Rosai-Dorfman disease of the subglottis

Subglottic Masses Revealing Rosai-Dorfman Disease

Rosai-Dorfman disease (RDD) is an uncommon lymphoproliferative disorder; RDD with oropharyngeal involvement is extremely rare, especially in adults. A 65-year-old woman with a complaint of progressive dyspnoea since 2016 presented with laryngeal involvement of RDD. A laryngoscopy examination revealed two solid, polypoid masses in the subglottic region, and a laryngeal biopsy concluded chronic inflammation without signs of malignancy. A second biopsy of axillary lymph nodes was performed, supporting the diagnosis of histiocytosis. The patient was treated with corticosteroids and then lost to follow-up. In 2019, she suffered from dyspnoea and a hoarse voice. Laryngoscopy examination showed a polypoid lesion causing airway obstruction at 70% and thickening of the lateral wall of the cavum. Physical examination found left axillary and submandibular adenopathy, and computed tomography revealed thickening of the supraglottic larynx narrowing the laryngeal pathway. Lymphadenectomy with immunohistochemical analysis revealed typical protein positive S-100 histiocytes and emperipolesis. The patient was treated with high doses of corticosteroids for six weeks then these were progressively decreased. The outcome was favourable; the laryngeal lesion disappeared after two weeks of treatment.

LEARNING POINTS

Rosai-Dorfman disease is a rare cause of lymphadenopathy in adults. Extranodal presentation of the disease is possible mainly in the head and the neck region.The diagnosis is based on histological examination with the presence of histiocytes, which are S-100 positive, CD68 positive, and CD1a negative immunohistochemistry.The outcome is usually good in asymptomatic forms of the disease with no critical organ involved. The surgical resection is appropriate to the localised symptomatic form of the disease while corticosteroids are indicated in disseminated RDD as a first-line therapy.Inspired by our case, rare localisation of Rosai-Dorfman disease (RDD), led to clinical and therapeutic issues. That is why a review of the literature must be undertaken, to share experiences.

Extranodal right-optic nerve Rosai-Dorfman disease: A rare localization case report

BACKGROUND

Rosai-Dorfman is a rare disease that usually occurs in young adults. It is characterized with massive painless cervical lymphadenopathy and histiocyte proliferation. Isolated intracranial involvement is extremely rare. Our aim is to present a new rare case of extranodal Rosai-Dorfman disease that involved the right optic nerve in a 4-year-old boy.

CASE DESCRIPTION

A 4-year-old boy with right-sided convergent strabismus and amblyopia lasting for 1 year was treated at the Department of pediatric ophthalmology. Initial optical fundus examination was normal. Examination repeated after 1 year noted the atrophy of the optic nerve papilla. Visual evoked potentials of the right eye showed normal findings of prechiasmatic visual pathway with severe dysfunction of the right optic nerve. Magnetic resonance imaging (MRI) of the brain and orbits showed expansive changed and elongated right optic nerve with contrast enhancement, and smaller lesion in the right temporal operculum region visible in T2 and fluid-attenuated inversion recovery sequence. Through small eyebrow "keyhole" osteoplastic frontoorbital craniotomy the fusiform enlarged (to 2 cm) right optic nerve was identified, resected between the eyeball and optic chiasm, and transferred for pathohistological analysis. Early postoperative course had no complications. Histological, immunohistochemical, and ultrastructural analyses revealed extranodal Rosai-Dorfman disease. Right periorbital edema was verified on the 7^th postoperative day and regressed to supportive therapy. Control multi slice computed tomography (MSCT) and MRI of endocranium and orbits showed total tumor removal with no signs of complications.

CONCLUSION

Although rare, extranodular intracranial Rosai-Dorfman disease should be taken into account in the differential diagnosis of intracranial and intraorbital lesions, especially in the pediatric age group.

Radiotherapy for steroid-resistant laryngeal Rosai-Dorfman disease

Rosai-Dorfman disease is a rare lymphoproliferative disorder that can have nodal and extranodal manifestations. In the absence of established guidelines for the management of this condition, various therapeutic modalities are used, including radiotherapy. Radiation dosages and fractionation schedules have not been reported in all instances. We present a case in which glottic and subglottic Rosai-Dorfman lesions causing airway obstruction in a frail steroid-refractory patient were put into complete remission using radiotherapy. The lesions responded transiently to a course of prednisone, but responded completely to external-beam radiation, with minimal side effects to the patient.

Rosai-Dorfman disease of the subglottis diagnosed by ultrasound-guided fine-needle aspiration biopsy: a case report

We report a case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in a 55-year-old man. To the best of our knowledge, no previous reports have described diagnosis using sonographic-guided fine-needle aspiration cytology for Rosai-Dorfman disease of the subglottis. This patient was diagnosed by sonographic-guided fine-needle aspiration biopsy, which revealed lymphocytes, plasma cells, and many foamy, multinuclear histiocytes with preserved lymphocytes in their cytoplasm (emperipolesis). The patient underwent an incisional biopsy of the tumor and received postoperative steroids and low-dose chemotherapy. The subglottic tumor was markedly regressed 6 months later.

Rosai-Dorfman disease in the differential diagnosis of cervical lymphadenopathy

Rosai-Dorfman Disease or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare benign disease of unknown etiology, which presents with cervical lymphadenopathy. It is usually seen in younger patients. The extranodal form affect various regions of the head and neck, and is more common in patients with immune abnormalities. It is a self-limited and seldom life-threatening disease, rendering therapy unnecessary in most cases. For those who require therapy because of persistent or worsening symptoms, treatments modalities include surgery, chemotherapy, radiotherapy and steroids. The authors describe one case of a 43-year-old man with bilateral cervical masses, nasal obstruction, fever, weight loss and decreased vision with 6 months duration. As his social history was positive for tobacco and alcohol use, the initial diagnosis was a possible rhinopharyngeal malignant tumor. Medical investigation established the diagnosis of SHML. After therapy, the 6-month follow-up evidenced the patient's clinical improvement, although cervical masses persisted. The clinical presentation, histological features, pathogenesis and treatment of this case are discussed.

Extranodal manifestation of Rosai Dorfman Disease of the nasopharynx

The aim of presenting this case is to highlight the fact that extranodal manifestation of Rosai Dorfman Disease (RDD) without lymphadenopathy was seen in a teenaged girl with recurrent episodes of epistaxis, due to a lobulated mass in the nasopharynx, which mimicked malignancy. This case is a rare presentation because the extranodal manifestation of RDD in multisystem organs are reported in literature, but the nasopharyngeal manifestation without lymphadenopathy is unique. The clinical presentation and surgical management of the case by endoscopic sinus surgery, the aetiopathology, differential diagnosis and review of literature are described here.

[Extranodal Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy). Report of 5 cases]

Sinus histiocytosis with massive lymphadenopathy (SHML) was described in 1969 by Rosai and Dorfman as an benign disorder of the lymph nodes. Involvement of extranodal sites by SHML may occur as part of a generalized disease involving lymph nodes as well as independently of the lymph node status. The clinical course is mostly benign and indolent, but in rare cases the SHML can cause death. We report 5 cases of extranodal Rosai Dorfman disease (ENSHML). The lesions were localized in the soft tissue of the extremities, the head and the skeleton. Histopathological examination revealed a lymphoplasmacellular infiltration and numerous histiocytes with an eosinophilic cytoplasma and vesicular nuclei with basophilic nucleoli. The histiocytes showed emperipolesis with multiple lymphocytes within the cytoplasm and occasionally phagocytosis of other inflammatory cells. The histiocytes were immunohistochemically positive for S 100 protein and macrophage-specific antibodies, but in paraffin material negative for CD1a. We briefly discuss aspects of differential diagnosis of this lesion, too.