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Presented by Dr. Jonathan Epstein and prepared by Dr. Armen Khararjian.
This case talks about:
A 65 year old man underwent a nephrectomy for a large renal mass.
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1. Question
Week 633: Case 3
A 65 year old man underwent a nephrectomy for a large renal mass.
Correct
Answer: A. Rosai Dorfman disease
Histology: The renal mass is composed of a mixture of histiocytes, lymphocytes, plasma cells, and some neutrophils. Many of the histiocytes contain inflammatory cells within the cytoplasm. Michaelis-Gutmann bodies are not seen.
Discussion: This is a classic case of Rosai Dorman disease and one of the best examples of numerous histiocytes with the characteristic finding of emperipolesis, defined as the presence of intact cells within the cytoplasm of another cell. In some cases, it may be more difficult to identify these cells and immunohistochemistry for S100 protein identifies and isolates the histiocytes containing the inflammatory cells. Rosai Dorfman disease in the male GU tract is rare and only seen in the kidney or testis. In some cases, the disease may be systemic. In the past, renal Rosai Dorfman disease was reported as often being bilateral with multi-organ involvement. In our more recent series, the lesion was typically localized to only one kidney with a more favorable prognosis.
Histopathology 65: 908-16, 2014.
Incorrect
Answer: A. Rosai Dorfman disease
Histology: The renal mass is composed of a mixture of histiocytes, lymphocytes, plasma cells, and some neutrophils. Many of the histiocytes contain inflammatory cells within the cytoplasm. Michaelis-Gutmann bodies are not seen.
Discussion: This is a classic case of Rosai Dorman disease and one of the best examples of numerous histiocytes with the characteristic finding of emperipolesis, defined as the presence of intact cells within the cytoplasm of another cell. In some cases, it may be more difficult to identify these cells and immunohistochemistry for S100 protein identifies and isolates the histiocytes containing the inflammatory cells. Rosai Dorfman disease in the male GU tract is rare and only seen in the kidney or testis. In some cases, the disease may be systemic. In the past, renal Rosai Dorfman disease was reported as often being bilateral with multi-organ involvement. In our more recent series, the lesion was typically localized to only one kidney with a more favorable prognosis.
Histopathology 65: 908-16, 2014.
