The Spine Journal 14 (2014) 3058–3059

Rosai-Dorfman disease: a rare lesion with dura tail sign mimicking spinal meningioma A 43-year-old man presented with an 8-month history of intermittent pain of upper back and progressively worsening numbness in his bilateral hands. Review of systems was negative for fever, chills, night sweats, or weight loss. No lymphadenopathy was found on palpation. Laboratory data were within normal limits. Preoperative magnetic resonance imaging (MRI) of the cervical spine demonstrated a convex shaped well-defined intradural lesion at the C5– C6 level. A contrast-enhanced MRI of the lesion showed homogeneously marked enhancement, compressing the cord ventrally with a dura tail sign, which was considered to be intraspinal meningioma (Fig. 1). The patient underwent a C5–C6 laminotomy, and total resection was achieved. A histopathologic examination revealed that the mass was consistent with a diagnosis of Rosai-Dorfman disease (RDD) (Fig. 2). During 18 months of follow-up, the man remained symptom free, and no evidence of recurrence was found on MRI examination. Rosai-Dorfman disease is a rare definitive histiocytic disorder, characterized by massive painless cervical lymphadenopathy variably associated with fever, leukocytosis, elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and weight loss [1]. Various extranodal localizations

have been described, and spinal involvement in RDD causing spinal cord compression is extremely rare [2]. The lesion is commonly attached to the dura mater, which can show dura tail sign and radiologically resemble meningiomas. Thus, RDD should be included in the differential diagnosis of intraspinal dural-based lesions, even without lymphadenopathy and associated systematic changes. References [1] Parmar V, Seward C, Huho A, Qian J, Gandhi R, Pilitsis JG. RosaiDorfman disease presenting as cervical radiculopathy. Clin Neurol Neurosurg 2013;115:808–10. [2] Dran G, Rasendrarijao D, Vandenbos F, Paquis P. Rosai-Dorfman disease causing spinal cord compression: case report. Neurosurgery 2008;62:E977–8.

Liang Wu, MD Yulun Xu, MD, PhD Department of Neurosurgery China National Clinical Research Center for Neurological Diseases Beijing Tiantan Hospital Capital Medical University No. 6 Tiantan Xili, Dongcheng District Beijing 100050, China FDA device/drug status: Not applicable. Author disclosures: LW: Nothing to disclose. YX: Nothing to disclose.

Fig. 1. Gadolinium-enhanced sagittal (Left) and axial (Right) T1-weighted magnetic resonance imaging demonstrate an intradural mass with homogeneously marked enhancement and a dura tail sign (arrowhead), compressing the cord ventrally at the C5–C6 level. http://dx.doi.org/10.1016/j.spinee.2014.07.016 1529-9430/Ó 2014 Elsevier Inc. All rights reserved.

L. Wu and Y. Xu / The Spine Journal 14 (2014) 3058–3059

Fig. 2. Photomicrograph reveals mixed inflammatory infiltrates of lymphocytes, plasma cells, and histiocytes in fibrous tissue with focal emperipolesis (arrow) (hematoxylin and eosin, 200).

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Rosai-Dorfman disease: a rare lesion with dura tail sign mimicking spinal meningioma.

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