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Slouma M, Bouzid S, Tlili K, Yedaes D, Radhwen K, Gharsallah I. Isolated Rosai-Dorfman disease of the spine: A systematic literature review. Clin Neurol Neurosurg 2024; 239:108206. [PMID: 38461672 DOI: 10.1016/j.clineuro.2024.108206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Rosai-Dorfman disease (RDD) is a rare non-Langerhans cell histiocytosis involving the central nervous system in 5% of cases. Spinal location occurs in less than 1% of extranodal RDD and can be responsible for neurological manifestations. We present a systematic review of cases of isolated spinal RDD. We also report a new case of isolated spinal RDD revealed by spinal cord compression. MATERIALS AND METHODS The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline using the MEDLINE and SCOPUS databases and included case reports and case series describing isolated RDD of the spine. RESULTS There were 53 patients with isolated spinal RDD (including our case). The mean age was 35.85±16.48 years. Neurological deficit was the most frequent clinical presentation (89%). RDD lesions were mainly located in the thoracic spine (51%), then the cervical spine (32%). The lesion was reported to be extradural (57%), intradural extramedullary (26%), intramedullary (7%), and in the vertebral body (10%). Histological examination showed emperipolesis in 73%. Histocytes were positive for S-100 protein in 83%. Treatment was based on surgery 96%), radiotherapy, chemotherapy, and adjunctive steroid therapy were indicated in four, one, and eight cases. After a mean follow-up period of 14.84±13.00 months, recurrence of RDD was noted in 15%. CONCLUSION Spinal RDD is a rare condition, requiring meticulous histological examination for accurate diagnosis. Complete surgical resection is the treatment of choice. Adjuvant chemotherapy and radiotherapy can also be indicated in patients demonstrating partial improvement following surgery.
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Affiliation(s)
- Maroua Slouma
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; University of Tunis El Manar, Tunisia.
| | - Sirine Bouzid
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; University of Tunis El Manar, Tunisia
| | - Karima Tlili
- Department of Anatomy and Cell Biology, Military Hospital, Tunis, Tunisia; Department of Neurosurgery, Military Hospital, Tunis, Tunisia
| | - Dahmani Yedaes
- Department of Neurosurgery, Military Hospital, Tunis, Tunisia; University of Tunis El Manar, Tunisia
| | - Khaled Radhwen
- Department of Neurosurgery, Military Hospital, Tunis, Tunisia; University of Tunis El Manar, Tunisia
| | - Imen Gharsallah
- Department of Rheumatology, Military Hospital, Tunis, Tunisia; University of Tunis El Manar, Tunisia
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Basu S, Gala R, Gohil K. Spinal Rosai-Dorfman disease-a report of 2 cases and review of literature. Spinal Cord Ser Cases 2023; 9:36. [PMID: 37516782 PMCID: PMC10387076 DOI: 10.1038/s41394-023-00600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023] Open
Abstract
INTRODUCTION Rosai-Dorfman Disease (RDD) is a rare benign histiocytic disease that infrequently affects the spine. We report two cases of spinal RDD and review the relevant literature. This report addresses the various diagnostic dilemmas related to the evaluation of Spinal RDD and its treatment. CASE PRESENTATION Case 1: A 32-year-old male presented with low back pain and left anterior thigh for last 8 months. On examination, there was sensory diminution on inner aspects of the thigh with an absent left knee jerk. CT/MRI scans revealed an extradural lesion at L2/3 with neural compression. PET scan showed several hypermetabolic lesions in ribs, humerus, femur, and vertebrae. He underwent en bloc excision of the extradural mass with L2-3 pedicle screw-rod fixation and was later managed with chemotherapy. Case 2: A 42-year-old male presented with spastic paraparesis with urinary incontinence for the last 4 weeks. On examination, he had a neurological level of T6. MRI scan revealed a lesion in posterior elements of T6-7 compressing the spinal cord. He underwent T6-7 laminectomy with decompression. In both cases, the diagnosis was confirmed by histopathology and further managed by Hemato-oncologist. They both did well at 1-year follow-up with improvement in neurology. DISCUSSION Spinal RDD to date remains a large diagnostic dilemma with no pathognomonic clinical or radiological features; mimicking many osteolytic lesions in the spine. The diagnosis is purely histopathological and immunological. The lesion's complete surgical excision is the mainstay of treatment with a better prognosis and decreased chances of recurrences.
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Affiliation(s)
- Saumyajit Basu
- Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Rohan Gala
- Department of Orthopedics, DY Patil University School of Medicine, Hospital and Research Centre, Nerul Navi Mumbai, India
| | - Kushal Gohil
- Department of Orthopedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India.
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Tan MH, Foo CH, Ohn MH, Ohn KM. Experience of diagnosing and managing a patient with spinal Rosai-Dorfman-Destombes disease in a tuberculosis hyperendemic region. BMJ Case Rep 2022; 15:e245360. [PMID: 35321909 PMCID: PMC8943736 DOI: 10.1136/bcr-2021-245360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/04/2022] Open
Abstract
Classic Rosai-Dorfman-Destombes disease (RDD) is a rare histiocytic disorder with bilateral massive painless cervical lymphadenopathy. It is a mysterious disease and there is little knowledge of its pathogenesis, clinical features, radiological findings, laboratory investigations, effective treatments and prognosis. Some of its clinical presentations may overlap with those of Mycobacterium tuberculosis infection. Just like tuberculosis infection, RDD may involve many other organs, for example, skin, kidney, bone, brain and spine. The diagnosis can easily be overlooked, especially in communities hyperendemic to tuberculosis infection. We report our experience in diagnosing and managing a patient with spinal RDD with concurrent tuberculosis infection, who was treated empirically for cervical tuberculous lymphadenitis without a conclusive laboratory finding prior to her spinal condition. In view of her acute neurological deficit, emergency spinal decompression was performed. Her intraoperative spinal samples had shown classic histopathological features of RDD. We believe the lymphadenopathy was part of the clinical presentation of RDD. She showed favourable neurological recovery throughout the follow-up.
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Affiliation(s)
- Ming Han Tan
- Orthopaedic Department, Sarawak General Hospital, Kuching, Malaysia
| | - Choong Hoon Foo
- Orthopaedic Department, Hospital Queen Elizabeth, Kota Kinabalu, Malaysia
| | - May Honey Ohn
- Cardiology Department, Croydon University Hospital NHS Trust, London, UK
| | - Khin Maung Ohn
- Orthopaedic Department, Faculty of Medicine and Health Sciences,Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
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Hoyo-Muñoz A, Collado-Borrell R, Escudero-Vilaplana V, Bastos-Oreiro M, Herranz-Alonso A, Sanjurjo-Sáez M. Thalidomide as treatment of refractory thoracic Rosai-Dorfman disease. J Clin Pharm Ther 2021; 47:548-551. [PMID: 34514634 DOI: 10.1111/jcpt.13513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/19/2021] [Accepted: 08/05/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Rosai-Dorfman disease (RDD) is an infrequent entity of unknown aetiology. Currently, there is no clear consensus on the treatment, and nothing has shown definitive safety and efficacy. We describe the case of a woman diagnosed with pulmonary RDD, who responded to thalidomide treatment after failure of four previous lines of systemic chemotherapy. CASE DESCRIPTION We present the case of a 74-year-old woman diagnosed with pulmonary RDD and autoimmune complications. We decided to use thalidomide as a rescue treatment after the failure of corticosteroids and several chemotherapies. Our patient achieved remission of the disease and remained stable for years. WHAT IS NEW AND CONCLUSION To the authors' knowledge, this is the first reported case in which thalidomide treatment induced remission in refractory pulmonary RDD. Thalidomide showed a rapid onset of action, with lasting responses, which could make it an exciting option for treating this life-threatening.
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Affiliation(s)
- Angela Hoyo-Muñoz
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roberto Collado-Borrell
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Vicente Escudero-Vilaplana
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mariana Bastos-Oreiro
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana Herranz-Alonso
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Sanjurjo-Sáez
- Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Hu PP, Wei F, Liu XG, Liu ZJ. Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review. Syst Rev 2021; 10:31. [PMID: 33461611 PMCID: PMC7814441 DOI: 10.1186/s13643-021-01581-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/02/2021] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To review and summarize the clinical features, diagnosis, treatment strategies, and prognosis of spinal Rosai-Dorfman disease (RDD). METHODS RDD is also termed as sinus histiocytosis with massive lymphadenopathy. We searched the databases of PubMed, Elsevier ScienceDirect, SpringerLink, and OVID. The keywords were Rosai-Dorfman disease and spine/central nervous system. Research articles and case reports with accessibility to full texts regarding spinal RDD were eligible for the inclusion. A total of 62 articles were included, and they contained 69 cases. We extracted the information of interest and analyzed them using SPSS statistics package. RESULTS The average age was 33.1 ± 18.3 years. The ratio of males to females was 1.9/1. Overall, 63 cases presented with spine-related symptoms. A total of 27 cases (39.1%) had multi-organ lesions, and 12 cases had records of massive lymphadenopathy. Among 47 cases who first manifested spine-related symptoms, 93.6% were preoperatively misdiagnosed. The disease had a predilection for cervical spine (38.8%) and thoracic spine (40.3%). 62.9% of lesions were dura-based. Surgery remained the mainstream treatment option (78.8%), with or without adjuvant therapies. Total lesion resection was achieved in 34.8% of cases. The rate of lesion recurrence/progression was 19.5%, which was marginally lower for total resection than for non-total resection. CONCLUSION Spinal RDD has no pathognomonic clinical and imaging features. Most cases first present with spine-relevant symptoms. Massive lymphadenopathy is not common, but a tendency for multi-organ involvement should be considered. Spinal RDD has a high recurrence rate; thus, total resection is the treatment of choice. Adjuvant therapies are indicated for multi-organ lesions and residual lesions. A wait and watch strategy is recommended for asymptomatic patients. Herein, a workflow of diagnosis and treatment of the spinal RDD is established.
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Affiliation(s)
- Pan-Pan Hu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Feng Wei
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China.
| | - Xiao-Guang Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
| | - Zhong-Jun Liu
- Department of Orthopaedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing, 100191, China
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Baeesa SS, Mahboob H, Maghrabi Y, Binmahfoodh M, Almaghrabi J. Long-Term Outcome of Spinal Extranodal Rosai-Dorfman Disease: A Report of Two Cases and Systematic Review. World Neurosurg 2020; 144:1-14. [PMID: 32827744 DOI: 10.1016/j.wneu.2020.08.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare pathologic entity caused by sinus histiocytosis with massive cervical lymphadenopathy. Isolated spinal involvement is an infrequent presentation of extranodal RDD. The clinical and radiologic appearance of RDD represents a diagnostic challenge. We report 2 patients with paraparesis caused by RDD of the thoracic spine and a PRISMA-style systematic review. CASE DESCRIPTION There were 2 patients with isolated extranodal thoracic spinal RDD without cervical lymphadenopathy. One patient presented with anterior thoracic RDD and a subtotal resection. The small residual disease completely responded to the postoperative course of steroids. The second patient had extradural thoracic spine RDD, which was resected completely. A 6-month postoperative follow-up magnetic resonance imaging (MRI) scan showed local recurrence, which responded to radiation therapy. Five years follow-up of both patients showed normal neurologic functions and no recurrence on MRI scan surveillance. CONCLUSIONS RDD is a rare occurrence and should be considered in the differential diagnosis of extradural or intradural spinal lesions. Gross total resection is recommended, and long-term clinical follow-up with MRI is advised. Residual or recurrent RDD requires steroids or radiation therapy.
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Affiliation(s)
- Saleh S Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
| | - Hani Mahboob
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yazid Maghrabi
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Binmahfoodh
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Jaudah Almaghrabi
- Department of Pathology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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