Rae Kang
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea
| | - Sung Won Jung
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea
| | - Sung Hoon Koh
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Anyang, Korea
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Redefining the Prevalence of Dural Involvement in Rosai-Dorfman Disease of the Central Nervous System. World Neurosurg 2016; 90:702.e13-702.e20. [PMID: 26968450 DOI: 10.1016/j.wneu.2016.02.121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/18/2016] [Accepted: 02/18/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease, is a rare condition, classically characterized by painless, massive cervical lymphadenopathy. Histologically, the pathognomonic findings include a dense, mixed inflammatory infiltrate with areas of emperipolesis. Albeit infrequent, when Rosai-Dorfman disease affects the central nervous system, it typically manifests as an isolated dural lesion, often mimicking a meningioma. A purely intraparenchymal manifestation of Rosai-Dorfman disease of the brain and spine with absent dural involvement is exceedingly rare. CASE DESCRIPTION In this report, we describe a 59-year-old woman who underwent surgical excision of an intraparenchymal cerebellar lesion. Histologic analysis of the resected specimen diagnosed isolated Rosai-Dorfman disease with absent systemic involvement. We also provide an updated review of the literature of nondural-based Rosai-Dorfman disease in the central nervous system. CONCLUSIONS With the recent increase of such reported cases, it becomes imperative that Rosai-Dorfman be considered more than as a dural lesion that may mimic meningioma. Diagnostic and therapeutic challenges surrounding this disease entity are also discussed.
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Abstract
Rosai-Dorfman disease (RDD) is a non-malignant pathology of histiocyte proliferation. The classical clinical presentation is with painless cervical lymphadenopathy, but extranodal involvement is frequent, occurring in approximately 40% of cases. The literature was systematically reviewed to identify reported cases of RDD with cardiac involvement. Eighteen cases were identified (3 pediatric and 15 adult). In adult cardiac RDD (cRDD), three patterns of disease were noted: an intra-cardiac mass, epicardial involvement, and pulmonary artery involvement. Reported cases suggest that surgical excision of intra-cardiac masses confers a good prognosis.
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Affiliation(s)
- Kevin O'Gallagher
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
- Address correspondence to: Dr. Kevin O'Gallagher, Cardiology Department, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. E-mail: k.o'
| | - Luke Dancy
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Aish Sinha
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Daniel Sado
- Cardiology Department, King's College Hospital NHS Foundation Trust, London, UK
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Kozak B, Talbott J, Uzelac A, Rehani B. Rosai-Dorfman Disease Isolated to the Thoracic Epidural Spine. J Radiol Case Rep 2015; 9:6-16. [PMID: 27252790 DOI: 10.3941/jrcr.v9i11.2629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rosai-Dorfman disease is a rare benign histiocytic disease that infrequently presents in the spine. We report a case of Rosai-Dorfman disease isolated to the epidural thoracic spine in a 26-year-old male. To our knowledge, this is the 15th reported case of isolated spinal disease and only the fourth case of isolated thoracic epidural disease. Given its rarity as well as non-specific symptoms and imaging findings, Rosai-Dorfman disease is often not considered and misdiagnosed on imaging studies. To help improve awareness of Rosai-Dorfman spinal disease, we review the literature and discuss the epidemiology, clinical presentation, imaging features, and treatment considerations for this condition.
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Affiliation(s)
- Benjamin Kozak
- School of Medicine, University of California, San Francisco, CA, USA
| | - Jason Talbott
- Department of Radiology and Biomedical Imaging, San Francisco General Hospital, San Francisco CA, USA; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Alina Uzelac
- Department of Radiology and Biomedical Imaging, San Francisco General Hospital, San Francisco CA, USA
| | - Bhavya Rehani
- Department of Radiology and Biomedical Imaging, San Francisco General Hospital, San Francisco CA, USA; Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Extranodal Rosai-Dorfman disease in the scrotum of a 13-month male: a unique anatomic presentation. Am J Dermatopathol 2015; 37:88-90. [PMID: 24999545 DOI: 10.1097/dad.0000000000000113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adult Xanthogranuloma, Reticulohistiocytosis, and Rosai-Dorfman Disease. Dermatol Clin 2015; 33:465-72; discussion 473. [DOI: 10.1016/j.det.2015.03.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Dalia S, Sagatys E, Sokol L, Kubal T. Rosai-Dorfman disease: tumor biology, clinical features, pathology, and treatment. Cancer Control 2015; 21:322-7. [PMID: 25310213 DOI: 10.1177/107327481402100408] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare, nonmalignant clinical entity characterized by a group of clinical symptoms and characteristic pathological features. METHODS Articles that reviewed tumor biology, clinical features, pathology, and treatment for RDD were identified in a search of the literature for the years 1990 to 2014. The results from this body of literature were reviewed and summarized. RESULTS Patients with RDD generally present with massive, painless cervical lymphadenopathy, fevers, and elevated inflammatory markers. Extranodal disease is typical, with the most common sites being the skin and the central nervous system. Rarely, the gastrointestinal tract is involved. Immunohistochemistry remains the mainstay of diagnosis with S100 and CD68 positive cells while CD1a will be negative of involved histiocytes. Histologically, the disease shows the classical characteristic finding of emperipolesis. Many patients do not require treatment; however, surgical resection remains the mainstay of treatment for symptomatic disease. The role of steroids, chemotherapy, and radiation therapy continue to be based on small case series and case reports. CONCLUSIONS RDD has a variable clinical presentation; therefore, a high degree of suspicion and a thorough pathological review are necessary to diagnose this rare clinical entity. Although some patients will experience spontaneous resolution, others may require surgical resection or steroid therapy and radiation or chemotherapy. Given the rarity of the disease and the lack of a clear therapeutic pathway, referring patients to a tertiary center is recommended for confirming the diagnosis and treatment considerations.
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Affiliation(s)
- Samir Dalia
- Mercy Clinic Oncology-Hematology, Joplin, MO 64804, USA.
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Arabadzhieva E, Yonkov A, Bonev S, Bulanov D, Taneva I, Pirdopska T, Terziev I, Dimitrova V. Rosai-Dorfman disease involving gallbladder and liver-Report of a case. Int J Surg Case Rep 2015; 12:140-2. [PMID: 26073916 PMCID: PMC4486402 DOI: 10.1016/j.ijscr.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic disorder of unclear etiology. Lymphadenopathy commonly affects the lymph nodes of the neck and the head, but extranodal involvement has been observed too. PRESENTATION OF CASE We describe an unusual case of RDD with involvement of the gallbladder, liver and cystic lymph node, clinically manifested as an exacerbated cholecystitis. The patient underwent a cholecystectomy with atypical liver resection because the finding was macroscopically suspected of gallbladder cancer. The diagnosis of RDD was confirmed by immunohistochemical study. DISCUSSION Histological features of RDD include histiocytic proliferation, emperipolesis and positive immunostaining for S-100 protein and typically negative for CD1a. Gastrointestinal localization of RDD, especially in the liver and pancreas, is extremely rare. Typically, the liver is affected as a part of systematic spread of RDD. We have not found reports for involvement of the gallbladder. CONCLUSION The presented case is valuable due to its rarity and difficulty in differential diagnosis.
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Affiliation(s)
- Elena Arabadzhieva
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria.
| | - Atanas Yonkov
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Sasho Bonev
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Dimitar Bulanov
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Ivanka Taneva
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
| | - Tatyana Pirdopska
- Department of General and Clinical Pathology, Medical University - Sofia, 2 Zdrave Str., 1431 Sofia, Bulgaria
| | - Ivan Terziev
- Department of General and Clinical Pathology, Medical University - Sofia, 8 Bialo more Str., 1527 Sofia, Bulgaria
| | - Violeta Dimitrova
- Department of General and Hepato-Pancreatic Surgery, University Hospital "Alexandrovska" - Sofia, Medical University - Sofia, 1 G.Sofiiski Str., 1431 Sofia, Bulgaria
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Rosai-Dorfman disease: a case report with nodal and cutaneous involvement and review of the literature. Am J Dermatopathol 2014; 36:353-7. [PMID: 23863552 DOI: 10.1097/dad.0b013e31829e5564] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a benign proliferative disorder of histiocytes with an unknown etiology. It is a rare disease characterized by overproduction and accumulation of histiocytes within lymph node sinuses and many other extranodal sites, including skin, oral and nasal cavities, respiratory tract, eyelid, and periorbital area. In this case, a 44-year-old woman with diagnosis of Rosai-Dorfman disease, with xanthelasma-like cutaneous lesions on facial area, extending to her neck and acneiform papules on her back, cervical lymph node involvement, and concomitant presence of diabetes insipidus was presented. Histopathological examination of the lesions demonstrated diffuse lymphocyte, plasmocyte, eosinophil, and sparse neutrophil infiltration, together with histiocytes showing phagocytosed inflammatory cells (emperipolesis). Histiocytes demonstrated immunoreactivity with the antibodies for CD68 and S100, whereas they were negative for CD1a and Langerin. Laboratory tests were normal, except mild immunoglobulin G hypergammaglobulinemia. Systemic methylprednisolone therapy was effective for cutaneous lesions.
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Forest F, N'guyen AT, Fesselet J, Metellus P, Bouvier C, de Paula AM, Roche PH, Figarella-Branger D. Meningeal Rosai-Dorfman disease mimicking meningioma. Ann Hematol 2013; 93:937-40. [PMID: 24366336 DOI: 10.1007/s00277-013-1994-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 12/06/2013] [Indexed: 11/26/2022]
Abstract
Rosai-Dorfman disease of the central nervous system is extremely rare and difficult to diagnose also for pathologists. We describe three unusual cases of meningeal Rosai-Dorfman disease and illustrate the difficulties of preoperative and pathological diagnosis. We retrospectively analyzed three patients who underwent surgery for a suspected meningioma for whom the final diagnosis was Rosai-Dorfman disease of the central nervous system. Pathological initial diagnosis was schwannoma, lymphoplasmacyte-rich meningioma, or inflammatory tumor, but final diagnosis in all cases was Rosai-Dorfman disease. These cases underline the preoperative and pathological difficulties of such diagnosis. Pathologists and physicians should be aware of the occurrence of such rare localization of this disease and should think about this differential diagnosis in lymphocyte-rich meningeal tumors mimicking, clinically and radiologically, a meningioma. Communication of significant previous medical history to pathologists and careful examination of slides with appropriate medical history and the use of S100 antibody in the diagnosis of meningeal tumors mimicking Rosai-Dorfman disease could lower the rate of misdiagnosis.
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Affiliation(s)
- Fabien Forest
- Department of Pathology and Neuropathology, Timone Hospital, 264 rue Saint Pierre, 18285 CEDEX 5, Marseille, France
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Les histiocytoses : comment classer ces affections hétérogènes à fort tropisme cutané ? Ann Dermatol Venereol 2013; 140:79-82. [DOI: 10.1016/j.annder.2012.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vuong V, Moulonguet I, Cordoliani F, Crickx B, Bezier M, Vignon-Pennamen MD, Flageul B, Bagot M, Petit A. [Cutaneous revelation of Rosai-Dorfman disease: 7 cases]. Ann Dermatol Venereol 2012; 140:83-90. [PMID: 23395488 DOI: 10.1016/j.annder.2012.06.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 05/14/2012] [Accepted: 06/28/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a benign form of non-Langerhans-cell histiocytosis. It is identified by a particular histological profile first observed in febrile lymph nodes. Extranodal sites are frequent. The most common site is the skin, which can reveal the disease despite a difficult and delayed diagnosis. Seven cases of cutaneous revelation of RDD were studied retrospectively in order to delineate the clinical characteristics and facilitate diagnosis and treatment of this extremely rare disease. PATIENTS AND METHODS Six cases of RDD from 1990 to 2011 were identified in the photographic and histopathological records of the Saint-Louis Hospital and one case came from a Bichat Hospital consultation. The diagnosis was based in all cases on histopathology results. RESULTS Patients consisted of four men and three women aged between 31 and 69 years. Cutaneous lesions (3 to 20) revealed the disease in all of them and the time from disease onset to diagnosis ranged from six months to five years. The clinical presentation was erythematous or orange popular nodules or plaques, usually on the face. Microscopically, a dense dermal infiltration was observed, in some cases extending into the subcutaneous tissue, with pale histiocytic cells characterised by emperipolesis, plasma cells, lymphocytes, some neutrophils and variable fibrosis. The diagnosis, initially erroneous in 4 cases, was rectified by a second reading of histopathology slides, and immunohistochemical studies showed expression of S-100 protein in histiocytes but not CD1a. Three patients had pure cutaneous RDD. Two neurological sites and one nasal site were also found, with one ENT site and sequelae of previous uveitis in one patient. All extra-cutaneous sites were identified by clinical examination. Different treatments were proposed according to the sites and impact of the disease. In one case, the lesions regressed spontaneously after 18 months. COMMENTS Few RDD series have been published and they mainly concern Asian patients. The ethnic origin of our patients was varied. The main findings were: 1) common clinical findings (orange or erythematous papules or nodules, mostly on the upper body), which should alert the dermatologist and histopathologist to the possible diagnosis of RRD; 2) the possibility, already mentioned in the literature, of spontaneous regression and a good prognosis; 3) the need for thorough evaluation by thoracic, abdominal and cerebral CT (computed tomography) or more a PET (positron emission tomography) scan to screen for potentially dangerous visceral sites, and also clinical follow up.
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Affiliation(s)
- V Vuong
- Service de dermatologie, hôpital Saint-Louis, GHU Paris Nord, AP-HP, Paris, France
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Emperipolesis: an additional common histopathologic finding in H syndrome and Rosai-Dorfman disease. Am J Dermatopathol 2012; 34:315-20. [PMID: 22356918 DOI: 10.1097/dad.0b013e31823b99fc] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
H syndrome is a recently described autosomal recessive disorder characterized by indurated, hyperpigmented, and hypertrichotic cutaneous plaques, mainly involving the lower abdomen and lower extremities. Associated systemic manifestations include hepatosplenomegaly, heart anomalies, hearing loss, hypogonadism, low height, and hyperglycemia. H syndrome is caused by mutations in the gene SLC29A3, which encodes hENT3, a member of the human equilibrative nucleoside transporter family. Histopathologically, cutaneous lesions of H syndrome consist of dermal and subcutaneous fibrosis with inflammatory infiltrate mostly composed of large histiocytes, some plasma cells, and scattered lymphoid aggregates. Recently, histopathologic and immunohistochemical studies have demonstrated that the immunophenotype of the histiocytes infiltrating the skin of a patient with H syndrome is similar to that of the lesions of Rosai-Dorfman disease. Furthermore, mutations in SLC29A3 gene have also been demonstrated in patients described as having an inherited form of Rosai-Dorfman disease, named Faisalabad histiocytosis or familial Rosai-Dorfman disease. We describe emperipolesis in the cutaneous lesions of a patient with H syndrome, further supporting the relationship between Rosai-Dorfman disease and H syndrome.
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Arakaki N, Gallo G, Majluf R, Diez B, Arias E, Riudavets MA, Sevlever G. Extranodal rosai-dorfman disease presenting as a solitary mass with human herpesvirus 6 detection in a pediatric patient. Pediatr Dev Pathol 2012; 15:324-8. [PMID: 22400904 DOI: 10.2350/11-11-1110-cr.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In Rosai-Dorfman disease (RDD), exclusive extranodal involvement with lesions limited to the kidneys is very uncommon and has been described only in adult patients. Occasionally, human herpesvirus 6 (HHV-6) has also been detected in RDD tissue samples. We present the case of a 7-year-old boy referred to our center presenting a single solid mass in the right kidney measuring 3.4 cm, detected both on contrast computed tomography and magnetic resonance imaging. Surgical excision was successfully completed, and the pathology report informed characteristic histopathology and immmunohistochemistry features of RDD. Human herpesvirus 6 was detected and amplified by polymerase chain reaction, as well as by immunohistochemistry. We discuss imaging and histology-based differential diagnoses in the pediatric age group. Although RDD is a rare histiocytic disorder of unknown etiology and pathogenesis, the presence of HHV-6 observed in this case supports the possibility of an abnormal immunologic response linked to viral presence.
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Affiliation(s)
- Naomi Arakaki
- Department of Neuropathology, FLENI, Montañeses 2325, 3rd Floor, Buenos Aires, Argentina, 1428
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Avilés-Izquierdo J, Parra Blanco V, Alfageme Roldán F. Dermoscopic Features of Cutaneous Rosai-Dorfman Disease. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Avilés-Izquierdo J, Parra Blanco V, Alfageme Roldán F. Características dermatoscópicas de la enfermedad de Rosai-Dorfman cutánea. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:446-8. [DOI: 10.1016/j.ad.2011.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 06/29/2011] [Accepted: 07/17/2011] [Indexed: 11/16/2022] Open
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Pang CS, Grier DD, Beaty MW. Concomitant Occurrence of Sinus Histiocytosis With Massive Lymphadenopathy and Nodal Marginal Zone Lymphoma. Arch Pathol Lab Med 2011; 135:390-3. [DOI: 10.5858/2010-0114-cr.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Sinus histiocytosis with massive lymphadenopathy (SHML), also known as Rosai-Dorfman disease, is a rare self-limiting disorder of histiocytes with unknown etiology. Sinus histiocytosis with massive lymphadenopathy is most common in children and young adults and is characterized by painless lymphadenopathy. Histologically there is a proliferation of sinus histiocytes with lymphophagocytosis or emperipolesis. On rare occasions, SHML has been associated with lymphoma, usually involving different anatomic sites and developing at different times. We report a case of concomitant SHML and nodal marginal zone lymphoma involving the same lymph node without involvement of other nodal or extranodal sites. The presence of concomitant SHML within the lymph node involved by nodal marginal zone lymphoma may represent the responsiveness of SHML histiocytes to B-cell–derived cytokines in lymphoproliferative disorders. To our knowledge, this is the first description of concomitant occurrence of SHML and nodal marginal zone lymphoma.
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Eiras JDC, Schettini APM, Lima LLD, Tubilla LHM, Oliveira RMLD. Doença de Rosai-Dorfman cutânea: relato de caso. An Bras Dermatol 2010; 85:687-90. [DOI: 10.1590/s0365-05962010000500014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 09/22/2008] [Indexed: 11/21/2022] Open
Abstract
A doença de Rosai-Dorfman, também denominada histiocitose sinusal com linfadenopatia maciça, é histiocitose de células não Langerhans, idiopática e de curso benigno. Descrita em 1969, caracteriza-se por linfadenomegalia não dolorosa, sendo a cadeia cervical a mais envolvida, além de febre, perda de peso e sudorese. O envolvimento extranodal ocorre em 43% dos casos, em que múltiplos sítios podem ser acometidos. Já foram descritos casos exclusivamente extranodais, inclusive formas limitadas à pele. Relata-se um caso de doença de Rosai-Dorfman extranodal cutânea pura, devido à raridade dessa apresentação clínica.
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Al-Daraji W, Anandan A, Klassen-Fischer M, Auerbach A, Marwaha JS, Fanburg-Smith JC. Soft tissue Rosai-Dorfman disease: 29 new lesions in 18 patients, with detection of polyomavirus antigen in 3 abdominal cases. Ann Diagn Pathol 2010; 14:309-16. [DOI: 10.1016/j.anndiagpath.2010.05.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 05/27/2010] [Indexed: 12/12/2022]
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Safdar A, Gillenwater AM, Jones DM, Jorgensen JL, Romaguera JE. Rosai-Dorfman disease misdiagnosed as active tuberculosis. Leuk Lymphoma 2009; 47:1441-2. [PMID: 16923590 DOI: 10.1080/10428190600625521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zivin SP, Atieh M, Mosier M, Paner GP, Aranha GV. Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) of the pancreas: second case report. J Gastrointest Surg 2009; 13:806-9. [PMID: 19020944 DOI: 10.1007/s11605-008-0752-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Accepted: 10/28/2008] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Rosai-Dorfman disease (RDD), originally described as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic proliferative disorder with a distinctive microscopic appearance. It formerly was thought to be a process limited to lymph nodes, yet RDD has been documented to occur in many organ systems, notably the bone, skin, soft tissue, central nervous system, eye and orbit, and upper respiratory tract. The digestive system, however, is affected only exceptionally, with this being only the second documented case involving the pancreas. CASE DESCRIPTION In this case report, we present a case of a 63-year-old African-American female who was found to have a pancreatic head mass and right middle lobe pleural nodule during evaluation for obstructive jaundice. DISCUSSION AND CONCLUSION She underwent a Whipple procedure. Her pathology of both the pancreatic mass and RML lung wedge resection showed sinus histiocytosis with massive lymphadenopathy, along with extensive fibrosis intertwined with nodular mixed inflammatory infiltrate. The histiocytes characteristically showed "emperipolesis," in which lymphocytes had penetrated the cytoplasm and remained viable within the histiocytes (lymphocytes continued to have free movement in the histiocyte). In addition, the histiocytic cells were positive with S-100 protein and CD68, hallmarks of RDD. Although rare, Rosai-Dorfman disease should be considered in the differential diagnosis of patients presenting with pancreatic and/or lung nodules, especially when biopsy or cytology results report atypical inflammatory findings.
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Affiliation(s)
- Sean P Zivin
- Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
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Long E, Lassalle S, Cheikh-Rouhou R, Hofman V, Lacour JP, Hofman P. Intestinal occlusion caused by Rosai-Dorfman disease mimicking colonic diverticulitis. Pathol Res Pract 2007; 203:233-7. [PMID: 17400399 DOI: 10.1016/j.prp.2007.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 01/10/2007] [Indexed: 11/26/2022]
Abstract
Rosai-Dorfman disease (RDD) involves the gastrointestinal tract only in exceptional cases, and this very unusual site of presentation can confuse the pathologist. We present a case of RDD manifesting as an intestinal occlusion caused by colonic diverticulitis. The patient was a 79-year-old man with myelodysplasia, who presented with fever, abdominal pain, and constipation. Colonoscopy revealed sigmoiditis and diverticulosis. Microscopic study of the sigmoid colon surgical specimen showed the histological and immunological features of RDD. No human DNA of herpesvirus types 6 and 8 (HHV6/HHV8), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) was detected in tissue by polymerase chain reaction. Electron microscopic study revealed no microbes or viral particles. Widespread nodal and extranodal RDD occurred, and the patient died 2y after initial surgery. The etiology of RDD is still under debate. We discuss the association of RDD with hematological disorders.
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Affiliation(s)
- Elodie Long
- Laboratory of Clinical and Experimental Pathology, 30 avenue de la voie romaine, Louis Pasteur Hospital, 06002 Nice, France
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Abstract
Cutaneous Rosai-Dorfman disease (CRDD) is a rare proliferative disorder of histiocytes with unknown etiology, broadly different from systemic Rosai-Dorfman disease. We present the largest series of CRDD, describing the clinical manifestation, histopathology, immunohistochemistry, and follow-up course of 25 cases in China. Clinically, 39 skin lesions in 25 patients were divided into 3 main types: papulonodular type (79.5%), indurated plaque type (12.8%), and tumor type (7.7%). Extremities were the most frequently involved, followed by trunk and face. None of the patients was found to have visceral organ involvement or lymphadenopathy. Microscopically, CRDD was characterized by scattering, clusters or sheets of large polygonal histiocytes intermingled with a florid, mixed inflammatory infiltrate. The most important feature was emperipolesis, which can be highlighted by S-100 protein stain. Patch and bandlike infiltrate of numerous mature plasma cells around glands and vessels was a constant finding in all lesions. Neutrophils existed in all cases to a variable degree with 2 cases forming microabscess. Four cases were remarkable for fibrosis, and xanthomatous change was observed in 2 cases. Coexistence of localized Langerhans cell histiocytosis and CRDD was interestingly found in case 7, which was evidenced by CD1a stain. Clinical follow-up in 22 patients, ranging from 2 to 55 months, indicated that surgical excision was the exclusive effective treatment for CRDD. Partial or complete spontaneous remission was achieved in 7 patients within 6 to 55 months. Owing to its favorable outcome, CRDD should be differentiated from a variety of benign and malignant lesions. Recognition of its wide clinical spectrum and histologic features combined with S-100 protein stain can help to establish the correct diagnosis.
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Affiliation(s)
- Yun-Yi Kong
- Department of Pathology, Cancer Hospital, Fudan University, Shanghai, PR China.
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Newman B, Hu W, Nigro K, Gilliam AC. Aggressive histiocytic disorders that can involve the skin. J Am Acad Dermatol 2006; 56:302-16. [PMID: 17097374 DOI: 10.1016/j.jaad.2006.06.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 05/16/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
Histiocytoses are a heterogeneous group of disorders that are characterized by the proliferation and accumulation of reactive or neoplastic histiocytes. Three classes of histiocytoses have been defined: class I, Langerhans cell disease; class II, non-Langerhans cell histiocytic disease without features of malignancy; and class III, malignant histiocytic disorders. Although the disorders in classes I and II usually have a benign appearance on histology and are commonly non-aggressive and self-healing, some can cause debilitating or even fatal outcomes. Such cases beg the question: what stimulates aggressive behavior of a classically benign disease? New molecular information may now provide insight into the driving force behind many of the aggressive histiocytoses. In this article, we review Langerhans cell disease and seven aggressive histiocytoses that can involve skin, discuss histologic features that may forecast a poor prognosis, and discuss the molecular findings that help to explain the pathophysiology of these aggressive histiocytic disorders.
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MESH Headings
- Histiocytosis/classification
- Histiocytosis/pathology
- Histiocytosis/physiopathology
- Histiocytosis, Langerhans-Cell/diagnosis
- Histiocytosis, Langerhans-Cell/pathology
- Histiocytosis, Langerhans-Cell/physiopathology
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/pathology
- Histiocytosis, Non-Langerhans-Cell/physiopathology
- Histiocytosis, Non-Langerhans-Cell/therapy
- Humans
- Lymphohistiocytosis, Hemophagocytic/pathology
- Lymphohistiocytosis, Hemophagocytic/physiopathology
- Necrobiotic Disorders/diagnosis
- Necrobiotic Disorders/pathology
- Necrobiotic Disorders/physiopathology
- Necrobiotic Disorders/therapy
- Prognosis
- Sea-Blue Histiocyte Syndrome/pathology
- Sea-Blue Histiocyte Syndrome/physiopathology
- Sea-Blue Histiocyte Syndrome/therapy
- Skin Diseases/diagnosis
- Skin Diseases/pathology
- Skin Diseases/physiopathology
- Skin Diseases/therapy
- Xanthogranuloma, Juvenile/pathology
- Xanthogranuloma, Juvenile/physiopathology
- Xanthogranuloma, Juvenile/therapy
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Affiliation(s)
- Brenda Newman
- Department of Dermatology, Case/University Hospitals of Cleveland, Ohio 44106-5028, USA
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Lu CI, Kuo TT, Wong WR, Hong HS. Clinical and histopathologic spectrum of cutaneous Rosai-Dorfman disease in Taiwan. J Am Acad Dermatol 2005; 51:931-9. [PMID: 15583585 DOI: 10.1016/j.jaad.2004.04.030] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Cutaneous Rosai-Dorfman disease (RDD) is a rare entity of unknown origin and is not well documented, especially in Asian populations. OBJECTIVE The purpose of this study was to evaluate the clinical manifestation, diagnostic histopathology, clinical course, and response to treatment of cutaneous RDD in Taiwan. MATERIALS AND METHODS This study included 21 patients with cutaneous RDD who presented at our institution from 1995 to 2003. Pathologic examinations with both hematoxylin-eosin and immunohistochemical stains were reviewed, as were associated clinical features and therapeutic methods. RESULTS None of the 21 patients with cutaneous RDD had nodal lesions. The clinical manifestation was variable, but most commonly involved a central noduloplaque with satellite papules. One patient manifested as an ulcerated nodule, something not reported previously. Multifocal involvement only occurred in 4 patients. Concurrent involvement of uvea or vocal cord occurred in two patients. The most prominent histologic feature was a florid and mixed inflammatory infiltration. The phagocytosis of inflammatory cells into the cytoplasm of histiocytes, a process called "emperipolesis," is a characteristic finding of nodular RDD but usually only focally presented in cutaneous ones. Positivity for S-100 protein helped to confirm the diagnosis. The most effective treatment was surgical excision of solitary lesions. High-dose thalidomide (300 mg/d), but not low-dose, was effective to control the extensive cutaneous diseases in two patients. A total of 3 patients experienced spontaneous remission 1 to 2 years after diagnosis. CONCLUSIONS Cutaneous RDD appeared more frequently in Asian populations than in reports from Western countries. The incidence of multifocal involvement in this series is much lower than in other literature. Although treatment of disseminated cutaneous RDD is difficult, high-dose thalidomide (300 mg/d), which was effective in two patients in this series, may be helpful.
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Affiliation(s)
- Ching-I Lu
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China
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