| Article Access Statistics | | | Viewed | 4867 | | | Printed | 190 | | | Emailed | 0 | | | PDF Downloaded | 84 | | | Comments | [Add] | | | Cited by others | 13 | | |
|
Click on image for details.
|
|
 |
| CASE REPORT |
|
|
|
| Year : 2011 | Volume
: 59
| Issue : 3 | Page : 438-442 |
Rosai-Dorfman disease presenting as cervical extradural lesion: A case report with review of literature
Tanmoy K Maiti1, Jagathlal Gangadharan1, Anita Mahadevan2, A Arivazhagan1, BA Chandramouli1, SK Shankar2
1 Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
2 Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| Date of Submission | 28-Sep-2010 |
| Date of Decision | 05-Oct-2010 |
| Date of Acceptance | 01-Nov-2010 |
| Date of Web Publication | 7-Jul-2011 |
Correspondence Address:
Jagathlal Gangadharan
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore-560 029, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.82769
Sinus histiocytosis with massive lymphadenopathy or Rosai-Dorfman disease is a rare, but well documented entity. We report a lady who presented with progressive quadriparesis, with cervical extradural lesion on magnetic resonance imaging. She underwent decompression of the lesion and histological diagnosis of the lesion was Rosai-Dorfman disease. On one-year follow-up, she had complete improvement of the deficits with no further progression of the lesion. The presentation of this disease as an isolated spinal extradural mass lesion is quite rare, with only six cases reported in literature.
Keywords: Rosai-Dorfman disease, sinus histiocytosis with massive lymphadenopathy, spinal extradural lesion, steroids, surgery
How to cite this article:
Maiti TK, Gangadharan J, Mahadevan A, Arivazhagan A, Chandramouli B A, Shankar S K. Rosai-Dorfman disease presenting as cervical extradural lesion: A case report with review of literature. Neurol India 2011;59:438-42 |
How to cite this URL:
Maiti TK, Gangadharan J, Mahadevan A, Arivazhagan A, Chandramouli B A, Shankar S K. Rosai-Dorfman disease presenting as cervical extradural lesion: A case report with review of literature. Neurol India [serial online] 2011 [cited 2022 Jun 30];59:438-42. Available from: https://www.neurologyindia.com/text.asp?2011/59/3/438/82769 |
| » Introduction | |  |
Rosai-Dorfman disease (RDD) is a rare, benign, self-limiting lymphoproliferative disorder first described by Rosai and Dorfman in 1969. [1] Typical clinical presentation is with massive painless cervical lymphadenopathy, but extranodal involvement is rare, seen in 30 - 40% of the cases, with skin, upper respiratory tract, orbit and eye, salivary gland, bone, and testis being reported. [1] In less than 5% of the cases, the central nervous system (CNS) is involved. [2] Involvement of the spine has been described in only 20 - 25% of those with CNS involvement [3],[4] and is generally not accompanied by lymphadenopathy. [3] We report a case of RDD presenting with extradural spinal cord compression, and briefly review the literature.
| » Case Report | | |
A 19-year-old lady presented with a two-month history of an insidious onset of gradually progressive neck pain and asymmetric progressive spastic quadriparesis without any sphincter dysfunction. Neurological examination revealed hypertonia of both lower limbs. She had motor power of 2/5 in the right side and 3/5 in the left side, with decreased sensation, below C5. Deep tendon reflexes were brisk and bilateral plantar response was extensor. There was no lymphadenopathy. A complete hemogram revealed hemoglobin of 10.8 gm/dL, total WBC count of 13,600/cu mm, and ESR of 62 mm /1 hour. Serum levels of immunoglobulin A, G, and M were normal. An ultrasound of the neck and abdomen did not reveal any abnormality. Magnetic resonance imaging (MRI) of the cervical spine revealed a posteriorly placed, extradural lesion at C3 - C6, with contrast enhancement and doubtful intradural encroachment [Figure 1]. She underwent C2 - C6 laminectomy and excision of the extradural lesion. The lesion was moderately vascular, fleshy, and adherent to the dura, extending from C2 - C7. The dura was freed from the lesion, and was lax and pulsatile after decompression. | Figure 1: (a-c) Preoperative MRI sagittal images: Lesion is isointense in T1- and T2-weighted images with homogenous contrast enhancement. Significant cord compression is seen (d) Postoperative MRI: small residual / recurrent lesion
Click here to view |
Histopathology revealed infiltration of the extradural soft tissue by dense aggregates of lymphocytes and histiocytes [Figure 2]a. Emperipolesis with intact lymphocytes within the cytoplasm of the large cells were present in the infiltrate [[Figure 2]a, inset]. Also seen were clusters of large histiocytes with eosinophilic, finely granular cytoplasm, and multinucleate giant cells [Figure 2]b that demonstrated strong immunoreactivity for S100 [[Figure 2]b, inset top right] and CD68 [[Figure 2]b, inset bottom left]. The cells were immunonegative for CD1a excluding the Langerhans cell histiocytic lesion. | Figure 2: Dense infiltration of an extradural soft tissue by large aggregates of lymphocytes and histiocytes [Figure a]. Note the emperipolesis of intact lymphocytes within the cytoplasm of large histiocytes [Figure a, inset, arrow]. Clusters of large multinucleate histiocytes with eosinophilic finely granular cytoplasm [Figure b] are seen. These cells show strong immunoreactivity for S100 [Figure 2b, inset top right] and CD68 [Figure b, inset bottom left]. [a: H and E, x80, a inset: H and E, x320, b: 400, b inset top right: S100 immunoperoxidase x280, inset bottom right: CD68 immunoperoxidase x280]
Click here to view |
Postoperatively the patient improved gradually with physiotherapy and became ambulatory in three weeks and returned to work within six weeks. At the 18-month, follow-up, she did not have any neurological deficits. There was no evidence of other extranodal or lymph node involvement. A one-year postoperative, follow-up MRI, showed doubtful residue/recurrence opposite C4. The patient did not receive any steroid, radiotherapy or chemotherapy.
| » Discussion | | |
CNS Rosai-Dorfman disease can present at any age, but most commonly in the third and fourth decade, with a slight male predominance. [1],[5] Over 90% of the CNS Rosai-Dorfman involve the leptomeninges and seen on neuroimaging as a dural-based, contrast-enhancing lesion, mimicking a meningioma. [2],[3],[5] Although thought to be benign, reversal of neurological deficits is mostly incomplete and deaths have been reported due to infiltration of the vital organs. [1]
The etiology of RDD remains largely unknown. It is presumed to be reactive in nature, as no evidence of clonality has been demonstrated by molecular analysis. A possible association with infective agents like HHV-6 and Parvo B19 have been suggested in a few studies. [6] The current hypothesis is that RDD is a subtle, yet undefined immunological defect, which promotes monocyte recruitment from the circulation into the nodal or extranodal sites followed by transformation into the immunophenotypically distinct RDD histiocytes demonstrating emperipolesis with functional uniqueness in terms of the cytokine expression profile. [7] Cytologically, emperipolesis is a consistent finding in nodal disease, although less apparent in extranodal sites, whereas, fibrosis is commonly seen. [5] Emperipolesis refers to phagocytosis of intact lymphocytes by macrophages (also known as lymphocytophagocytosis). [5] It differs from phagocytosis, in that the lymphocytes taken up are not attacked by the enzymes and appear intact within the histiocytes.
A biopsy remains the gold standard for diagnosis and the differential diagnoses include hematopoietic and primary CNS lesions that are accompanied by dense inflammatory infiltrates, such as, lymphoplasmacytic meningioma, Langerhans histiocytosis, nodular sclerosing variant of Hodgkin's disease, intracranial plasmacytoma, and plasma cell granulomas. Immunohistochemistry aids in differentiating these from the other Langerhans and non-Langerhans cell histiocytosis. The possibility that many of the earlier reported cases of CNS plasma cell granulomas or inflammatory pseudotumors are RDD, has also been suggested. [8]
There is no established treatment protocol for systemic RDD as it is often self-limiting except in the event of the compression of vital organs or airway obstruction. Local recurrence is possible following surgical resection. [1],[4] Steroids often resolve fever and reduce lymph node size. The role of radiotherapy and chemotherapy is controversial. [9]
A thorough literature search revealed at least 35 previously reported cases with spinal involvement, as depicted in the [Table 1], although isolated spinal involvement was seen in only six of them. Analyzing them, there is a male predominance [21:11] with the age group varying from two-and-a-half years to 78 years with a mean age of 31.8 years. Simultaneous nodal involvement was found in only ten cases. Cranial involvement was found in six cases and the highest interval between cranial and spinal involvement was five years. Extra-CNS involvement was found in six patients. Lesion were most prevalent at the thoracic level (12 cases) followed by the cervical level (six cases); three were found in the cervicodorsal region; two each in the lumbar and sacral levels; and one in the craniovertebral junction. The lesions were multiple in five cases. The plane of the lesion was primarily extradural in 18 cases, whereas, eight were intradural and three were intramedullary. In three cases, the lesions were primarily involving the body with extradural extension. Surgery was the treatment of choice in most cases, for relieving cord compression. Recurrence was noted in three cases after surgery, all within one year. [4] In eight cases where chemotherapy, radiotherapy or their combination was preferred over surgery, the control of disease was possible, although the reversal was not complete. Two patients expired because of multiple organ involvement. [1]
In our case, a significant challenge was encountered in diagnosing as well as formulating a further line of treatment, in view of the exclusive extranodal involvement of this disease, which resulted in rapidly progressive quadriparesis. Early diagnosis of the extranodal intraspinal RDD could help to avoid a permanent long-term neurologic sequel only if there is a high index of suspicion on the part of clinicians and pathologists, of this very rare cause of spinal cord compression.[10]
| » References | | |
| 1. | Foucar E, Rosai J, Dorfman R. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): Review of the entity. Semin Diagn Pathol 1990;7:19-73. 
[PUBMED] |
| 2. | Ma J, Xiao J, Wang L. Extranodal Rosai-Dorfman disease with multilevel lumbar spinal lesions. J Neurosurg Spine 2008;9:55-7.
[PUBMED] [FULLTEXT] |
| 3. | Hargett C, Bassett T. Atypical presentation of sinus histiocytosis with massive lymphadenopathy as an epidural spinal cord tumor: A case presentation and literature review. J Spinal Disord Tech 2005;18:193-6.
[PUBMED] [FULLTEXT] |
| 4. | Raslan O, Ketonen LM, Fuller GN, Schellingerhout D. Intracranial Rosai-Dorfman disease with relapsing spinal lesions. J Clin Oncol 2008;26:3087-9.
[PUBMED] [FULLTEXT] |
| 5. | Andriko JA, Morrison A, Colegial CH, Davis BJ, Jones RV. Rosai-Dorfman disease isolated to the central nervous system: A report of 11 cases. Mod Pathol 2001;14:172-8.
[PUBMED] [FULLTEXT] |
| 6. | Mehraein Y, Wagner M, Remberger K, Fuzesi L, Middel P, Kaptur S, et al. Parvovirus B19 detected in Rosai-Dorfman disease in nodal and extranodal manifestations. J Clin Pathol 2006;59:1320-6.
|
| 7. | Middel P, Hemmerlein B, Fayyazi A, Kaboth U, Radzun HJ. Sinus histiocytosis with massive lymphadenopathy: Evidence for its relationship to macrophages and for a cytokine-related disorder. Histopathology 1999;35:525-33.
[PUBMED] [FULLTEXT] |
| 8. | Mirra SS, Tindall SC, Check IJ, Brynes RK, Moore WW. Inflammatory meningeal masses of unexplained origin. An ultrastructural and immunological study. J Neuropathol Exp Neurol 1983;42:453-68.
[PUBMED] |
| 9. | Konca C, Ozkurt ZN, Deger M, Aki Z, Yagci M. Extranodal multifocal Rosai-Dorfman disease: Response to 2-chlorodeoxyadenosine treatment. Int J Hematol 2009;89:58-62.
|
| 10. | Dran G, Rasendrarijao D, Vandenbos F, Paquis P. Rosai-Dorfman disease causing spinal cord compression: Case report. Neurosurgery 2008;62:E977-8.
[PUBMED] [FULLTEXT] |
[Figure 1], [Figure 2]
[Table 1]
| This article has been cited by | | 1 |
MR imaging of cerebral involvement of Rosai–Dorfman disease: a single-centre experience with review of the literature |
|
| Marco Varrassi, Antonella Corridore, Emanuele Tommasino, Giorgia Saltelli, Federico Bruno, Alessandra Di Sibio, Alessandra Splendiani, Ernesto Di Cesare, Carlo Masciocchi | | La radiologia medica. 2021; 126(1): 89 | | [Pubmed] | [DOI] | | | 2 |
Diagnosis and treatment of Rosai-Dorfman disease of the spine: a systematic literature review |
|
| Pan-pan Hu, Feng Wei, Xiao-guang Liu, Zhong-jun Liu | | Systematic Reviews. 2021; 10(1) | | [Pubmed] | [DOI] | | | 3 |
Rosai-Dorfman disease mimicking images of meningiomas: Two case reports and literature review |
|
| Rafael Trindade Tatit, Paulo Eduardo Albuquerque Zito Raffa, Giovana Cassia de Almeida Motta, André Alexandre Bocchi, Júlia Loripe Guimaraes, Paulo Roberto Franceschini, Paulo Henrique Pires de Aguiar | | Surgical Neurology International. 2021; 12: 292 | | [Pubmed] | [DOI] | | | 4 |
Craniocervical Rosai-Dorfman Disease Involving the Vertebral Artery: Case Report and Literature Review |
|
| Wassim Baassiri, Charbel K. Moussalem, Elie Massaad, Youssef H. Zeidan, Houssein Darwish | | World Neurosurgery. 2020; 133: 69 | | [Pubmed] | [DOI] | | | 5 |
Long-Term Outcome of Spinal Extranodal Rosai-Dorfman Disease: A Report of Two Cases and Systematic Review |
|
| Saleh S. Baeesa, Hani Mahboob, Yazid Maghrabi, Mohammad Binmahfoodh, Jaudah Almaghrabi | | World Neurosurgery. 2020; 144: 1 | | [Pubmed] | [DOI] | | | 6 |
Cranio-spinal Rosai Dorfman disease: case series and literature review |
|
| Shashank S. Joshi,Shilpa Joshi,Girish Muzumdar,Keki E. Turel,Rajan M. Shah,Indoo Ammbulkar,Muhammad Masood Hussain,Kishor A. Choudhari | | British Journal of Neurosurgery. 2017; : 1 | | [Pubmed] | [DOI] | | | 7 |
Spinal Rosai–Dorfman disease: case report and literature review |
|
| Haocheng Xu,Fan Zhang,Feizhou Lu,Jianyuan Jiang | | European Spine Journal. 2017; 26(S1): 117 | | [Pubmed] | [DOI] | | | 8 |
Isolated intradural Rosai-Dorfman disease of the spine: report of two cases |
|
| Yu Xin,Hui Shen,Desheng Kong,Wenqing Jia,Hai Liu,Jun Yang | | Chinese Neurosurgical Journal. 2016; 2(1) | | [Pubmed] | [DOI] | | | 9 |
Rosai-Dorfman Disease of the Central Nervous System |
|
| Jose D. Sandoval-Sus,Ana C. Sandoval-Leon,Jennifer R. Chapman,Jose Velazquez-Vega,Maria J. Borja,Shai Rosenberg,Alexander Lossos,Izidore S. Lossos | | Medicine. 2014; 93(3): 165 | | [Pubmed] | [DOI] | | | 10 |
Rare Presentation of Rosai-Dorfman Disease Mimicking a Cervical Intramedullary Spinal Cord Tumor |
|
| Mohamed El Molla,Tamadur Mahasneh,Sue-Ellen Holmes,Darweesh Al-Khawaja | | World Neurosurgery. 2013; | | [Pubmed] | [DOI] | | | 11 |
Sphenoid wing lymphoplasmacyte-rich meningioma with occasional emperipolesis closely simulating an intracranial Rosai-Dorfman disease: A diagnostic dilemma |
|
| Majumdar, K. and Saran, R.K. and Chaurasia, P.K. and Tyagi, I. and Singh, D. | | Clinical Neuropathology. 2013; 32(2): 122-127 | | [Pubmed] | | | 12 |
Extranodal Rosai-Dorfman Disease presenting as spinal extradural lesion: A case report with a review of the literature |
|
| Roy, C. and Saha, A. and Roy, S. and Ghosh, A. | | Journal of Cancer Research and Therapeutics. 2012; 8(4): 647-649 | | [Pubmed] | | | 13 |
Rosai-Dorfman Disease and neurological manifestations |
|
| Sundaram, C. | | Neurology India. 2011; 59(3): 329-330 | | [Pubmed] | |
|
|
|
|
|
|
|
|
