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Ju J, Kwon YS, Jo KJ, Chae DR, Lim JH, Ban HJ, Chi SY, Oh IJ, Kim KS, Kim YI, Kim YC, Lim SC. Sinus histiocytosis with massive lymphadenopathy: a case report with pleural effusion and cervical lymphadenopathy. J Korean Med Sci 2009; 24:760-2. [PMID: 19654967 PMCID: PMC2719199 DOI: 10.3346/jkms.2009.24.4.760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Accepted: 04/27/2008] [Indexed: 11/20/2022] Open
Abstract
Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder characterized by a nonneoplastic proliferation of distinctive histiocyte cells within lymph node sinuses and lymphatics in extranodal sites. SHML occurs worldwide and is primarily a disease of childhood and early adulthood. A 26-yr-old man presented with painless palpable lymph node in cervical area. Radiographic studies revealed pleural effusion with lymphadenopathy and calcification in mediastinum. The cervical lymph node biopsy showed dilated sinuses filled with histiocytes with clear cytoplasm. The cells stained positive with CD68 and S-100. These cytologic and immunohistochemical findings were considered consistent with the diagnosis of SHML.
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Affiliation(s)
- Jinyung Ju
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kae Jung Jo
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Ryeol Chae
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jung Hwan Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hee Jung Ban
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Su Young Chi
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - In Jae Oh
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ku Sik Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Chul Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
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Maric I, Pittaluga S, Dale JK, Niemela JE, Delsol G, Diment J, Rosai J, Raffeld M, Puck JM, Straus SE, Jaffe ES. Histologic features of sinus histiocytosis with massive lymphadenopathy in patients with autoimmune lymphoproliferative syndrome. Am J Surg Pathol 2005; 29:903-11. [PMID: 15958855 DOI: 10.1097/01.pas.0000157997.61177.08] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Autoimmune lymphoproliferative syndrome (ALPS) is an inherited disorder associated with defects in Fas-mediated apoptosis, characterized most often by childhood onset of lymphadenopathy, splenomegaly, hypergammaglobulinemia, and autoimmune phenomena. Children with sinus histiocytosis with massive lymphadenopathy (SHML) have a somewhat similar clinical phenotype in which prominent adenopathy also is associated with hypergammaglobulinemia, and autoimmune phenomena are reported in 10-15% of cases. We observed histopathological features of SHML in the lymph nodes of some of our ALPS patients, further suggesting an association between these two disorders. We, thus, reviewed the lymph nodes from 44 patients ALPS type Ia, all of whom were confirmed to have germline mutations in the TNFRSF6 gene encoding Fas (CD95/Apo-1). Eighteen of 44 (41%) patients had a histiocytic proliferation resembling SHML. The affected patients included 15 males and 3 females ranging in age from 11 months to 30 years at the time of the LN biopsy. The lymph nodes contained S-100+ histiocytes with characteristic nuclear features of SHML, and showed evidence of emperipolesis in both hematoxylin and eosin (H and E) and immunostained sections. The extent of the histiocytic proliferation was variable, being confluent in 2 cases, multifocal in 13, and only evident as isolated SHML-type histiocytes in 3. In lymph nodes without confluent SHML changes, increased numbers of CD3+CD4-CD8+ (double negative) alphabeta T-cells, also negative for CD45RO, a feature of ALPS, could be identified in the paracortex. Furthermore, because SHML shares many clinical features with ALPS, we sought evidence of ALPS in sporadic SHML. We attempted to sequence TNFRSF6 DNA from archived tissue of 14 cases of Rosai-Dorfman disease. Full sequencing of the gene was successful in 4 of the cases; no mutations were identified. Nevertheless, our observations suggest that histologic features of SHML are part of the pathologic spectrum of ALPS type Ia. It remains to be determined if some cases of apparently sporadic SHML may be associated with heritable defects in Fas-mediated apoptosis.
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Affiliation(s)
- Irina Maric
- Hematopathology Section, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Kismet E, Köseoglu V, Atay AA, Deveci S, Demirkaya E, Tuncer K. Sinus histiocytosis with massive lymphadenopathy in three brothers. Pediatr Int 2005; 47:473-6. [PMID: 16118898 DOI: 10.1111/j.1442-200x.2005.02096.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Erol Kismet
- Department of Pediatric Oncology, Gülhane Military Medical Academy and Medical School, Ankara, Turkey.
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Sennes L, Koishi H, Cahali R, Sperandio F, Butugan O. Rosai-Dorfman Disease with Extranodal Manifestation in the Head. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408301219] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The term sinus histiocytosis with massive lymphadenopathy (SHML) was introduced by Rosai and Dorfman in 1969. Although SHML was initially described as low-pain cervical lymphadenopathy accompanied by fever, leukocytosis, an increased erythrocyte sedimentation rate, and hypergammaglobulinemia, extranodal involvement is observed in 25 to 40% of cases. This pathology is very rare and involvement of the nasal fossae and paranasal sinuses is exceptional. We present two atypical cases of extranodal involvement exclusively confined to the head and review the literature. The first case showed a dramatic involvement of facial skin and muscles, orbit, and paranasal sinuses. In the second case, the disease was limited to the nasal fossae. Both cases showed exclusive extranodal involvement limited to the head region. In the absence of lymphadenopathy, diagnosing Rosai-Dorfman disease is difficult because of the lack of the most typical manifestation of the disease.
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Affiliation(s)
- Luiz Sennes
- Department of Otorhinolaryngology, Sao Paulo University, Brazil
| | - Henry Koishi
- Department of Otorhinolaryngology, Sao Paulo University, Brazil
| | - Rafael Cahali
- Department of Otorhinolaryngology, Sao Paulo University, Brazil
| | | | - Ossamu Butugan
- Department of Otorhinolaryngology, Sao Paulo University, Brazil
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Carbone A, Passannante A, Gloghini A, Devaney KO, Rinaldo A, Ferlito A. Review of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) of head and neck. Ann Otol Rhinol Laryngol 1999; 108:1095-104. [PMID: 10579239 DOI: 10.1177/000348949910801113] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The entity known as sinus histiocytosis with massive lymphadenopathy (SHML), or Rosai-Dorfman disease (RD disease), is an uncommon benign proliferation of hematopoietic and fibrous tissue that often presents in the head and neck region. Its initial manifestations most often include a roughly symmetric, painless, bilateral cervical adenopathy, although extranodal disease may develop in a minority of patients. The key histologic feature of SHML is the presence of various numbers of large, pale histiocytic cells that contain within their cellular borders apparently engulfed lymphocytes ("emperipolesis"); these distinctive large, pale cells - RD cells - are S-100 protein-positive by immunostaining and so differ from ordinary histiocytes. Despite its sometimes impressive clinical presentation, SHML is a benign and self-limited disease, whose treatment is aimed largely at controlling its local manifestations (most often by surgical therapy). The microscopic differential diagnosis, particularly in extranodal disease, is at times challenging and can include Langerhans' cell histiocytosis, Hodgkin's disease, non-Hodgkin's lymphoma, metastatic carcinoma, and metastatic malignant melanoma.
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Affiliation(s)
- A Carbone
- Division of Pathology, Centro di Riferimento Oncologico, National Cancer Institute, Aviano, Italy
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Patterson FR, Rooney MT, Damron TA, Vermont AI, Hutchison RE. Sclerotic lesion of the tibia without involvement of lymph nodes. Report of an unusual case of Rosai-Dorfman disease. J Bone Joint Surg Am 1997; 79:911-6. [PMID: 9199391 DOI: 10.2106/00004623-199706000-00017] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- F R Patterson
- Department of Orthopedic Surgery, State University of New York Health Science Center, Syracuse 13202, USA
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Lehnert M, Eisenschenk A, Dienemann D, Linnarz M. Sinus histiocytosis with massive lymphadenopathy. Skeletal involvement. Arch Orthop Trauma Surg 1993; 113:53-6. [PMID: 8117513 DOI: 10.1007/bf00440596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A 64-year-old female patient has been suffering from sinus histiocytosis with massive lymphadenopathy (SHML) for 2 years. After 12 months of illness, the patient developed swelling and pain in various skeletal regions. Scintigraphic, radiological and CT imaging revealed multiple osseous lesions. Subsequent biopsies yielded the histomorphological findings typical for SHML. After operative resection of the left cuboid, which was the most painful region during walking, the defect was filled with an autologous bone transplant. At this time no other osteolytic region was treated surgically, because the patient had first to undergo ENT treatment.
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Affiliation(s)
- M Lehnert
- Orthopedic Clinic of the Free University of Berlin at Oskar-Helene-Heim, Germany
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Maennle DL, Grierson HL, Gnarra DG, Weisenburger DD. Sinus histiocytosis with massive lymphadenopathy: a spectrum of disease associated with immune dysfunction. PEDIATRIC PATHOLOGY 1991; 11:399-412. [PMID: 1714075 DOI: 10.3109/15513819109064776] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A detailed immunologic study of three cases of sinus histiocytosis with massive lymphadenopathy (SHML) was performed to better characterize this rare disorder. One patient had prominent cervical lymphadenopathy that regressed spontaneously, whereas the other two patients had persistent cervical lymphadenopathy and recurrent infections. The first patient was otherwise healthy and had normal immunologic studies. One of the latter patients had a relative increase in blood B cells, a decreased level of serum immunoglobulin A (IgA), decreased blood lymphocyte mitogenic responses to multiple mitogens (37-42% of controls), and cutaneous anergy. The other patient with persistent disease also had a relative increase in blood B cells, polyclonal hypergammaglobulinemia, and circulating immune complexes, as well as decreased blood T cells and markedly decreased blood lymphocyte responses to mitogens (12-37% of controls). Immunohistochemical stains of the lymph nodes of the three patients revealed a characteristic phenotype for the sinus histiocytes: S-100 protein, 3/3; CD14 (Leu M3) 3/3; CD11c (Leu M5), 1/1; CD71 (OKT9), 3/3; CD4 (Leu 3a), 2/3; CD1a (OKT6), 1/3; alpha-1-antitrypsin, 3/3; alpha-1-antichymotrypsin, 3/3; CD35 (C3b), 1/1; CD11b (Mo1), 0/3; CD15 (Leu M1), 0/3; HLA-DR, 0/3; and lysozyme, 0/3. This phenotype suggests that the cells of SHML have features of both the Langerhans/interdigitating cell and mononuclear phagocyte lineages. Emperipolesis by the histiocytes of B cells, T cells, and natural killer cells was demonstrated by a double-staining technique. Our findings indicate that patients with SHML may have a variably expressed immunodeficiency that predisposes them to recurrent infections.
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Affiliation(s)
- D L Maennle
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198
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Thomson ER, Newman P, Dunstan S, Coull H. The Rosai Dorfman syndrome in a 50-year-old male. Br J Oral Maxillofac Surg 1989; 27:39-45. [PMID: 2920162 DOI: 10.1016/0266-4356(89)90125-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A case is presented of a 50-year-old man with Rosai Dorfman Syndrome (Sinus histiocytosis with massive lymphadenopathy) who had facial, cervical and cutaneous involvement.
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Affiliation(s)
- E R Thomson
- Faculty of Medical Sciences, University of the West Indies, Mount Hope Medical Sciences Complex, Trinidad
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Affiliation(s)
- J D Yao
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
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Aoyama K, Terashima K, Imai Y, Katsushima N, Okuyama Y, Niikawa K, Mukada T, Takahashi K. Sinus histiocytosis with massive lymphadenopathy. A histogenic analysis of histiocytes found in the fourth Japanese case. ACTA PATHOLOGICA JAPONICA 1984; 34:375-88. [PMID: 6741550 DOI: 10.1111/j.1440-1827.1984.tb07565.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The present paper deals with immunohistochemical and ultrastructural study of the lymph nodes of sinus histiocytosis with massive lymphadenopathy (Rosai and Dorfman, SHML) of a 12-year-old Japanese boy. This is the fourth case in Japan. Osseous manifestation was also found in the bilateral ulnae. With hallmarks of S-100 protein and interdigitating cytoplasmic extensions, the phagocytizing histiocytes proliferating in the sinuses were considered to be derived mostly from interdigitating cells in the paracortex or T cell dependent area, which have heretofore been regarded as nonphagocytizing. Furthermore, it is most interesting that lymphoid cells bearing thymic cortical cell-antigen (OKT 6) were increasingly recognized in the patient's peripheral blood. These results suggested that SHML is a specialized reactive histiocytosis analogous to histiocytosis X and histiocytic medullary reticulosis.
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Sanchez R, Sibley RK, Rosai J, Dorfman RF. The electron microscopic features of sinus histiocytosis with massive lymphadenopathy: a study of 11 cases. Ultrastruct Pathol 1981; 2:101-19. [PMID: 7268923 DOI: 10.3109/01913128109064239] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Eleven cases of sinus histiocytosis with massive lymphadenopathy (SHML) involving lymph nodes were studied electron microscopically. Histiocytes were the most conspicuous element of the infiltrate. They could be divided into small and large forms, although transitions were apparent among them. Most of the small histiocytes were located in the medullary cords. The large histiocytes were predominantly seen within sinuses and were subdivided into two types on the basis of their appearance. The most distinctive feature of these histiocytes was the presence of lymphocytes, plasma cells, and neutrophils within their cytoplasm. Other cells present in the infiltrate were lymphocytes, plasma cells, and occasional neutrophils and mast cells. Blood vessels were prominent throughout. Virus particles, bacteria, and Langerhans' granules were consistently absent. No morphologic clues were provided by this study as to the etiology of this disorder.
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