diagnostic slide session american association of neuropathologists caitlin latimer, m.d., ph.d
DESCRIPTION
Diagnostic Slide Session American Association of Neuropathologists Caitlin Latimer, M.D., Ph.D. University of Kentucky. No financial relationships to disclose. Disclosures. 15-year-old African-American male Prior “ eosinophilic cellulitis ” Several months of headaches seizure. - PowerPoint PPT PresentationTRANSCRIPT
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Diagnostic Slide SessionAmerican Association of Neuropathologists
Caitlin Latimer, M.D., Ph.D.University of Kentucky
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Disclosures No financial relationships to disclose
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Case history 15-year-old African-American male
Prior “eosinophilic cellulitis”
Several months of headaches seizure
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Imaging
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Questions Additional special stains or studies?
Diagnosis?
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CD68
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CD1a
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S-100
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S-100
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Final Diagnosis
Rosai-Dorfman Disease of the dura
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Rosai-Dorfman Disease
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Rosai-Dorfman Disease
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Rosai-Dorfman Disease 40% present with extranodal disease
CNS involvement is rareolder patientsextra-axial mass HA, seizures, focal deficits
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Radiologic DDx:
Hemangiopericytoma Gliosarcoma Leiomyosarcoma Hodgkin’s disease Plasmacytomas Neurosarcoidosis Plasma Cell Granuloma
Meningioma
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Histopathologic DDx: Inflammatory myofibroblastic tumor
Infection/Abscess
Plasmacytoma
Langerhans Cell Histiocytosis
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Rosai-Dorfman Disease: histology
Mixed inflammatory infiltrate
Large pale cells CD68+, CD1a- , S-100+
Emperipolesis
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Treatment & Prognosis
Surgery, corticosteroids, radio/chemotherapy
Isolated CNS disease =
Widespread dissemination =
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Follow-Up on Our Patient
Initial increase in residual tumor, but stable
Gradually tapered off Sz meds Status epilepticus 1 yr ago
Suggested course of vinblastine and prednisone
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References1. Johnson, M.D., Powell, S.Z., Boyer, P.J., Weil, R.J. & Moots, P.L. Dural lesions
mimicking meningiomas. Human pathology 33, 1211-1226 (2002).2. Theeler, B.J., Keylock, J.B. & Yoest, S.M. Teaching NeuroImage: isolated
intracranial Rosai-Dorfman disease mimicking a meningioma. Neurology 70, e42 (2008).
3. Konishi, E., Ibayashi, N., Yamamoto, S. & Scheithauer, B.W. Isolated intracranial Rosai-Dorfman disease (sinus histiocytosis with massive lymphadenopathy). AJNR. American journal of neuroradiology 24, 515-518 (2003).
4. Andriko, J.A., Morrison, A., Colegial, C.H., Davis, B.J. & Jones, R.V. Rosai-Dorfman disease isolated to the central nervous system: a report of 11 cases. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 14, 172-178 (2001).
5. Zhu, H., et al. Imaging characteristics of Rosai-Dorfman disease in the central nervous system. European journal of radiology 81, 1265-1272 (2012).
6. Pulsoni, A., et al. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a case and literature review. American journal of hematology 69, 67-71 (2002).
7. Le Guenno, G., et al. Successful treatment with azathioprine of relapsing Rosai-Dorfman disease of the central nervous system. Journal of neurosurgery 117, 486-489 (2012).