Intrathoracic Rosai-Dorfman Disease with Spontaneous Remission: A Clinical Report and a Review of the Literature

Abstract

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare non-neoplastic disease that is characterized by a proliferation of histiocytes mostly in lymph nodes. However, the etiological mechanism of RDD still remains unclear. Intrathoracic manifestations of RDD are only observed in 2% of patients with RDD. Spontaneous remission was reported in about 20% of patients with RDD; however, there are no reports of an intrathoracic manifestation of RDD that showed a spontaneous remission within a short period of time. A 64-year-old Japanese female with dry cough and left chest pain was introduced to our hospital, and computed tomography revealed a pulmonary nodular lesion and enlarged mediastinal lymph nodes. The bronchial specimen obtained from the abnormal mucosal lesion showed massive infiltration of histiocytes underneath the bronchial epithelium and emperipolesis, a typical pathological finding in RDD, which is characterized by the presence of histiocyte-like cells engulfing intact lymphocytes. These histiocytes were positive for S-100 (one of the known positive markers of RDD) and for CD68 (a marker for various cells of the macrophage lineage). All these findings are consistent with the diagnosis of RDD. These radiological and endoscopic findings spontaneously resolved within four months without any treatment. In conclusion, clinicians should be aware of this disease as one of differential diagnoses of pulmonary nodules in combination with mediastinal lymph node enlargements, especially in order to differentiate it from primary lung cancer.

Tracheobronchial Involvement of Rosai–Dorfman Disease

“…To our knowledge, only 12 cases of tracheobronchial involvement of RDD, including our case, have been reported in the English language literature 1,13,15–23 and some of these cases consisted of laryngeal involvement with tracheal extension 16 (Table 1). These cases were observed in 6 men and 5 women (missing data, n = 1) with a mean age of 40.6 years at the time of diagnosis of airway involvement.…”

“…1,11,12 Intrathoracic manifestations are rarely observed (2%), including pulmonary nodules or masses, interstitial lung disease, central airway involvement, and pleural effusion. 1,2,13–15 Patients with a chronic aggressive form affecting the kidneys, liver, or lower respiratory tract may have a poorer prognosis. 1 …”

“…24 Increased uptake on positron emission tomography has been reported. 13 Therefore, in absence of medical history, airway involvement of RDD can mimic tracheal carcinoma, other rare tracheal tumors (including plasmocytoma, melanoma, papilloma), or more rarely granulomatous lesions (as reported in Crohn disease, polyangeitis granulomatosis, or tracheal amyloidosis). Diagnosis can only be established on histological examination.…”

Çocukluk çağında nadir görülen bir lenfadenopati nedeni: masif lenfadenopatili sinüs histiositozu (Rosai-Dorfman hastalığı)

“…Yüksek sedimentasyon hızı, ateş, lökositoz, hipergammaglobulinemi ile birlikteliği, infeksiyöz teoriyi desteklemektedir. Bazı vakalarda seroloji pozitif saptandığı için EBV ve HHV-6 virüsleri ile ilişkili olabileceği düşünülmektedir (3)(4)(5)(6)(7)(8)(9) .…”

“…Ekstranodal tutulum sıklıkla nazal kavite, paranazal sinüslerde bildirilmiştir. Yumuşak doku, santral sinir sistemi, orbita, deri, oral kavite, kemik, böbrekler, üst solunum yolu, gastrointestinal sistem, testisler ve tükrük bezleri diğer ekstranodal tutulum görülen böl-gelerdir (4,(6)(7)(8)(9)(10) . Maoxin ve ark.…”