Rosai–Dorfman disease of the central nervous system: A clinical, radiological, and prognostic study of 12 cases

Diagnostic Challenges in Intracranial Rosai-Dorfman Disease: Differentiating It From Meningiomas Using Imaging

Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis (non-LCH) with intracranial involvement being exceptionally uncommon. We report a 45-year-old woman presenting with neurological symptoms initially suggestive of a stroke, later found to have a dural-based lesion resembling a meningioma. MRI revealed a mixed T1 isointense to hyperintense and T2 hyperintense mass with restricted diffusion on diffusion-weighted imaging (DWI) and lower apparent diffusion coefficient (ADC) values, findings atypical for meningiomas. Intracranial RDD commonly mimics meningiomas radiographically but can be distinguished by unique imaging features. Surgical resection remains the treatment of choice for isolated lesions, though recurrence is possible. This case highlights the importance of recognizing RDD in the differential diagnosis of dural-based lesions to ensure accurate diagnosis and tailored management.

Case report: Pediatric intraventricular Rosai-Dorfman disease: clinical insights and surgical strategies in a decade-long observational study and literature review

Background

Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive lymphadenopathy (SHML), is a rare benign disorder characterized by the proliferation of histiocytes of uncertain origin. Central nervous system (CNS) involvement, particularly intraventricular, is exceptionally rare and poses significant diagnostic challenges due to its non-specific clinical and radiographic presentation. This study aims to present a case of intraventricular RDD and review existing literature on its clinical features, treatment strategies, and prognosis.

Methods

We report the case of a five-year-old male with recurrent headaches and epilepsy caused by an intraventricular mass. The mass was surgically resected and histopathological examination was performed to confirm the diagnosis. A comprehensive literature review was conducted to identify similar cases of intraventricular RDD, focusing on clinical features, diagnostic methods, treatment strategies, and outcomes.

Results

Histopathological examination of the resected tumor revealed typical features of RDD, including large histiocytes, lymphocyte infiltration, and immunohistochemical positivity for CD68, S-100, and Vimentin. The patient remained asymptomatic ten years post-surgery with no recurrence of epilepsy or tumor. The literature review identified six similar cases, all of which showed favorable outcomes post-surgery, highlighting the self-limiting nature and favorable prognosis of intraventricular RDD following surgical resection.

Conclusion

Intraventricular RDD, though rare, should be considered in the differential diagnosis of intraventricular masses in pediatric patients. Surgical resection remains the primary treatment modality, and histopathological confirmation is essential for accurate diagnosis. The prognosis is generally favorable with appropriate surgical intervention, although recurrence can occur, necessitating long-term follow-up. Further research is required to refine diagnostic criteria and explore adjuvant therapies for improved management of this rare CNS disorder.

Radiology-pathology correlation: Rosai-Dorfman disease

Rosai-Dorfman Disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-Langerhans cell histiocytic neoplasm. Although the disease classically presents as massive painless lymphadenopathy in young adults, RDD can also involve the central nervous system in some patients. CNS lesions, can cause headaches, neurologic deficits, and even neurologic deficits. The imaging appearance of CNS RDD typically mimics that of meningiomas: well-circumscribed dural-based lesions that often have dural tails. However, some imaging clues also exist that might help a radiologist recognize RDD, even before histopathologic confirmation. This radiology-pathology report of a patient with CNS RDD highlights the most pertinent clinical, imaging, and pathologic features of CNS RDD, and discusses what the neuroradiologist needs to know about the disease.

Rosai-Dorfman sphenoorbital histiocytosis with intraparenchymal invasion: Do we have to consider this skull base pathology as a malignant disease?

Background

Rosai-Dorfman disease (RDD) is a rare type of histiocytosis that can manifest with diverse symptoms. It usually presents with systemic involvement, and only a few cases have been reported at the level of the skull base. RDD typically follows a benign course during the progression of the disease. In this particular case reported, after the skull base invasion, the disease started to infiltrate the brain parenchyma. Our objective for this case report was to present this particular progression pattern and the nuances of its surgical treatment. In addition, a revision of the current literature was performed about skull base RDD with intracranial invasion and brain parenchyma infiltration not previously described.

Case Description

We are presenting the case study of a 57-year-old male patient who was experiencing severe headaches and an increase in volume in the right fronto-orbital region. On clinical examination, no neurologic clinical symptoms were observed. Contrast computed tomography and magnetic resonance imaging showed a tumor mass that affected the right orbit, frontal paranasal sinus, greater sphenoid wing, and right frontal lobe with moderate adjacent brain edema. The patient underwent surgery using an extended pterional approach with intracranial, orbital decompression, and frontal sinus cranialization, accompanied by frontal lobe tumor resection. Neuropathologic diagnosis revealed a Rosai-Dorfman histiocytosis disease.

Conclusion

The etiopathogenesis of RDD is still not completely understood. The current literature considers this disease to have a predominantly benign course. Nevertheless, as we have shown in this case, it may, in some cases, present direct parenchymal invasion. We consider that prompt surgical treatment should be ideal to avoid the local and systemic progression of the disease.

Management of intracranial Rosai-Dorfman disease: An institutional experience

OBJECTIVE

Rosai-Dorfman disease (RDD) is a rare benign proliferative disorder of histiocytes. The study discusses the intracranial RDD approach, its management, and its outcome.

METHODS

It is a retrospective study performed in a tertiary center, the National Institute of Mental Health and Neuroscience, Bangalore, from January 2010 to December 2022. The biopsy-proven patients of RDD were recruited in the present cohort. Demographic and surgical details were collected from the record section, and radiology was collected from the internal storage system. Follow-up assessments were done clinically and telephonically.

RESULTS

A total of 25 patients matched the criteria. The mean age was 32 ± 13.4 years, with male predominance. We have included only cranial cases (N=25). Among the intracranial lesions, 5/25 (20 %) patients had multicentric lesions. All the lesions were avidly enhancing on contrast, and 16 (64 %) lesions were hypointense on T2. Perilesional edema (T2/Flair hyperintensities in the surrounding white matter) was seen in 12 (48 %) patients. Gross total resection (GTR) was carried out in six (24 %) cases. Sub-total resection was in 14 (56 %), and biopsy was in five cases (20 %). Nineteen patients received adjuvant therapy, either only steroid (40 %), only low-dose radiotherapy (16 %), only Chemotherapy (4 %), or a combination of both. At follow-up,44 % of patients had stable disease,28 % had primary disease or recurrence growth, and regression in 12 % of cases.

CONCLUSION

We demonstrate that surgical resection is an effective therapy for treating isolated intracranial RDD. Adjuvant therapy is an add-on treatment for skull base locations in multicentric locations or surgically inaccessible locations.

Radiotherapeutic outcomes of Rosai-Dorfman disease with falx cerebri and superior sagittal sinus involvement: A rare case report with long-term follow-up

Key Clinical Message

Intracranial RDD is rare medical event mimicking different diagnoses. Although the surgical resection is the best treatment option, but radiation therapy can also achieves long-term suboptimal outcomes.

Abstract

An 83-year-old male with a history of tension-type headaches was evaluated. He was conscious with no focal neurological deficits. His brain MRI revealed an enhancable bifrontal tumor originating from falx cerebri and superior sagittal sinus dura. Due to the patient's preference and decline for gross total resection, she underwent a stereotactic biopsy. The pathology was positive for Rosai-Dorfman diseases. He received definitive targeted radiation with a total dose of 4500 cGy administered in 200 cGy daily fractions. His 4-year follow-up showed regional tumor control with excellent neurological outcome.

A rare presentation of Rosai-Dorfman disease involving the central nervous system

A 29-year-old gentleman diagnosed with Rosai-Dorfman disease (RDD) on corneal biopsy, 2 years ago, presented with fluctuating left-sided numbness, intermittent slurred speech, and urinary incontinence, progressively worsening over the past three months.

Imaging features of ALK-positive histiocytosis with neurological involvement: a case report and literature review

Background

ALK-positive histiocytosis is an exceptionally rare neoplasm of histiocytes that predominantly involves the nervous system and can also affect the skin and other parts of the body. Previous relevant literature has provided limited information regarding the imaging manifestations of this disease with neurological involvement.

Methods

We reported a case of ALK-positive histiocytosis with multisystem involvement. Together with a comprehensive literature review, the imaging characteristics of this disease in the nervous system were summarized.

Results

A 3-year-old girl with abdominal pain and ambulation difficulty checked in at the Department of Pediatric Neurology. The initial diagnosis was "acute cerebellitis with ataxia" based on the elevated protein level in the cerebrospinal fluid (CSF). However, despite 3 months of treatment, her condition deteriorated. MRI showed an oval-shaped, intradural extramedullary nodule at the T6-T7 level. The patient was ultimately diagnosed as ALK-positive histiocytosis, accompanied by cauda equina and skin involvement. The literature review showed a total of 23 patients who had involvement of the nervous system and provided imaging descriptions. Together with our case, the imaging features were summarized as follows: iso-dense or slightly hyperdense on computed tomography (CT), isointense or iso-hypointense on T2-weighted imaging (T2WI), moderate homogeneous enhancement with mildly/markedly punctate enhancement or/and smooth ring enhancement on contrast-enhanced T1-weighted imaging (T1WI), restricted diffusion on diffuse weighted imaging (DWI), and elevated fluorodeoxyglucose (FDG) uptake on positron-emission tomography/computed tomography (PET/CT).

Conclusion

The multimodal imaging findings of ALK-positive histiocytosis exhibit distinct characteristics, familiarity with which will enhance radiologists' expertise and facilitate accurate diagnosis of this disease.

Rosai-Dorfman disease of the cauda equina: illustrative case

BACKGROUND

Rosai-Dorfman disease (RDD) is a rare, nonmalignant histiocytosis. It typically occurs in lymph nodes, skin, and soft tissues, but numerous reports of central nervous system involvement exist in the literature. The peripheral nervous system has rarely been involved. In this study, the authors present a case of RDD isolated to the cauda equina. The presentation, management, surgical technique, and adjunctive treatment strategy are described.

OBSERVATIONS

A 31-year-old female presented with 6 months of progressive left lower-extremity numbness involving the lateral aspect of the foot and weakness of the left toes. Magnetic resonance imaging of the lumbar spine demonstrated a homogeneously enhancing intradural lesion involving the cauda equina at the L2-3 levels. Histopathology after resection revealed a histiocytic infiltrate, positive for CD68 and S100, and emperipolesis consistent with RDD. No adjuvant therapy was administered, and the patient had full remission at the 1-year follow-up. Only five other cases of intradural RDD lesions of the cauda equina have been reported in the literature.

LESSONS

RDD of the cauda equina is an especially rare and challenging diagnosis that can mimic other dura-based lesions, such as meningiomas. A definitive diagnosis of RDD relies on pathognomonic histopathological and immunohistochemical findings.

Hints to Diagnose Intracranial Rosai-Dorfman Disease: A Case Report and Literature Review of Cases in Saudi Arabia

Rosai-Dorfman disease (RDD) was recognized as a distinct clinical entity by Rosai and Dorfman in 1969. It is a rare histiocytic proliferative disorder that occurs in various locations and occasionally involves the central nervous system. In this article, we aim to describe a case of intracranial RDD and to provide a review of the literature on intracranial RDD in Saudi Arabia. A 37-year-old woman presented with a history of generalized seizures. Physical examination disclosed bilateral cervical lymphadenopathy with no neurological deficit. Brain magnetic resonance imaging (MRI) demonstrated an extra-axial, homogenous, Gadolinium-enhancing, space-occupying lesion with extensive dural involvement. The patient was successfully treated by total surgical resection. Postoperatively, the patient did not receive any adjuvant therapy. Biopsy with immunohistochemical analysis confirmed the diagnosis of intracranial RDD. On follow-up examination, six months later, there was no recurrence of the lesion. A preoperative diagnosis of intracranial RDD is challenging since its MRI appearance can be similar to other intracranial diseases. Herein, we discussed some neuroradiographic findings that might help distinguish RDD from other intracranial diseases.

Intracranial Rosai-Dorfman disease: a case report and review of the literature

RDD involving the central nervous system is rarely reported. To better understand the disease and explore the treatments, we reported this case and review the literature.