Extranodal Rosai-Dorfman disease: a rare soft tissue neoplasm masquerading as a sarcoma

Rare Presentation of Rosai-Dorfman Disease in Soft Tissue: Diagnostic Findings and Surgical Treatment

Introduction and Importance. Rosai-Dorfman disease (RDD) is a rare, benign type II histiocytosis characterized by the infiltration of S100+ histiocytes and emperipolesis. The disease may present in the lymph nodes (nodal RDD), in extranodal sites, or in both nodal and extranodal sites. Among those patients who present exclusively in extranodal sites, only a minority of cases present in the soft tissue. Case Presentation. An 18-year-old female presented to orthopedic oncology clinic with a chief complaint of a mass located in her lower back. The patient underwent excision of the lumbosacral mass. Pathologic review demonstrated emperipolesis of lymphocytes and plasma cells within enlarged, eosinophilic histiocytes in a background of lymphoplasmacytic infiltration and collagenous stroma. Immunohistochemical staining demonstrated S100+ and CD163+ histiocytes, consistent with diagnosis of soft tissue RDD. Clinical Discussion. Histologically, RDD is generally characterized by emperipolesis—the presence of intact lymphocytes within the histiocyte cytoplasm—and a mixed infiltrate of S100+ histiocytes, mononuclear cells, plasma cells, and lymphocytes. Although soft tissue RDD may histologically resemble nodal RDD, soft tissue RDD also demonstrates some notable histologic differences including the lack of nodal architecture, the presence of increased fibrosis and collagen deposition, and generally fewer RDD cells. Conclusion. This case presentation demonstrates one few reports of isolated soft tissue RDD within the lumbosacral region without associated lymphadenopathy or skin changes and highlights the heterogeneity that still exists in the treatment paradigm of extranodal RDD.

Rosai-Dorfman Disease of Bone and Soft Tissue

Context.—

Rosai-Dorfman disease is a rare histiocytic proliferative disorder of unknown pathogenesis that may be diagnostically difficult in extranodal sites. It is commonly an unsuspected diagnosis when arising in bone and soft tissue, especially when it presents without associated lymphadenopathy. Its variable clinical presentation and nonspecific imaging findings make the diagnosis quite challenging, particularly in small biopsies. The problem is compounded by its less-characteristic histomorphologic features in comparison with nodal disease. Awareness of the potential diagnostic pitfalls in Rosai-Dorfman disease of bone and soft tissue should raise the degree of diagnostic accuracy.

Objective.—

To review the clinical manifestations, imaging characteristics, and histomorphologic features of Rosai-Dorfman disease of bone and soft tissue along with a brief discussion of its differential diagnosis, pathogenesis, and current management.

Data Sources.—

Thorough review of the literature with focus on clinical manifestations, imaging findings, key histomorphologic features, pathogenesis, and treatment.

Conclusions.—

The diagnosis of Rosai-Dorfman disease of bone and soft tissue may be quite challenging because of its variable clinical presentation and nonspecific imaging findings. It may be asymptomatic without systemic manifestations or associated lymphadenopathy. The definitive diagnosis relies on histopathologic identification of the characteristic S-100–positive histiocytes demonstrating emperipolesis. Bone and soft tissue lesions tend to have lower numbers of characteristic histiocytes and less conspicuous emperipolesis and often demonstrate areas of fibrosis or storiform spindle cell areas resembling fibrohistiocytic lesions. Awareness of these unusual features is necessary in order to consider Rosai-Dorfman disease in the differential diagnosis when confronting these rare and often misleading lesions.

Cytological Diagnosis of Rosai-Dorfman Disease: A Study of Twelve Cases with Emphasis on Diagnostic Challenges

Context:

Rosai–Dorfman disease, also known as Sinus histiocytosis with massive lymphadenopathy, is a benign proliferative disorder of histiocytes. It typically affects lymph nodes; however, extranodal disease is being increasingly reported. The latter entity poses exceptional diagnostic challenge clinico-radiologically by forming mass lesions. Fine needle aspiration cytology (FNAC) is the investigation of choice to avoid unnecessary surgery as the majority are self-limiting.

Aims:

The objective is to assess the utility of FNAC in the diagnosis of Rosai–Dorfman disease and to highlight the diagnostic difficulties.

Material and Methods:

The cytology features of 12 cases of Rosai–Dorfman disease were analyzed and correlated with histopathology and immunohistochemistry.

Results:

The present study included six nodal and six extranodal Rosai–Dorfman disease. The cytology smears showed a variable number of large histiocytes exhibiting characteristic emperipolesis. Ten cases diagnosed as Rosai–Dorfman disease on cytology were confirmed on histopathology. The presence of granulomas, atypical histiocytes, insignificant emperipolesis, and eosinophil infiltration were the challenges we faced.

Conclusions:

FNAC, a simple and cost-effective method with its unique cytology features is the first line of investigation in the diagnosis of Rosai–Dorfman disease.

Recurrent Cutaneous Rosai-Dorfman Disease

Rosai-Dorfman disease (RDD) is a rare proliferative histiocytic disorder, most commonly presenting with cervical lymphadenopathy. When extranodal, a rare manifestation of the disease is the presence of cutaneous lesions. Surgical excision has shown promising results in patients with cutaneous RDD; however, no optimal management has been elucidated. We present a 60-year-old female with recurrence of left thigh cutaneous lesions consistent with extranodal RDD whose optimal management required combined used of excision and chemotherapy.

Rosai-dorfman disease of the fibula: A case report

Rosai–Dorfman disease (RDD) is usually characterized by painless bilateral cervical lymphadenopathy associated with fever and leukocytosis. Although the disease may occur outside lymphnodes, manifestation of skeletal system occurs in less than 8% of cases. In addition, presentation of this disease in a purely skeletal form without lymph nodes involvement is extremely uncommon. This case report describes a 17-year-old female with a pure skeletal presentation of RDD in the fibula. Trocar biopsy was performed, and immunohistochemical staining using S100 and CD68 was done to confirm the diagnosis.

A rarity in breast pathology: First recurrent male case of Rosai-Dorfman disease

INTRODUCTION

Rosai-Dorfman Disease (RDD) is a rare pathological finding in the breast. Although it is usually palpated as a breast mass, it can be identified on ultrasound or mammogram. The hallmark of the disease is histiocytes with emperipolesis. The case presented in this study represents the first known documented male breast recurrence of RDD and the first association of the disease with pseudoangiomatous stromal hyperplasia (PASH).

PRESENTATION OF CASE

A 55-year-old male, with a prior history of right breast excisional biopsy of a mass in 2015 that showed RDD, presented to our breast clinic for follow up. A breast sonogram showed a hypoechoic mass. Biopsy and excision were performed revealing recurrent RDD along with PASH.

DISCUSSION

RDD is a benign condition that normally presents in lymph nodes but can present in extranodal sites, such as the breast. Location and symptoms guide treatment which can include medical or surgical therapy. PASH of the breast is a benign process that may be amenable to treatment by observation, medical management, or surgical excision. Treatment continues to be controversial given the lack of long term sequelae.

CONCLUSION

Definitive treatment for RDD of the breast and PASH has not been established. Based on the available data in the literature, our conclusion is that recurrent RDD of the breast can be observed without need for surgical therapy.

Chest wall resection and reconstruction for Rosai-Dorfman disease masquerading as a chest wall sarcoma

Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disease that can present as a pseudotumour of soft tissue. We describe the first chest wall resection and reconstruction.

Soft Tissue Rosai-Dorfman Disease: Case report

Rosai-Dorfman disease (RDD) is a rare benign proliferative histiocytic disorder characterised by massive lymphadenopathy. While extranodal involvement can occur in generalised RDD, isolated soft tissue RDD (STRDD) is extremely rare. We report a 17-year-old male patient who presented to the maxillofacial outpatient department of the Sultan Qaboos Hospital, Salalah, Oman, in 2015 with a painless cheek mass which had been slowly growing over the previous two months. Routine histopathological examinations and immunohistochemistry confirmed a diagnosis of STRDD. Currently, surgical excision is considered to be the most effective curative treatment for STRDD, as the outcomes of other treatment modalities are still unknown. Despite its rarity, STRDD should be considered in the differential diagnosis of histiocytic soft tissue lesions.

Extranodal Rosai-Dorfman Disease: Clinicopathologic Series of 10 Patients With Radiologic Correlation and Review of the Literature

OBJECTIVES

To describe the radiologic and clinicopathologic features of extranodal Rosai-Dorfman disease (RDD) in our patient population.

METHODS

Via a data mining engine, we evaluated 13 cases of extranodal RDD in 10 patients treated at our institution from 2000 to 2014.

RESULTS

There was a marked female predominance (90%) in our series. The most common clinical presentation was a palpable, painless mass, which often simulated a neoplasm. Only two cases occurred in children. Multicentric and recurrent disease were uncommon. Histologically, all cases showed large histiocytes with emperipolesis in a mixed inflammatory background, with areas of dense, storiform collagen fibrosis. Positive S-100 and CD68 with negative CD1a in histiocytes are characteristic.

CONCLUSIONS

Extranodal RDD is rare and its manifestations varied. It may constitute a clinical and pathologic diagnostic challenge. Clinical suspicion and recognition of its histologic features are necessary for correct diagnosis and avoiding unnecessary treatment. Resection is curative in most cases.

Cutaneous Rosai-Dorfman Disease presenting as a flank swelling

Rosai-Dorfman disease (RDD) is primarily a disease of lymph nodes caused by accumulation of excessive histiocytes. The extra-nodal sites are simultaneously involved in almost half the cases. However, presentation with isolated extra-nodal sites is uncommon and disease confined to skin and soft tissues is a rare entity. We report RDD in a 33 year old man who presented as a flank mass and was a diagnostic challenge for the surgical team. This case report strengthens the evidence that RDD should be added to the list of rare causes of skin and soft tissue swellings and informs how to manage such patients.