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Presented by Jonathan Epstein, M.D. and prepared by Ali Ansari-Lari, M.D.,Ph.D.
Case 4: 68-year-old male with dural mass.
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Question 1 of 1
1. Question
Week 118: Case 4
68-year-old male with dural mass.images/ESPT4a.JPG
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images/ESPT4d.JPGCorrect
Answer: Rosai-Dorfman disease
Histology: Adjacent to the dura is an inflammatory mass consisting predominantly of lymphocytes and histiocytes. The histiocytes have an abundant foamy cytoplasm. Also noted are numerous plasma cells. Within some of the histiocytes, one can appreciate clusters of engulfed lymphocytes and plasma cells.
Discussion: This lesion has the classic morphology of Rosai-Dorfman disease. The finding of histiocytes engulfing other cells is termed emperipolesis, which is diagnostic of the disease. The cells lack Michaelis-Gutmann bodies for malakoplakia. These histiocytes also do not have the morphology of Langerhan cell histiocytes. There is no meningioma present in the current case to entertain a meningioma with inflammation, despite the clinical impression that this was a meningioma. Rosai-Dorfman disease has rarely been reported within the meninges. Most of these patients have been cured by simple excision.
Incorrect
Answer: Rosai-Dorfman disease
Histology: Adjacent to the dura is an inflammatory mass consisting predominantly of lymphocytes and histiocytes. The histiocytes have an abundant foamy cytoplasm. Also noted are numerous plasma cells. Within some of the histiocytes, one can appreciate clusters of engulfed lymphocytes and plasma cells.
Discussion: This lesion has the classic morphology of Rosai-Dorfman disease. The finding of histiocytes engulfing other cells is termed emperipolesis, which is diagnostic of the disease. The cells lack Michaelis-Gutmann bodies for malakoplakia. These histiocytes also do not have the morphology of Langerhan cell histiocytes. There is no meningioma present in the current case to entertain a meningioma with inflammation, despite the clinical impression that this was a meningioma. Rosai-Dorfman disease has rarely been reported within the meninges. Most of these patients have been cured by simple excision.
