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Rosai-Dorfman Disease

NORD is very grateful to Juan Rosai, MD, Pathology Cancer Center Clinics, Italian Diagnostic Center (CDI), Milan, Italy for assistance in the preparation of this report.

Synonyms of Rosai-Dorfman Disease

  • RDD
  • SHML
  • sinus histiocytosis with massive lymphadenopathy

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Rosai-Dorfman disease is a rare disorder characterized by overproduction (proliferation) and accumulation of a specific type of white blood cell (histiocyte) in the lymph nodes of the body (lymphadenopathy), most often those of the neck (cervical lymphadenopathy). In some cases, abnormal accumulation of histiocytes may occur in other areas of the body besides the lymph nodes (extranodal). These areas include the skin, central nervous system, kidney, and digestive tract. The symptoms and physical findings associated with Rosai-Dorfman disease vary depending upon the specific areas of the body that are affected. The disorder predominantly affects children, adolescents or young adults. The exact cause of Rosai-Dorfman disease is unknown.

Symptoms

The symptoms and physical findings associated with Rosai-Dorfman disease vary greatly from one person to another depending upon the extent of the disorder and the specific organ systems affected. Some cases may only affect the lymph nodes and may not cause any serious complications. Less often, some cases may affect various organ systems of the body and may potentially cause serious complications. Any organ system of the body may become affected.

In most cases, affected individuals exhibit painless swelling or enlargement of affected lymph nodes (lymphadenopathy), most often those of the neck (cervical lymphadenopathy). Many individuals with Rosai-Dorfman disease do not develop any additional symptoms of the disorder (asymptomatic).

In some cases, affected individual may experience nonspecific symptoms that are common to many different conditions including fever, paleness of the skin (pallor), unintended weight loss, a general feeling of ill health (malaise) and a chronically runny nose (rhinitis). In extremely rare cases, affected individuals may experience abnormal enlargement of the liver and/or spleen (hepatosplenomegaly).

In approximately 43 percent of cases, other areas of the body besides the lymph nodes may also be affected (extranodal). Some individuals may have extranodal disease without the presence of lymphadenopathy. The skin is the most common extranodal site. Skin lesions associated with Rosai-Dorfman disease are usually yellow or purple. A reddish rash-like inflammation of the skin (erythema), small solid elevations on the skin (papules), or knots visible under the skin (nodules) may be present. Skin lesions may occur anywhere on the body, but most often affect the head and neck. In some cases, skin abnormalities precede the development of lymphadenopathy.

The salivary glands, nasal cavity, upper respiratory tract, various bones, and the eyes and eye sockets (orbits) may also be affected. In rare cases, the central nervous system, digestive system, or the kidneys may be affected. Involvement of these areas may result in additional (secondary) symptoms. For example, loss of vision may occur secondary to the involvement of the eyes, and seizures may occur secondary to involvement of the central nervous system. In some cases of Rosai-Dorfman disease, the accumulation of histiocytes into masses may cause compression of vital organs potentially resulting in serious complications.

In some cases, the lymph nodes may not be affected. Instead a specific area of the body such as the skin, a solitary bone, or the central nervous system may be affected. These cases may be known as isolated Rosai-Dorfman disease. A distinct type of isolated Rosai-Dorfman disease has been identified called cutaneous Rosai-Dorfman disease, in which only the skin is affected. Initial reports indicate that cutaneous Rosai-Dorfman disease is more common in female adults.

Causes

The exact cause of Rosai-Dorfman disease is unknown (idiopathic), but it does not seem to be of neoplastic nature. Researchers have suggested that the disorder may be caused by an infectious agent, immunodeficiency, or autoimmunity.

Symptoms of Rosai-Dorfman disease develop due to the overproduction and accumulation of histiocytes in the channels (sinuses) that allow for the passage of lymph (sinus histiocytosis).

Affected Populations

Some studies suggest that Rosai-Dorfman disease affects males more often than females. The disorder can affected individuals of any age, but most often affects young adults under the age of 20. Cutaneous Rosai-Dorfman disease occurs more often in females in their 20s or 30s. More than 650 cases have been reported in the medical literature since the disorder's first description in the medical literature in 1969.

Related Disorders

Symptoms of the following disorders can be similar to those of Rosai-Dorfman disease. Comparisons may be useful for a differential diagnosis:

Langerhans cell histiocytosis (LCH) is a rare spectrum of disorders characterized by over-production (proliferation) and accumulation of a specific type of white blood cell (histiocyte) in the various tissues and organs of the body (lesions). Associated symptoms and findings may vary from case to case, depending upon the specific tissues and organs affected and the extent of involvement. Most affected individuals have single or multiple bone lesions characterized by degenerative changes and loss of the calcium of bone (osteolysis). Although the skull is most commonly affected, there may also be involvement of other bones, such as those of the spine (vertebrae) and the long bones of the arms and legs. Affected individuals may have no apparent symptoms (asymptomatic), experience associated pain and swelling, and/or develop certain complications, such as fractures or secondary compression of the spinal cord. In some cases, other tissues and organs may also be affected, including the skin, lungs, or other areas. In some individuals, LCH may be associated with involvement of the pituitary gland leading to diabetes insipidus. The exact cause of Langerhans cell histiocytosis is unknown. (For more information on this disorder, choose "Langerhans cell histiocytosis" as your search term in the Rare Disease Database.)

Meningiomas are benign, slow-growing tumors, classified as brain tumors, but actually growing in the three protective membranes that surround the brain (meninges). Sometimes they cause thickening or thinning of adjoining skull bones. Meningiomas do not spread to other areas of the body. Symptoms of meningiomas vary according to the size and location of the tumor and may include progressive weakness on one side of the body or in a localized area such as a leg, seizures that may be limited to one area (focal), or generalized, and mental changes. Some cases of Rosai-Dorfman disease that affect the central nervous system may resemble meningiomas. (For more information on this disorder, choose "Meningioma" as your search term in the Rare Disease Database.)

Lymphoma is a general term for a group of cancers affecting the lymphatic system. Functioning as part of the immune system, the lymphatic system helps to protect the body against infection and disease. It consists of a network of tubular channels (lymph vessels) that drain a thin watery fluid known as lymph from different areas of the body into the bloodstream. Lymph accumulates in the tiny spaces between tissue cells and contains proteins, fats, and certain white blood cells known as lymphocytes. Abnormal enlargement of the lymph nodes, liver, and spleen may occur. A malignant lymphoma may spread to affect other areas of the body such as the central nervous system and gastrointestinal tract. Affected individuals may experience fevers, fatigue, and weight loss. Lymphoma may be slow-growing or rapidly-growing. The main two types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma. (For more information on lymphoma, choose "lymphoma" as your search term in the Rare Disease Database.)

Lyme disease is an infectious disease caused by the spirochete bacterium Borrelia burgdorferi. The bacterium is carried and transmitted by deer ticks (Ixodes scapularis). In most cases, Lyme disease is first characterized by the appearance of a red skin lesion (erythema chronicum migrans), which begins as a small elevated round spot (papule) that expands to at least five centimeters in diameter. Symptoms may then progress to include low-grade fever, chills, muscle aches (myalgia), headaches, a general feeling of weakness and fatigue (malaise), and/or pain and stiffness of the large joints (infectious arthritis), especially in the knees. Such symptoms may tend to occur in recurrent cycles. In severe cases, heart muscle (myocardial) and/or neurological abnormalities may occur. (For more information, choose "Lyme disease" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
The diagnosis of Rosai-Dorfman disease may be confirmed by a thorough clinical evaluation, a detailed patient history and a variety of specialized tests, such as surgical removal and microscopic examination of affected tissue (biopsy).

Treatment
In many cases, the symptoms of Rosai-Dorfman disease may disappear without treatment (spontaneous remission) within in months or a few years. Clinical observation without treatment is preferred for individuals with Rosai-Dorfman disease whenever possible. In many cases, no therapy will be necessary.

In some cases, various treatment options may become necessary. In these cases, the treatment of Rosai-Dorfman disease is directed toward the specific symptoms that are apparent in each individual. Several different treatment options have been used to treat individuals with Rosai-Dorfman disease including surgical removal of histiocytic lesions. In more serious cases, additional treatment options have included therapy with certain drugs including steroids (e.g., prednisone), alfa-interferon, and a regimen of certain anticancer drugs (chemotherapy). In some cases, affected individuals have shown improvement of symptoms with these treatments. In other cases, drug therapies have been ineffective.

Other treatment is symptomatic and supportive.

Investigational Therapies

According to the medical literature, an individual with intracranial Rosai-Dorfman disease was treated with microsurgical resection and stereotatic radiosurgery. Initial results suggested that the associated lesion regressed significantly. More research is necessary to determine the long-term safety and effectiveness of these surgical techniques for the treatment of individuals with intracranial Rosai-Dorfman disease.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. Government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

For information about clinical trials conducted in Europe, contact:
https://www.clinicaltrialsregister.eu/

Organizations related to Rosai-Dorfman Disease

Please note that some of these organizations may provide information concerning certain conditions potentially associated with this disorder.

References

TEXTBOOKS
Zeiger B, Kohler S, Burgdorf W. Sinus Histiocytosis with Massive Lymphadenopathy (Rosai-Dorfman Disease). In: World Health Organization Classification of Tumors. Pathology and Genetics of Skin Tumors, LeBoit PE, Burg G, Weedon D, Sarasain A, Eds. 2006 IARC Press, Lyon. pp. 221.

JOURNAL ARTICLES
LaBarge III DV, Salzman K, Harnsberger HR, et al. Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): imaging manifestations in the head and neck. AJR. 2008;191:W299-W306.

Vemuganti GK, Naik MN, Honavar SG. Rosai Dorfman disease of the orbit. J Hematol Oncol. 2008;1:1-17.

Coras B, Michel S, Landthaler M, Hohenleutner U. Rosai-Dorfman disease with cutaneous manifestations (sinus histiocytosis with massive lymphadenopathy). Eur J Derm. 2006;16:293-296.

Frater JL, Maddox JS, Obadiah JM, Hurley MY. Cutaneous Rosai-Dorfman disease: comprehensive review of cases reported in the medical literature since 1990 and presentation of an illustrative case. J Cutan Med Surg. 2006;10:281-290.

Chopra D, Svensson WE, Forouhi P, Poole S. A rare case of extranodal Rosai-Dorfman disease. Br J Radiol. 2006;79:e117-e119.

Rodriguez-Galindo C, et al. Extranodal Rosai-Dorfman disease in children. J Pediatr Hematol Oncol. 2004;26:19-24.

Pitamber HV, Grayson W. Five cases of cutaneous Rosai-Dorfman disease. Clin Exp Dermatol. 2003;28:17-21.

Hadjipanayis CG, et al. Intrancranial Rosai-Dorfman disease treated with microsurgical resection and stereotactic radiosurgery. Case report. J Neurosurg. 2003;98:165-8.

Pulsoni A, et al. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a case and literature review. Am J Hematol. 2002;69:67-71.

Kitai R, et al. Meningeal Rosai-Dorfman disease: report of three cases and literature review. Brain Tumor Pathol. 2001;18:49-54.

Wu M, et al. A report of intracranial Rosai-Dorfman disease with literature review. Ann Diagn Pathol. 2001;5:96-102.

Petzold A, et al. Relapsing intracranial Rosai-Dorfman disease. J Neurol Neurosurg Psychiatry. 2001;71:538-41.

Wang E, et al. Rosai-Dorfman disease presenting with isolated bilateral masses: report of two cases. AJNR Am J Neuroradiol. 2001;22:1386-88.

Carbone A, et al. Review of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) of head and neck. Ann Otol Rhinol Laryngol. 1999;108:1095-104.

Huang HY, et al. Isolated intracranial Rosai-Dorfman disease: case report and literature review. Pathol Int. 1998;48:396-402.

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.

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2014/03/05 00:00:00 GMT+0

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