Rosai-Dorfman disease presenting as a parotid mass

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare, benign disease of unknown aetiology. This disease typically presents with massive, painless cervical lymphadenopathy but may occur in a wide variety of extranodal sites. Our report describes a 71-year-old man who presented with a discrete, unilateral parotid mass which was clinically suggestive of a primary salivary gland tumour. Initial cytological examination of a fine needle aspirate specimen taken from the mass demonstrated a discohesive cell population with nuclear atypia, raising the possibility of malignancy. However, excision of the mass and histological examination enabled a definitive diagnosis to be made.

Signet-ring sinus histiocytosis: a reactive disorder that mimics metastatic adenocarcinoma

BACKGROUND

Signet-ring sinus histiocytosis is a rare and distinctive reactive disorder recently observed in the axillary lymph nodes of patients with breast carcinoma. This form of sinus histiocytosis closely resembles and can easily be confused with metastatic adenocarcinoma.

METHODS

To determine the incidence of this reactive process in lymph nodes from different anatomic sites, broaden its morphologic spectrum, and discuss the differential diagnosis, the authors examined lymph nodes from 316 radical prostatectomy specimens, 184 modified radical mastectomy specimens, 108 colectomy specimens, 57 gastrectomy specimens, and 27 radical hysterectomy specimens. These surgical procedures were performed to treat carcinoma of the prostate, breast, colon, stomach, and uterine cervix, respectively. A total of 9741 lymph nodes were histologically examined. The lymph nodes containing sinus signet-ring cells were stained with mucicarmine, Alcian blue, and periodic acid-Schiff stains (PAS). Immunostains for epithelial, lymphoid, and histiocytic markers were also performed. In two cases, tissue was retrieved from the paraffin block and subsequently processed for electron microscopic examination.

RESULTS

Only 4 of 316 radical prostatectomy specimens (1.2%) and 2 of 184 axillary dissections (1.08%) contained lymph nodes with signet-ring sinus histiocytosis. Of 9741 lymph nodes reviewed, 37 (24 pelvic and 13 axillary lymph nodes) had signet-ring sinus histiocytosis, for an incidence of 0.38%. Microscopically, the signet-ring histiocytes lacked nuclear atypia and were mucin negative. In two cases, clusters of histiocytes with rounded, eosinophilic, diastase resistant, PAS positive cytoplasmic globules were observed. Both types of signet-ring cells showed reactivity for histiocytic markers and were negative for cytokeratin and lymphoid markers. By electron microscopy, most histiocytes were shown to have a large empty vacuole that displaced the nucleus. Granular material was observed in some of the vacuoles. Some histiocytes exhibited a rounded cytoplasmic body composed of central electron dense, granular material and a rim of microfibrils. No lipid droplets were identified.

CONCLUSIONS

Signet-ring sinus histiocytosis is a rare and distinctive reactive disorder found incidentally in the pelvic and axillary lymph nodes of patients with carcinoma of the prostate and breast, respectively. Although this histiocytic reaction mimics metastatic adenocarcinoma and signet-ring cell lymphoma, it can be identified by careful cytologic analysis together with positive reactivity for histiocytic markers, negative mucin stains, and lack of reactivity for epithelial and lymphoid markers. The etiology and pathogenesis of this unusual form of sinus histiocytosis remains unclear.

Cytologic features of sinus histiocytosis with massive lymphadenopathy. A report of three cases

BACKGROUND

Sinus histiocytosis with massive lymphadenopathy (SHML) was described over 20 years ago by Rosai and Dorfman. Originally it was described as occurring in young males, predominantly with cervical lymphadenopathy. Since then over 423 histologically documented cases of SHML have been documented, including many extranodal sites. Few studies have characterized the cytologic features of SHML.

CASE

Three cases of lymph node involvement by SHML occurred, one also with skin involvement. Cytologic findings included numerous histiocytes with phagocytized lymphocytes, atypical forms of histiocytes and a reactive, lymphoid background. Surgical biopsy and immunohistochemical stain for S-100 protein of all three cases confirmed the cytologic impression.

CONCLUSION

Sinus histiocytosis with massive lymphadenopathy can be diagnosed by cytology in conjunction with clinical history and immunohistochemistry.

Extranodal sinus histiocytosis with massive lymphadenopathy presenting as an intramedullary spinal cord tumor: a case report

Involvement of the central nervous system by sinus histiocytosis with massive lymphadenopathy (SHML) is rare. Less than 30 cases have been reported. To the best of our knowledge, we describe the first case of an intramedullary spinal cord lesion which occurred in a 34-year-old black male, causing paraplegia. Laboratory evaluation revealed anemia, increased erythrocyte sedimentation rate, and polyclonal gammopathy. Microscopic examination of the lesion revealed lymphocytes within the cytoplasm of the histiocytic cells, a phenomenon known as emperipolesis. Immunohistochemical stains showed the large eosinophilic histiocytic cells to be positive for S-100 protein and Kp1 antigen. Special stains for fungi and acid-fast organisms were negative. There was no evidence of clonality in the lymphocytic aggregates. Glial fibrillary acidic protein was negative in the lesion, although positive in the surrounding tissue. These features confirmed the diagnosis of extranodal SHML involving the intramedullary spinal cord.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a patient with isolated renotesticular involvement after cure of non-Hodgkin's lymphoma

Sinus histiocytosis with massive lymphadenopathy (SHML)-Rosai-Dorfman disease-is a rare but well-defined benign histiocytic proliferative disorder. We report an unusual patient, cured of non-Hodgkin's lymphoma, who presented 12 years later with renotesticular SHML associated with IgA monoclonal gammopathy, but without any evidence of relapsed lymphoma. The genitourinary manifestations of this disorder with massive lymphadenopathy and its rare association with malignant lymphoma are reviewed.

Inflammatory pseudotumour and Rosai-Dorfman disease of soft tissue: a histological continuum?

A lesion of the chest wall in a 34 year old woman, which had a combination of histological and immunophenotypic features of inflammatory pseudotumor and Rosai-Dorfman disease of soft tissue, is described. There was considerable overlap in the pathogenesis, histology and immunophenotype of these two lesions. The similarities between these two lesions suggest that there is a temporal sequence and a histological continuum with early histiocyte-rich and late fibroblast- and myofibroblast-rich lesions. Alternatively, the morphological and immunophenotypic features could be because of aberrant cytokine expression in an inflammatory pseudotumour, resulting in transformation of histiocytes to resemble those seen in Rosai-Dorfman disease.

Rosai-Dorfman disease presenting as a meningioma

This report documents an unusal case of extranodal sinus histiocytosis (Rosai-Dorfman disease) which produced a solitary intracranial mass lesion that was diagnosed clinically and radiologically as a meningioma. Morphological features have been described and literature extensively reviewed.

Steroid-responsive Rosai-Dorfman disease

Nodular skin lesions on the lateral aspects of the legs of a female child were first noticed at the age of 6 days. A biopsy of the lesions was done at the age of 6 months when the child had also developed cervical and inguinal lymphadenopathy and angiomatous lesions on the face. The diagnosis of Rosai-Dorfman disease (RDD; also known as sinus histiocytosis with massive lymphadenopathy, SHML) was made. Increasing respiratory obstruction by lymphoid tissue prompted a 2-week trial with oral prednisolone. A dramatic response occurred, with complete resolution of all clinical findings within 5 days, but with recurrence of lymphadenopathy 6 weeks after stopping with medication. Further observations over the next 3 years established a consistent response to prednisolone and a pattern of steroid dependence.

Osseous localization of Rosai-Dorfman disease

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a disease of bone marrow stem cell origin which primarily affects lymph nodes. Solitary bone lesions are rare and can cause diagnostic difficulties. A primary lesion in the right index finger of a 10-month-old child is reported.

Extranodal sinus histiocytosis with massive lymphadenopathy: isolated central nervous system involvement mimicking meningioma

We present the fifth reported case of extranodal sinus histiocytosis with massive lymphadenopathy (SHML) isolated in the central nervous system. This case emphasizes the importance of recognizing the clinical and radiographic presentation of SHML and shows that immunohistochemical evaluation is required for definitive diagnosis.

[Sinus histiocytosis with massive lymphadenopathy--a disseminated form of the Rosai-Dorfman syndrome]

A 20 year-old black male presented with a generalized lymphadenopathy, skin papules with maximum involvement of the head and trunk region, and elevated temperature. Ultrasound, CT and bone scans revealed infiltration of the kidneys and bones. Surgical specimens of the cervical lymph nodes showed massive infiltration of sinuses by histiocytes with engulfed lymphocytes and granulocytes in their cytoplasm. A similar finding was found in the excised dermis and nasopharyngeal mucosa. Immunohistochemical investigations showed a strong positive reaction of sinusoidal macrophages with anti S100 protein, anti alpha-1 antitrypsin and alpha-1 antichymotrypsin antibodies, negative CD1a. The engulfed granulocytes were positive with lysozyme and MAC387 antibodies; lymphocytes reacted with antilymphocytic antibodies L26, HLADR, UCHL-1 and OPD4 only rarely, possibly due to alterations of their cell membranes in the cytoplasmic environment of histiocytes. Occasional plasma cells were also entrapped in the macrophages. The best results were obtained with CD3 antibody which showed focal predominance of phagocytosed T cells. These findings confirm a nonselective nature of the emperipolesis. In situ hybridization with probes EBER and BHLF against Epstein-Barr virus sequences was negative. The pacient was treated by multidrug chemotherapy with a moderate regression of the infiltrates. The symptoms of the disease persisted for 10 months from the treatment start but further course of the disease is uncertain. The patients is lost to follow up.

Cytologic appearance of sinus histiocytosis with massive lymphadenopathy: a case report

BACKGROUND

Sinus histiocytosis with massive lymphadenopathy is a benign, massive lymphadenopathy, usually cervical, of unknown etiology.

CASE

Cytologic smears revealed a polymorphic population of cells consisting of mature lymphocytes, plasma cells, occasional neutrophils and many histiocytes, characteristically showing emperipolesis. A reactive lymphadenopathy was diagnosed. The histopathologic diagnosis on open biopsy specimen was sinus histiocytosis with massive lymphadenopathy.

CONCLUSION

Cytologic diagnosis of sinus histiocytosis with massive lymphadenopathy is possible with high accuracy provided that the cytologic findings are interpreted in the appropriate clinical context. The cytologic examination also can help with follow-up.

Extranodal Rosai-Dorfman disease of the head and neck

Rosai-Dorfman disease is a rare, idiopathic, benign histiocytic proliferation usually seen in younger patients. Massive lymphadenopathy most commonly involves the cervical lymph nodes, with a predominant infiltration of sinusoidal histiocytes. Nearly half of the patients will have extranodal involvement, 75% occurring in sites in the head and neck. Three cases of extranodal Rosai-Dorfman disease of the head and neck involving the nose, paranasal sinuses, and parotid gland are presented. The clinical presentation, histologic characteristics, radiographic findings, and treatment of the disease are discussed. Because of the scarcity of cases, the clinical and histopathologic features of this disease may be overlooked. Familiarity with its relatively frequent clinical manifestations in the head and neck, as well as with the diagnostic histopathology, should preclude confusion with other disease entities.

Egg shell nodal calcification in a patient with sinus histiocytosis with massive lymphadenopathy treated with interferon

CT showed egg shell calcification in the cervical lymph nodes in a patient with sinus histiocytosis with massive lymphadenopathy treated for 1 year with interferon. CT scans before interferon treatment had shown no nodal calcification.

[Uncommon tumor and pseudotumor lesions of the submandibular fossa]

The histological examination of the salivary gland tumors is a very important step in the diagnostic approach of the lesions, on which depends the success of therapeutic outcome. Some surprises may occur; four examples were reported. In one case the lesion was not a tumor but a tuberculous lymphadenitis; another showed a Destombes Rosai Dorfman syndrome. Two other cases were found to be unusual tumors: a carcinosarcoma of the submandibular gland and a metastasis of a Merkel carcinoma in the submandibular gland.

Rosai-Dorfman disease mimicking multiple meningioma: case report

Rosai-Dorfman disease is a rare idiopathic histioproliferative disease affecting the lymph nodes. Extranodal involvement has also been recognized, but central nervous system manifestations are extremely rare. Only 12 patients with intracranial involvement have been reported previously, and they all presented with clinical and radiological findings suggestive of meningioma. We report multiple meningeal nodules in a patient presenting with seizures whose pathological findings at surgery confirmed the diagnosis of Rosai-Dorfman disease. A review of all previously reported intracranial lesions is presented.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) and extranodal involvement of the orbit

We present the case of a 5-year-old boy who was referred to the Neurosurgical Service of the San Jorge Children's Hospital for evaluation of right eye proptosis. At the age of one year the diagnosis of sinus histiocytosis with massive lymphadenopathy (SHML) had been rendered on a cervical lymph node biopsy. The right orbit mass causing the proptosis was the result of extranodal involvement of the orbital tissue by SHML. The clinical and pathologic features of this entity are discussed.

[Destombes-Rosai-Dorfman syndrome: 2 uncommon clinical forms]

Two cases of Destombes Rosai Dorfman's syndrome are presented. Diagnosis was performed by superficial lymph node biopsy. The first case concerned a nine and half years old girl with cervical adenopathy who developed a compressive mediastinal adenopathy responsible for a right lower lobe atelectasis. Because of local lung suppuration a lobectomy had to be performed. The second case concerned a fourteen years old boy with recurrent fever, diffuse superficial lymph nodes and erythematous skin rash. The two patients showed clinical and biological inflammatory symptoms without any immunodeficiency. No aetiological agent could be identified. Antibiotics and corticoids had no effect but the two patients recovered (after 18 months follow up in case 2). These two particular cases confirm the clinical course heterogeneicity of the syndrome which requires histological diagnosis.

Sinus histiocytosis (Rosai-Dorfman disease) clinically limited to the skin. An immunohistochemical and ultrastructural study

A case study of sinus histiocytosis of Rosai-Dorfman (SH) clinically limited to the skin is presented with immunohistochemical study of the infiltrate, in both paraffin and cryostat sections. Factor XIIIa, a dendrocyte marker, was demonstrated in the cytoplasm of histiocytes. This feature had not been previously reported in this disease. In addition, the cells expressed S100 protein, CD4, CD1a, CD68, and CD11c. This immunophenotyping study suggests that SH could affect the antigen-presenting activity of Factor XIIIa cells, i.e., the skin dermal dendrocyte.