SHM Converge Scientific Abstract ePoster Gallery-A Case of Rosai-Dorfman Disease Manifesting as Intracranial Dural-Based Tumors

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A 64-year-old man with coronary artery disease, hypertension, and recent 20-pound weight loss presented after a 10-minute seizure-like episode with transient altered mental status. Initial labs did not reveal an infectious source. Brain CT and MRI showed two dural-based extra-axial masses with vasogenic edema and mass effect, raising concern for meningioma or other dural lesions. CT scans of the chest, abdomen, and pelvis did not identify a primary malignancy. He was started on levetiracetam and dexamethasone, and EEG was negative for seizures.<br /><br />He later underwent elective left craniotomy with resection of the masses. Postoperative imaging showed decreased edema, reduced midline shift, and smaller residual extra-axial lesions. Pathology demonstrated chronic lymphohistiocytic and plasmacytic inflammation involving the meninges and dura with extension into the brain parenchyma, along with fibroconnective tissue proliferation. Immunohistochemistry was positive for S100, CD3, CD20, CD31, CD45, and CD68, and negative for CD1a and desmin, supporting Rosai-Dorfman disease (RDD). Histology also showed rare acid-fast bacilli, leading to concern for concomitant tuberculosis despite negative cultures and CSF studies.<br /><br />Because of the possible AFB findings, he was started on standard anti-tuberculous therapy with isoniazid, rifampin, ethambutol, pyrazinamide, and vitamin B6. Follow-up MRI later showed resolution of the lesions.<br /><br />This case highlights that extranodal RDD is a rare non-Langerhans cell histiocytic disorder that can present as isolated intracranial dural-based tumors and clinically mimic meningioma or tuberculoma. Surgical resection is the most effective treatment, and RDD should be considered in the differential diagnosis of dural masses.

Asset Subtitle

Amy Pulikeyil

Meta Tag

Author List Amy Pulikeyil, Cristine K. Arcilla, Irina Mikolaenko, Natalia Plotskaya

Category Clinical Vignettes

Concept Rosai-Dorfman Disease

Concept Surgical Resection

Concept Intracranial Mass

Concept Dural-Based Lesion

Concept Histopathology

Distinguished Non-Finalist

Presenter Organization Capital Health Regional Medical Center, Trenton, NJ

Presenting Author Amy Pulikeyil

Track Adult

Keywords

Rosai-Dorfman disease

dural-based masses

intracranial lesion

meningioma mimic

seizure-like episode

vasogenic edema

craniotomy resection

histiocytic disorder

tuberculosis

extra-axial tumor

Rosai-Dorfman Disease

Surgical Resection

Intracranial Mass

Dural-Based Lesion

Histopathology