CONGENITAL ROSAI-DORFMAN DISEASE WITHOUT LYMPHADENOPATHY

Rosai-Dorfman disease (RDD) is a rare histiocytic proliferative disorder with massive lymphadenopathy. We here describe RDD of a neonate who presented with paleness and hepatosplenomegaly but not lymph-node swelling. Routine laboratory studies showed anemia, thrombocytopenia, and an elevated value of gamma-glutamyl transpeptidase. Histological examination of the liver revealed a proliferation of histiocytes with abundant eosinophilic cytoplasm, which were positive for S-100 protein and CD68 but not CD1a and did not reveal Birbeck granules. Radiological studies showed hepatosplenomegaly and a narrowing of the hepatic vein, which might have contributed to hypersplenism resulting in anemia and thrombocytopenia. This case is thought to be congenital RDD without lymphadenopathy.

Isolated intracranial Rosai?-?Dorfman disease mimicking meningioma in a child

A 9-year-old boy presented with a 12-month history of headaches and recent grand mal seizures. Computed tomography and magnetic resonance imaging of the brain revealed an enhancing right frontal convexity lesion. The preoperative diagnosis was meningioma. However, histological examination was diagnostic of Rosai-Dorfman disease. Rosai-Dorfman disease confined to the intracranial compartment is very rare, of 34 reported cases only one presented in the first decade. Optimal treatment has not been established, but complete surgical resection alone seems effective and allows histological distinction from meningioma.

Rosai-Dorfman disease in an Asian Indian woman with classic generalized lymphadenopathy and nasal obstruction: a case report

Rosai-Dorfman disease is rare. When it does occur, it usually affects children, and it has a propensity for whites and blacks as opposed to members of other races. We report the case of a 45-year-old Asian Indian woman who presented with painful masses in the area of the axillary, cervical, and inguinal lymph nodes. She had a decade-long history of tonic-clonic seizures and a recent history of digestive complaints and progressive nasal stuffiness. Endoscopic examination of the left nasal cavity revealed the presence of submucosal bulges along the septum and the lateral wall; hypertrophy of the adenoids was also noted. Histologic analysis of lymph node specimens revealed dilated parenchymal sinuses, germinal activity with infiltration of numerous histiocytes (emperipolesis), and chronic inflammatory cells. The patient was diagnosed with Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy) with atypical extranodal involvement (the nasal area). An aggressive course of polychemotherapy thrice daily was initiated, but it had no lasting effect, and the patient died 8 months later of an undetermined cause. Our patient's age at the onset of her disease, her race, and the extranodal involvement make this case of Rosai-Dorfman disease unusual and perhaps unique.

Isolated intracranial Rosai-Dorfman disease mimicking suprasellar meningioma: case report with review of the literature

Rosai-Dorfman disease (RDD) is an idiopathic histiocytic proliferation affecting the lymph nodes. Isolated intracranial RDD is rare and usually appears as a well-defined, dural-based lesion without lymphadenopathy. The clinical and radiological features of intracranial RDD are similar to meningioma. Histopathology and immunohistochemistry are essential for a definitive diagnosis. This is a report of a 43-year old male with isolated intracranial RDD, which manifested as a suprasellar meningioma. The clinical, radiological and pathological aspects of the disease are discussed within the context of a review of previously reported cases.

Report of two cases of Rosai-Dorfman disease with only skin involvement

Although cutaneous localization associated with lymphadenopathy is a common phenomenon in Rosai-Dorfman disease, cutaneous and subcutaneous involvement alone occurs only rarely. We herein report two cases of cutaneous lesions in the absence of lymph node localization and systemic symptoms or signs. Characteristic features of the disease, such as emperipolesis, were evident in both cases.

[Rosai-Dorfman's disease (sinus histiocytosis with massive lymphadenopathy): a report of a case and bibliographic review]

Rosai-Dorfman's illness, also denominated sinus histiocytosis with massive lymphadenopathy is considered benign entity of unknown etiology; although it is believed it may be due to alterations of immune system. It was described in 1969 by Rosai and Dorfman and there are nearly 500 cases worldwide reported. The most frequent clinical manifestation is massive lymph node enlargement, mainly cervical, but almost in the fifth percent of cases any lymph node may be affected. Diagnosis is pathological, without treatment of choice, evolution is often spontaneous resolution. In extraganglionar compromise, illness may be progressive and fatal. A45 year-old woman with cervical and nasal lymphadenopathy and fever is presented. Biopsy report: histiocytosis with emperipolesis phenomenon and immunohistochemical markers S-100, CD48, and CD45, positives. Encountering total T lymphopenia, mainly CD4+ diminished relationship CD4/CD8 and polyclonal gammopathy. Relevant in this case, clinical presentation multiple lymph nodes, distinct of other reported in our country whose presentation was mainly cutaneous plus association among Rosai-Dorfman with immunological changes and good clinical response to immunomodulator treatment, not previously seen, as in this patient.

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.

Rosai Dorfman disease

Rosai Dorfman disease is rare benign disease of lymph nodes but extra nodal sites may also be affected. It was discovered in 1969. Probably this is the first case report of such case in Bangladesh. Recently I found a girl of 14 years old with gradual painless massive cervical lymphadenopathy for six weeks duration with no signs of acute inflammation. Along with lymphadenopathy she had mild low grade fever. The common probable causes of lymphadepathy were excluded by history, physical examination and laboratory examination. Excisional biopsy and later histopathology confirmed the case as Rosai Dorfman disease. This disease usually follows a benign course and does not require any treatment other then periodic follow up. In course of time it gradually subside. In our case the patient comes every month for follow up. She is doing better now, there is mild regression of the size of lymphnodes. She is attending school regularly and appearing in exams as well. Now our patient is receiving vitamins & occasional paracetamol only.

Rosai Dorfman disease--a rare entity report of two cases with nodal and extranodal involvement

Rosai Dorfman Disease (RDD) also known as Sinus Histiocytosis with Massive Lymphadenopathy (SHML)is a very rare variety of reactive histiocytoses. It commonly involves cervical lymph nodes; although involvement of other lymph node regions, skin and other organ involvement can occur. It has a good prognosis so there is a need to differentiate it from other lympho proliferative disorders of poorer prognosis. We present two cases of this rare disorder illustrating its clinical spectrum; a 22 years old woman with involvement of submandibular lymph nodes, nasal septum and sub-glottic region and a 45 years old male with prominent skin involvement.

Multifocal nodal and extranodal Rosai-Dorfman disease initially diagnosed as histiocytic lymphoma

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a systemic disease involving nodal and extranodal tissues. We report a 48-year-old female with recurrent nasal obstruction due to polypoidal masses involving the nasal sinuses, turbinates and septum bilaterally, and lumps in the right infra-orbital region and region of the right lacrimal sac. A 4 cm right upper neck mass was also noted, which was initially diagnosed as histiocytic lymphoma. Histopathology of the nasal and infraorbital lesions revealed fibro-inflammatory masses containing histiocytic cells with large vesicular nuclei and abundant foamy cytoplasm exhibiting emperipolesis and lymphophagocytosis, admixed with scattered plasma cells and lymphocytes. These histiocytes revealed immunohistochemical positivity for S-100 protein and CD68, but were negative for CDla. The findings supported a diagnosis of RDD. This report serves to remind pathologists and clinicians of the extranodal manifestations of RDD and its potential confusion with lymphomas.

[Rosai-Dorfman's disease: a propos of an interesting case study]

We present a case with involvement of both nostrils by the Rosai-Dorfman's disease. Physical examination revealed tumorous lesions totally occupying the right nostril and partially the left one. The presence of proliferation of histiocytes was proved by the histological test, several of them full of non-disintegrated lymphoid nuclei, i.e. emperipolesis, the basic histological characteristic in Rosai-Dorfman's disease. The patient underwent surgical treatment with a combined approach by means of lateral rhinotomy and endoscopic nasal resection using a microdebrider.

Cutaneous Rosai-Dorfman disease

A 63-year-old woman developed multiple nodules at the site of a recently biopsied proliferation of CD 68+ histiocytes. Clinical lymphadenopathy was not present on physical examinaton or on computed tomography scans. A subsequent skin biopsy specimen showed changes consistent with Rosai-Dorfman disease. Rosai-Dorfman disease is a benign, histiocytic proliferative disorder also known as sinus histiocytosis with massive lymphadenopthy. A particularly rare, extranodal, purely cutaneous form has been described. Spontaneous regression tends to occur over months to years, with surgical intervention remaining the most effective treatment. Documented success with a number of other therapies has been reported, which include systemic high-dose thalidomide in extensive cutaneous disease.

Sinushistiozytose mit massiver Lymphadenopathie (Rosai-Dorfman-Erkrankung)

Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare, painless lymphoproliferative disorder of unknown origin with a usually benign course. About 40% of the patients show an extranodal involvement with skin being the most common site in 27% of these patients. We describe a patient with widespread disease involving the respiratory tract, kidneys and skin. Histopathology revealed the characteristic features of SHML with emperipolesis and immunohistochemical positivity of histiocytes for S100 and macrophage-associated antigens.

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman's Disease) as cause of isolated hilar lymphadenopathy and complete remission after high dose steroid

Rosai-Dorfman's Disease, also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a rare histiocytic proliferative disorder and a distinct clinico-pathological feature of unknown origin. Painless cervical lymphadenopathy is the most common clinical presentation. Different treatment modalities have been tried with variable responses, however, there is no consensus on the best modality of treatment. Here, we present a case report of SHML causing isolated hilar lymphadenopathy with complete remission for more than 6 years, after a short course of high dose steroid (dexamethasone 20 mg daily for 3 days).

Rosai-Dorfman disease presenting as laryngeal masses

Extranodal lesions may be the sole manifestation of Rosai-Dorfman disease (RDD). Although the head and neck region is one of the most common extranodal sites, laryngeal involvement is very rare. A 44-year-old woman presented with a complaint of progressive dyspnea. She had a three-year history of treatment for asthma and a history of operation for a nasal mass that afflicted her for 15 years and was diagnosed as rhinoscleroma. On physical examination, she had three subcutaneous lesions, in the left lower eyelid, right epicanthal area, and left forearm, respectively. No lymphadenopathy was present. Laryngoscopic examination revealed three solid, polypoid masses in the subglottic region, 1 cm in diameter. With a two-staged operation, the laryngeal masses were excised totally together with the subcutaneous lesions. Histological examination of all the specimens showed proliferation of histiocytes. Immunohistochemical staining revealed typical S-100 protein-positive histiocytes and emperipolesis. Both laryngeal and subcutaneous lesions were diagnosed as RDD. A re-evaluation of sections from the previous operation specimen of the nasal mass showed the same morphological features. The patient was healthy without recurrence, nine months following surgery.

[Destombes Rosaï Dorfman syndrome: description of one case and diagnostic challenges in the tropical setting]

Destombes Rosaï Dorfman (DRD) syndrome is form of nonlangerhans cell sinus histiocytosis. The main symptoms are cervical adenopathy, fever and fluctuating hepatosplenomegaly. It can be confused with ganglionary tuberculosis especially in our region where tuberculosis is common. This report describes a case of Destombes Rosaï Dorfman syndrome in a 40-year-old woman from Senegal. The main presenting symptom was the presence of massive tumour-like lesions on the neck with altered general condition and fever. Based on these clinical findings, ganglionary tuberculosis was suspected and presumptive treatment was initiated in the local hospital. However further workup failed to confirm the diagnosis and the patient was transferred to the Internal Medicine Department. Clinical examination in our service revealed the presence of extensive adenopathy in the supraclavicular, axillary, and inguinal regions. Laboratory tests demonstrated a nonspecific inflammatory syndrome. Abdominal ultrasonography depicted extensive mesenteric and para-aortic adenopathy. Chest x-ray showed bilateral and asymmetric mediastinal adenopathy. Medullogram findings were normal. Histology confirmed DRD syndrome. DRD syndrome is rare disease of unknown aetiology. In tropical areas differential diagnosis with ganglionary tuberculosis, lymphoma, and reactive hemophagocytic syndrome can be challenging. Lymph node biopsy should be performed in all patients presenting fever and polyadenopathy.

Rosai-Dorfman disease of the breast and parotid gland

Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy (SHML) is a histiocytic proliferative disorder that typically involves the cervical lymph nodes with or without extranodal involvement of the skin, soft tissues, respiratory tract, or virtually any other site of the body. We present a case report of SHML involving the cervical lymph nodes, parotid gland and breast. There is only one other Rosai-Dorfman registered case that involves both breast and parotid disease and no previously published case reports. The patient presented atypically with breast masses found on screening mammogram rather than massive cervical lymphadenopathy. We describe the subsequent radiographic and surgical pathologic evidence that led to the diagnosis of this rare disease.

Histiocytose sinusale de Rosai-Dorfman

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, is a benign histiocytic proliferation that can cause large lymph node masses, most often cervical. Visceral damage is not rare. Diagnosis requires histologic examination: intrasinus histiocytic proliferation with cells showing emperipolesis or lymphocytophagocytosis. These histiocytes have a normal activated phenotype. Association with immunological abnormalities or autoimmune events, most often autoimmune cytopenia, is possible. This association is a poor prognostic factor. Clinical course is generally spontaneously favorable. There is nonetheless a substantial risk of compression associated with large tumor masses, especially in cases of retro-orbital or epidural involvement. Expectant management is most often appropriate. Treatment is reserved for forms that are directly threatening, progressive, or when poor prognostic factors are present. The treatment, when it is indicated, is not codified. It combines, according to the individual case, surgery, corticosteroids, antimetabolites and interferon alpha.

Rosai–Dorfman disease of the breast mimicking cancer

Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a rare proliferative histiocytic disorder of the lymph nodes. Extranodal involvement occurs in a considerable number of cases; however, involvement of the breast is very rare, and it is even rarer for the lesion to be localized in the breast alone without affecting any other sites. This report describes the case of a 50-year-old Brazilian woman with a lump confined to her left breast that had clinical and radiological characteristics indistinguishable from cancer. The proliferation of histiocytes, displaying lymphophagocytosis and an S-100 protein immunophenotype on a core biopsy of the lesion, led to a diagnosis of Rosai-Dorfman disease and permitted conservative therapy. Recognition of this rare condition, when occurring at an unexpected site such as the breast, is difficult, and the correct diagnosis is important prior to therapeutic management.