Relapsing Bilateral Uveitis and Papilledema in Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease)

Ophthalmic Rosai-Dorfman disease: a multi-centre comprehensive study

Background

To provide basic demographic information and clinicopathologic features of ophthalmic Rosai–Dorfman disease (RDD) with a literature review.

Methods

A multi-centre retrospective case series reviewing all patients with histopathologically confirmed ophthalmic RDD at three tertiary eye care centres between January 1993 and December 2018.

Results

Eleven eyes of eight patients with histopathologically confirmed ophthalmic RDD were included, with equal numbers of males and females. The median age was 40.25 years (range: 26.6–72.4). Two patients had familial RDD. The orbit was the most commonly involved site (90.9% eyes). One patient (one eye) presented with a scleral nodule, anterior uveitis and cystoid macular oedema. Visual acuity ranged from 20/25 to light perception. Six patients had an extra-nodal ophthalmic disease, and the remaining two had an associated submandibular lymphadenopathy (nodal RDD).

Conclusions

Ophthalmic RDD can be the only manifestation of this systemic disease, with the orbit being the most commonly involved site, exhibiting bone destruction, intracranial and/or sinus involvement and variable degree of visual loss. Ophthalmic familial RDD represent a severe form with a malignant course. Steroid monotherapy may be inadequate to control orbital RDD; thus, combined treatment is usually necessary. A comprehensive approach to assessment and management is recommended.

Rosai-Dorfman disease masquerading as Uveal Melanoma: Case report and review of literature

OBJECTIVE/BACKGROUND

Intra ocular Rosai-Dorfman disease (RDD) is an extremely rare disease. We are reporting the first case of RDD presenting as ciliary body mass mimicking ciliary body melanoma, and we are reviewing the English literature reporting on cases of RDD presented with intraocular disease.

METHODS

An 18-year-old lady presented with loss of vision in the right eye, and was found to have intraocular mass lesion. She was diagnosed clinically and radiologically as a case of ciliary body melanoma associated with total retinal detachment.

RESULTS

Histopathological sections and stains proved to be intraocular RDD. Review of the literature revealed three cases of intraocular RDD; two of them had choroid thickening associated with serous retinal detachment, and one presented with intraocular mass mimicking choroid melanoma. Two of the three cases were enucleated. Our case is the first case in English literature of intraocular ciliary body RDD, mimicking ciliary body melanoma.

CONCLUSION

RDD can present as an intraocular mass that mimics ciliary body melanoma. This case emphasizes the importance of diagnostic biopsy before considering the final therapy in unclear cases, mainly when associated with unusual systemic features like lymphadenopathy.

Ophthalmic Findings of Rosai-Dorfman Disease

PURPOSE

To describe the ophthalmic, pathologic, and BRAF V600E mutation status of Rosai-Dorfman disease (RDD).

DESIGN

Retrospective case series.

METHODS

A retrospective review of all cases of RDD seen at Mayo Clinic from 1992 to 2016 identified patients with ophthalmic manifestations (n = 8). Immunostain for BRAF and molecular studies for BRAF V600E mutation were performed on cases with tissue available.

RESULTS

Of 76 patients with RDD, 15 had eye examinations; of those, 8 (5 female and 3 male) had ophthalmic manifestations. In RDD patients with ophthalmic manifestations compared to RDD patients without ophthalmic manifestations, the respective median (range) age in years was 42 (15-70) and 56 (32-79) (P = .13) and median (range) logMAR visual acuity was 0.048 (0.000-1.824) and 0.000 (-0.124 to 0.301) (P = .19). Of the 8 patients with ophthalmic manifestations, 4 had ocular involvement and 4 had orbital masses. Patients with ocular involvement had multiorgan disease including tracheal, aortic, renal, skeletal, and soft tissue lesions (n = 4). Patients with orbital masses had no systemic involvement (n = 2), skeletal involvement only (n = 1), or multiorgan disease (n = 1). BRAF immunostaining and molecular studies were negative in all available specimens (n = 6).

CONCLUSIONS

In this series of patients with ophthalmic manifestations of RDD, those with ocular involvement had multiorgan disease while those with orbital masses had more limited systemic disease. Patients with ophthalmic manifestations tended to be younger and have worse visual acuity. Additionally, ophthalmic RDD does not seem to be associated with BRAF mutation.

Sclerouveitis associated with Rosai-Dorfman disease in an HIV-infected patient

PURPOSE

To describe a case of Rosai-Dorfman-associated sclerouveitis in an HIV-infected patient.

DESIGN

Case report.

METHODS

A 49-year-old man with HIV had bilateral eye pain, redness, photophobia, and multiple systemic complaints. He underwent serial ocular examinations, abdomen/pelvis CT scan, and lymph node biopsy.

RESULTS

Ophthalmologic evaluation revealed bilateral, nongranulomatous anterior uveitis and anterior scleritis. Biopsy of a retroperitoneal lymph node identified on CT revealed mixed inflammatory infiltrate composed of histiocytes, lymphocytes, and plasma cells involving fibroadipose tissue, indicating Rosai-Dorfman disease.

CONCLUSIONS

This is the first report of sclerouveitis in Rosai-Dorfman disease. Rosai-Dorfman is typically self-limiting, occurring rarely in HIV.

Orbital Rosai-Dorfman disease: a literature review

INTRODUCTION

Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder with a predilection for the head and neck. Isolated orbital involvement without systemic clinical features is very uncommon.

BACKGROUND

Classic histopathologic features include phagocytized but intact lymphocytes within large histiocytes; a conditioned termed emperipolesis. Immunohistochemical stains are strongly positive for S-100 and CD68 but negative for CD1a in most cases. Orbital cases are often amenable to complete surgical resection.

CONCLUSION

RDD should be considered in the differential diagnosis of a young patient in good health who presents with a marked but benign enlargement of an orbital mass. A review of the literature regarding this disease entity and its orbital manifestations is discussed.

Rosai-Dorfman disease presenting as choroidal melanoma: a case report and review of the literature

BACKGROUND

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-malignant proliferation of histiocytes of unknown aetiology. It was first recognised as a distinct clinicopathologic entity in 1969, and is classified as an idiopathic non-Langerhans cell histiocytosis. The disease process is usually self-limiting and often involves lymph nodes, but extranodal involvement is well-described and any anatomic site can be involved.

METHODS

We describe a unique case of a 40-year-old male who presented with a fundus mass diagnosed clinically as choroidal melanoma. The tumour showed rapid growth. The patient developed a total retinal detachment and underwent enucleation. The globe contained a choroidal tumour with histologic and immunophenotypic features characteristic of RDD. The literature of ocular Rosai-Dorfman disease was reviewed.

RESULTS

This is the first case in the English literature of intraocular choroidal RDD, mimicking choroidal melanoma.

CONCLUSIONS

Rosai-Dorfman disease can present as a mass-producing lesion in the choroid and may mimic other choroidal tumours. The case emphasises the need to consider diagnostic biopsy prior to definitive treatment of choroidal tumours.

Rosai-dorfman disease diagnosed because of bilateral choroidal masses

PURPOSE

To describe a case of bilateral choroidal masses leading to the diagnosis of Rosai-Dorfman disease.

METHOD

Case report. Color photographs, fluorescein angiography, autofluorescence, indocyanine green angiography, and high-definition optical coherence tomography imaging of both eyes and computed tomography and biopsy of pelvis mass were performed. A 47-year-lady presented with unknown choroidal masses in both eyes. She had no visual complaints. Her medical history was noncontributory.

RESULTS

Workup included a computed tomography of the chest and abdomen that demonstrated soft tissue masses in the renal pelvis bilaterally. A core needle biopsy from the renal mass demonstrated numerous histiocytoid that were positive for CD163 and S100 protein.

CONCLUSION

Based on this spectrum of findings, the diagnosis of Rosai-Dorfman disease was made. To date, the patient has been followed-up for 3 years without medical intervention and without visual deterioration. Careful follow-up is a reasonable management if patients are asymptomatic.

[Histiocytic disorders with orbital involvement]

The eosinophilic granuloma of bone is the most common type of histiocytic disorder involving the orbital area. Imaging data typically show bony defects with an intra-orbital soft-tissue extension. Surgical debulking is most often required. Rosai-Dorfman disease is commonly associated with uni- or bilateral orbital locations. The other histiocytic disorders are very rare, but some have a poor prognosis such as Erdheim-Chester disease.

Extranodal Rosai-Dorfman Disease presenting as an epibulbar tumor

PURPOSE

To describe a case of an epibulbar tumor as a manifestation of Rosai-Dorfman Disease (RDD) and review the pertinent literature.

METHODS

This was an interventional case report and literature review. A 19-year-old African-Brazilian man was referred for evaluation of a 12 x 11-mm subconjunctival mass at the temporal limbus OD. Intraocular pressure was normal, and funduscopy was unremarkable OU. Ultrasound biomicroscopy showed an ill-defined scleral homogeneous lesion at the temporal quadrant, without intraocular invasion. A superficial sclerokeratectomy was performed.

RESULTS

Histopathologic evaluation revealed inflammatory aggregates composed of lymphocytes, plasma cells, and histiocytes. The histiocytes appeared pale, and some of them had intact lymphocytes and plasma cells within their cytoplasm. Russell bodies were also found. The histiocytes were positive for CD68 and S-100 and negative for lysozyme and CD1a. Special stains for microorganisms were all negative. Those findings were consistent with the diagnosis of extranodal RDD. Systemic workup failed to reveal lymphadenopathy or extranodal disease elsewhere. At the 14-month follow-up, there were no signs of recurrence.

CONCLUSIONS

Although extranodal manifestations are common in RDD and the lack of lymph node involvement is rare, our study supports that whenever there is an epibulbar tumor as a manifestation of RDD, the absence of lymphadenopathy is characteristic. Only 2 of the 9 reported cases presented with lymphadenopathy. The presence of emperipolesis and S-100-positive histiocytes during histopathologic evaluation confirms the diagnosis even in the absence of lymphadenopathy.

Atypical ocular presentations of Rosai-Dorfman disease

PURPOSE

To report atypical ocular findings of Rosai-Dorfman disease and to determine association with parvovirus 19.

DESIGN

The study is an observational case series of three patients that had atypical ocular presentations of Rosai-Dorfman disease.

METHODS

A multicenter, retrospective case series of 3 patients was evaluated for varied ocular complaints, including enlarging epibulbar masses and uveitis. Histologic specimens were examined retrospectively for parvovirus 19 antigen.

RESULTS

Patients presented with ocular findings prior to or concurrently with systemic findings, with and without associated lymphadenopathy. Two cases presented with epibulbar masses, one with the mass as the only sign of disease while the other exhibited multinodal involvement with bilateral epibulbar masses and anterior granulomatous inflammation. Parvovirus B19 antibody staining was negative in these cases. The final case exhibited bilateral anterior granulomatous inflammation and choroidal infiltrates.

CONCLUSIONS

Ocular findings may be the sole or presenting complaint in Rosai-Dorfman disease prior to recognition of systemic disease and should be considered in the differential diagnosis of epibulbar masses as well as anterior and posterior granulomatous inflammation.

Bilateral papillitis associated with bilateral anterior uveitis in a child

Slit-lamp and dilated fundus examination of a 6-year-old boy revealed bilateral anterior uveitis associated with optic disk edema with mild leakage on fluorescein angiography in both eyes. Anterior uveitis resolved with topical therapy in 3 months and optic disk edema and fluorescein leakage 1 month later. Optic nerve function was intact. Resolution of optic disk edema followed that of anterior uveitis with no sequelae.

Uveitic glaucoma and Rosai-Dorfman disease (sinus histiocytosis)

PURPOSE

To report a novel association of uveitic glaucoma with Rosai-Dorfman disease.

METHODS

Case report.

RESULTS

A 67-year-old Caucasian woman presented with a chronic bilateral granulomatous uveitis which did not respond to conventional topical steroid therapy. She also had raised intraocular pressures, glaucomatous optic disc changes and diffuse nodular fibrous skin lesions. Subsequent skin biopsy immuno-cytochemistry showed S-100 staining, consistent with Rosai-Dorfman disease. The uveitis and glaucoma were highly resistant to standard medical treatments, but completely resolved together with the systemic features of the disease after six months.

CONCLUSIONS

Rosai-Dorfman disease has not previously been reported to cause uveitic glaucoma and should be considered in non-responsive cases presenting with a rash. The disease is entirely self-limiting and early diagnosis may therefore avoid unnecessary trabeculectomy and/or systemic immune suppression.

Faisalabad histiocytosis mimics Rosai-Dorfman disease: brothers with lymphadenopathy, intrauterine fractures, short stature, and sensorineural deafness

Rosai-Dorfman disease (RDD) is a rare, sporadic histiocytic disorder characterized by painless but protracted lymphadenopathy. Its etiology remains unclear. The observation of congenital disease and reports of familial cases with seven pairs of siblings including three sets of identical twins suggests a genetic predisposition in some patients with this condition. We now report two brothers of consanguineous Palestinian parents, whose lymphadenopathy, lymph node histology, and polyclonal hypergammaglobulinemia indicated RDD. The presence of intrauterine fractures, short stature, and sensorineural hearing impairment suggested a rare familial form of the disorder. Moynihan et al. recently described a Pakistani family with a familial histiocytic disorder highly reminiscent of the brothers reported here, whose lymph node morphology was apparently consistent with RDD as well. The presence of sensorineural deafness, short stature, and joint contractures, however, suggested a separate, rare autosomal recessive syndrome referred to as Faisalabad histiocytosis, after the family's place of origin. We believe that the brothers described here represent a second family with Faisalabad histiocytosis, which mimics RDD histologically.

The spectrum of orbital Rosai-Dorfman disease

PURPOSE

To describe the spectrum and treatment of orbital Rosai-Dorfman disease and to review previously documented cases.

METHODS

Retrospective, interventional case series of seven patients and literature review.

RESULTS

Each patient with Rosai-Dorfman disease had unique disease expression requiring aggressive therapy, such as chemotherapy, radiation, and/or surgical excision. One systemically aggressive case presented with intraocular and choroidal invasion, a previously unreported finding. Response to therapy was variable and unpredictable.

CONCLUSIONS

Rosai-Dorfman disease, although historically described as benign and self-limiting, may cause significant morbidity and mortality involving multiple organ systems. Available treatment options may not control the disease. Further research and long-term clinical correlation is necessary.

Cutaneous Rosai-Dorfman disease: clinicopathological profiles, spectrum and evolution of 21 lesions in six patients

BACKGROUND

An uncommon histiocytosis primarily involving the lymph nodes, Rosai-Dorfman disease (RDD, originally called sinus histiocytosis with massive lymphadenopathy) involves extranodal sites in 43% of cases; cutaneous RDD (C-RDD) is a rare form of RDD limited to the skin. The clinicopathological diagnosis of C-RDD may sometimes be difficult, with different clinical profiles from those of its nodal counterpart, and occasionally misleading histological pictures. There have been few multipatient studies of C-RDD and documentation of its histological spectrum is rare.

OBJECTIVES

To identify the clinical and histopathological profiles, associated features, and the chronological changes of this rare histiocytosis.

METHODS

From 1991 to 2002, patients diagnosed as having C-RDD were collected in four academic hospitals. Clinical presentations, treatments, and courses of each case were documented. In total, 21 biopsy specimens obtained from these patients were re-evaluated and scored microscopically with attention to the uncommon patterns and chronological evolution both clinically and histologically.

RESULTS

We examined six patients with C-RDD, three men and three women. The mean age at the first visit was 43.7 years. The clinical presentations were mostly papules, nodules and plaques, varying with the duration and depth of lesions. Although the anatomical distribution was wide, the face was most commonly involved. Evolutional changes were identified clinically, as the lesions typically began with papules or plaques and grew to form nodules with satellite lesions and resolved with fibrotic plaques before complete remission. No patient had lymphadenopathy or extracutaneous lesions during follow-up (mean 50.5 months). At the end of follow-up, the lesions in four patients had completely resolved irrespective of treatment; two patients had persistent lesions. The histopathological pattern of the main infiltrate, the components of cells and the stromal responses showed dynamic changes according to the duration of lesions. The characteristic Rosai-Dorfman cells (RD cells) were found in association with a nodular or diffuse infiltrate in 15 lesions (71%). Four lesions (19%) demonstrated a patchy/interstitial pattern. One lesion (5%) assumed the pattern of a suppurative granuloma. RD cells were less readily found in these atypical patterns. Conspicuous proliferation of histiocytes associated with RD cells was found in three lesions, including xanthoma, localized Langerhans cell histiocytosis and xanthogranuloma. Along with lymphocytes, plasma cells were present in all lesions, often in large numbers with occasional binucleated or trinucleated cells. Variably found in the lesions were neutrophils (nine lesions, 43%) and eosinophils (13 lesions, 62%). The former occasionally formed microabscesses, while the latter were often few in number. Vascular proliferation was a relatively constant feature (90%). Fibrosis was found in 10 lesions (48%).

CONCLUSIONS

Our study further confirms that C-RDD is a distinct entity with different age and possibly race distributions from RDD. Compared with its nodal counterpart, C-RDD demonstrates a wider histopathological spectrum with different clinicopathological phases depending on duration of the lesions. Awareness of these features is helpful in making a correct diagnosis. The associations of C-RDD with other histiocytoses may have important implications for the pathogenesis of this rare histiocytosis.

Bilateral anterior granulomatous uveitis associated with cutaneous Rosai-Dorfman disease

BACKGROUND

Rosai-Dorfman disease (RDD) is a benign, rare, histiocytic disorder of unknown etiology. We describe the case of a 61-year-old woman who presented to the ophthalmology clinic with bilateral granulomatous anterior uveitis.

METHODS

The uveitis was controlled on topical prednisolone acetate 1%. One month after presentation, she developed generalized macules and papules, and dermatologic and systemic evaluations were performed.

RESULTS

On the basis of skin biopsy, purely cutaneous RDD was established.

CONCLUSION

Anterior granulomatous uveitis may be the presenting sign of cutaneous RDD. Consultation is necessary for accurate diagnosis.

Orbital, adnexal, and unusual systemic involvement in Rosai-Dorfman disease

PURPOSE

To describe the unusual clinical course of a patient with Rosai-Dorfman disease (RDD) affecting the eyelid and orbital tissues and involving the spinal cord.

METHODS

Case report.

RESULTS

A 68-year-old Indian man first presented in 1994 with a right lower eyelid lump for 1 year. An en bloc excisional biopsy was reported to show "reactive lymphoid hyperplasia with sclerosis." The patient subsequently defaulted follow-up and presented again in 1999 with bilateral lower eyelid masses and proptosis. Computerized tomography showed bilateral orbital, ethmoidal sinus, and frontal sinus soft tissue masses. Bilateral excisional biopsies of the orbital and eyelid masses showed histologic features of RDD. The patient had a history of paraplegia with decompression laminectomy and excision of an epidural mass in 1994. In addition, he underwent excision of soft tissue masses from the abdominal wall in 1993. Retrospective review of the histologic specimens from these two areas showed a histologic picture similar to that of eyelid specimens (in 1994 and 1999).

CONCLUSIONS

It is important to consider RDD in addition to lymphoproliferative disorders in a patient with orbital and ocular adnexal masses. The initial histologic presentation may not be pathognomonic.

Marginal corneal infiltrates: a possible new manifestation of sinus histiocytosis with massive lymphadenopathy

PURPOSE

To describe unilateral deep marginal corneal infiltrates and chronic anterior uveitis in a young patient with sinus histiocytosis and massive lymphadenopathy.

METHODS

A 20-year-old man with a painless enlargement of his cervical lymph nodes was followed for five years after debulking of these nodes on the right side for right chronic anterior uveitis and deep marginal corneal infiltrates.

RESULTS

Histological sections of cervical lymph node confirmed the diagnosis of sinus histiocytosis with the typical emperipolesis. The uveitis partially responded to topical corticosteroid treatment but tended to recur upon its withdrawal. The marginal corneal infiltrates resolved gradually over a period of five years.

CONCLUSIONS

Marginal corneal infiltrates and uveitis may presumably be associated with sinus histiocytosis. Patients with sinus histiocytosis should also be screened for rare ocular involvement, such as uveitis and corneal infiltrates.

Cutaneous sinus histiocytosis and chronic uveitis

Sinus histiocytosis with massive lymphadenitis or Rosai-Dorfman disease (RDD) is a rare, benign, proliferative histiocytic disease of unknown origin. It predominately affects the lymph nodes The skin is the extranodal organ most frequently involved, although a few patients present with only lesions of the skin and soft tissues, without involvement of the lymph nodes (purely cutaneous RDD). Ocular involvement is rare, and generally localized to the eyelid. We report an unusual case of cutaneous sinus histiocytosis without nodal involvement and with bilateral uveitis in a girl. As far as we know, this is the first case reported in which cutaneous and ocular RDD occurred without nodal involvement.