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Namoglu EC, Hughes ME, Plastaras JP, Landsburg DJ, Maity A, Nasta SD. Management and outcomes of sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease). Leuk Lymphoma 2019; 61:905-911. [PMID: 31876204 DOI: 10.1080/10428194.2019.1703971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease [RDD]), is a rare, benign but clinically heterogeneous histiocytic disorder. Our aims were to analyze the clinical characteristics of the disease and explore the outcomes of patients with RDD followed at our institution. Between January 2000 and February 2019, there were 15 patients with a pathologically confirmed diagnosis of RDD. Median age at diagnosis was 48 years old (range 26-78). The majority (87%, n = 13) of the patients had extranodal disease. Frontline approaches included surgical intervention/complete excision (n = 5, 33%), rituximab monotherapy (n = 5, 33%), observation (n = 3, 20%), and radiation (n = 2, 13%). Two of the five patients underwent surgical excision and were subsequently treated with rituximab. Of the 7 patients who were given rituximab, 64% remained progression free 24 months after the initial rituximab administration. Our review parallels previous reports and highlights rituximab as a favorable option for therapy if ineligible for surgery or radiation.
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Affiliation(s)
- Esin C Namoglu
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mitchell E Hughes
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John P Plastaras
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Landsburg
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Maity
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sunita D Nasta
- Division of Hematology Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Abla O, Jacobsen E, Picarsic J, Krenova Z, Jaffe R, Emile JF, Durham BH, Braier J, Charlotte F, Donadieu J, Cohen-Aubart F, Rodriguez-Galindo C, Allen C, Whitlock JA, Weitzman S, McClain KL, Haroche J, Diamond EL. Consensus recommendations for the diagnosis and clinical management of Rosai-Dorfman-Destombes disease. Blood 2018; 131:2877-2890. [PMID: 29720485 PMCID: PMC6024636 DOI: 10.1182/blood-2018-03-839753] [Citation(s) in RCA: 300] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/27/2018] [Indexed: 12/21/2022] Open
Abstract
Rosai-Dorfman-Destombes disease (RDD) is a rare non-Langerhans cell histiocytosis characterized by accumulation of activated histiocytes within affected tissues. RDD, which now belongs to the R group of the 2016 revised histiocytosis classification, is a widely heterogeneous entity with a range of clinical phenotypes occurring in isolation or in association with autoimmune or malignant diseases. Recent studies have found NRAS, KRAS, MAP2K1, and ARAF mutations in lesional tissues, raising the possibility of a clonal origin in some forms of RDD. More than 1000 reports have been published in the English literature; however, there is a lack of consensus regarding approach for the clinical management of RDD. Although in most cases RDD can be observed or treated with local therapies, some patients with refractory or multifocal disease experience morbidity and mortality. Here we provide the first consensus multidisciplinary recommendations for the diagnosis and management of RDD. These recommendations were discussed at the 32nd Histiocyte Society Meeting by an international group of academic clinicians and pathologists with expertise in RDD. We include guidelines for clinical, laboratory, pathologic, and radiographic evaluation of patients with RDD together with treatment recommendations based on clinical experience and review of the literature.
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Affiliation(s)
- Oussama Abla
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jennifer Picarsic
- Department of Pathology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Zdenka Krenova
- Pediatric Oncology Clinic, Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Pathology, University Hospital, Brno, Czech Republic
| | - Ronald Jaffe
- Department of Pathology, Magee Women's Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jean-Francois Emile
- Pathology Department, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France
- Research Unit EA4340, Versailles SQY University, Paris-Saclay University, Boulogne, France
| | - Benjamin H Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jorge Braier
- Department of Hematology, Oncology, Hospital de Pediatría JP Garrahan, Buenos Aires, Argentina
| | - Frédéric Charlotte
- Department of Pathology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
- Department of Internal Medicine, Paris VI University, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
| | - Jean Donadieu
- Department of Haematology, AP-HP, Trousseau Hospital, Paris, France
| | - Fleur Cohen-Aubart
- Department of Internal Medicine, Paris VI University, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
- Department of Internal Medicine 2, French National Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | - Carl Allen
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Texas Children's Cancer Center, Texas Children's Hospital, Houston, TX
- Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX
| | - James A Whitlock
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Sheila Weitzman
- Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth L McClain
- Section of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Julien Haroche
- Department of Internal Medicine, Paris VI University, Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
- Department of Internal Medicine 2, French National Centre for Rare Systemic Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY; and
- Department of Neurology, Weill Cornell Medical College, New York, NY
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Tan S, Ruan L, Jin K, Wang F, Mou J, Huang H, Yang G. Systemic Rosai-Dorfman disease with central nervous system involvement. Int J Neurosci 2017; 128:192-197. [PMID: 28881164 DOI: 10.1080/00207454.2017.1377709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rosai-Dorfman disease (RDD) is a rare idiopathic and lymphoproliferative disorder. Central nervous system (CNS) involvement is infrequent and typically manifests as an isolated lesion. In this article, we describe an unusual case of RDD with multiple lesions in the CNS, upper respiratory tract and lymph nodes. A literature review revealed 45 cases (including the one described herein) of systemic RDD with CNS involvement documented to date. Among these cases, 29 (64.4%) presented with intracranial lesions, 10 (22.2%) with spinal lesions and 6 (13.3%) with both. While the condition of most patients was stable, only four died from RDD or for other reasons. Prognosis is good for most patients, even those with extensive lesions. Although there are various treatments for RDD, surgery is preferred. Given the rarity of RDD, multicenter international collaborations are advocated in order to study disease pathogenesis and develop effective treatment strategies.
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Affiliation(s)
- Song Tan
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Lunliang Ruan
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Kai Jin
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Fuchao Wang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Jiamin Mou
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Hua Huang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Gang Yang
- a Department of Neurosurgery , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
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Mercaptopurine Treatment in an Adult Man with Orbital and Intracranial Rosai-Dorfman Disease. Case Rep Neurol Med 2016; 2016:1030478. [PMID: 27840753 PMCID: PMC5093240 DOI: 10.1155/2016/1030478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 10/03/2016] [Indexed: 12/28/2022] Open
Abstract
Background. Rosai-Dorfmann disease (RDD) is a rare, idiopathic non-Langerhans cell histiocytosis, affecting children and young adults, that commonly presents as painless, massive cervical lymphadenopathy with fever, weight loss, and polyclonal hypergammaglobulinemia. Cervical lymphadenopathy and extranodal involvement are the main presentations. On the contrary, ophthalmic involvement and localisation in the central nervous system are rare. Case Report. An old man was admitted to our hospital for first seizure. Brain imaging studies revealed on the left an extra-axial thickening of the dura mater with enhancement and perilesional oedema, infiltrating the sphenoorbital fissure and an isointense mass with enhancement in the orbital region with dislocation of the optic nerve. Pathological and immunohistochemistry examination of the bioptical specimen was consistent with a diagnosis of RDD. Treatment with levetiracetam and steroids was started obtaining only remission of seizures. Because of the patient refusal of the surgical debulking, therapy with mercaptopurine was started, stopping disease progression. Conclusion. So far, very few cases of extranodal RDD with multiple CNS lesions involving the orbital region have been described. Our case is significant because it is the first case in which the efficacy of mercaptopurine treatment has been documented in an adult patient with isolated ocular and intracranial RDD.
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Dalia S, Sagatys E, Sokol L, Kubal T. Rosai-Dorfman disease: tumor biology, clinical features, pathology, and treatment. Cancer Control 2015; 21:322-7. [PMID: 25310213 DOI: 10.1177/107327481402100408] [Citation(s) in RCA: 133] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Rosai-Dorfman disease (RDD) is a rare, nonmalignant clinical entity characterized by a group of clinical symptoms and characteristic pathological features. METHODS Articles that reviewed tumor biology, clinical features, pathology, and treatment for RDD were identified in a search of the literature for the years 1990 to 2014. The results from this body of literature were reviewed and summarized. RESULTS Patients with RDD generally present with massive, painless cervical lymphadenopathy, fevers, and elevated inflammatory markers. Extranodal disease is typical, with the most common sites being the skin and the central nervous system. Rarely, the gastrointestinal tract is involved. Immunohistochemistry remains the mainstay of diagnosis with S100 and CD68 positive cells while CD1a will be negative of involved histiocytes. Histologically, the disease shows the classical characteristic finding of emperipolesis. Many patients do not require treatment; however, surgical resection remains the mainstay of treatment for symptomatic disease. The role of steroids, chemotherapy, and radiation therapy continue to be based on small case series and case reports. CONCLUSIONS RDD has a variable clinical presentation; therefore, a high degree of suspicion and a thorough pathological review are necessary to diagnose this rare clinical entity. Although some patients will experience spontaneous resolution, others may require surgical resection or steroid therapy and radiation or chemotherapy. Given the rarity of the disease and the lack of a clear therapeutic pathway, referring patients to a tertiary center is recommended for confirming the diagnosis and treatment considerations.
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Affiliation(s)
- Samir Dalia
- Mercy Clinic Oncology-Hematology, Joplin, MO 64804, USA.
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Le Guenno G, Galicier L, Uro-Coste E, Petitcolin V, Rieu V, Ruivard M. Successful treatment with azathioprine of relapsing Rosai-Dorfman disease of the central nervous system. J Neurosurg 2012; 117:486-9. [PMID: 22725985 DOI: 10.3171/2012.5.jns12148] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Rosai-Dorfman disease (RDD) is a rare non-Langerhans histiocytosis that usually presents with lymphadenopathy. Although isolated involvement of the CNS was considered to be uncommon, numerous cases have been reported in recent years. For RDD of the CNS, the treatment consists, in general, of surgery. In cases of partial resection or relapse, chemotherapy regimens, corticosteroids, and/or radiotherapy have yielded negative results. The authors describe the case of a 57-year-old man with a history of chronic Q fever who presented with aphasia and partial seizure. Computed tomography of the brain revealed a left frontotemporal lesion that was suggestive of a meningioma. The lesion was partially resected and histopathological evaluation revealed the presence of RDD. Nineteen months later, a Jacksonian seizure prompted MRI evaluation, which disclosed a local recurrence of the tumor. Computed tomography and FDG-PET demonstrated that the RDD involved no other site, but the presence of ileitis, noted on ileoscopy, led to the diagnosis of Crohn disease. Treatment with the purine analog azathioprine was initiated, leading to an objective and sustained response in both the RDD tumor and ileitis over 35 months of follow-up. This case report highlights the potential use of a purine analog in cases of relapsing RDD of the CNS and a possible common defect of macrophage regulation in RDD, Crohn disease, and Q fever.
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