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Final Program


Final Program

1610 - Beyond the Obvious: Discovering Rosai-Dorfman Disease in a Case of Suspected Meningioma

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • JW

    Jason Wang, BA

    Medical student
    Rutgers Robert Woods Johnson Medical School
    New York, New York, United States

    • Co-Author(s)

  • KC

    Kevin Chun, BA

    Medical Student
    NSU-KPCOM
    Atlanta, Georgia, United States

  • DM

    Daniel S. Marte, MD

    PGY-2 Resident Physician
    Icahn School of Medicine at Mount Sinai
    New York, New York, United States

  • JM

    Julia Marx, BS

    Medical Student
    Rutgers Robert Wood Johnson Medical School
    New Brunswick, New Jersey, United States

  • CM

    Carolina Mallar, BS

    Medical Student
    University of Miami
    Miami, Florida, United States

  • Miguel X. Escalon, MD

    Program Director
    Icahn School of Medicine at Mount Sinai
    NY, New York, United States

Case Diagnosis: Rosai-Dorfman Disease

Case Description: A 78-year-old male, with a history of prior CVA and an intracranial mass presented to the hospital after two syncopal episodes without head trauma. MRI revealed a 7.8 cm frontoparietal dural-based, extra-axial mass with involvement of the calvarium, suggestive of a meningioma. The patient underwent a left trap door craniotomy for tumor resection. Postoperatively, the patient was transferred to rehabilitation, presenting with flat affect, weakness, and speech difficulties affecting mobility and ADLs. The diagnosis of Rosai-Dorfman disease (RDD) was later confirmed with histopathologic findings showing emperipolesis with vimentin, in which foamy lymphocytes exist undisturbed within the cytoplasm of histiocytes. Ancillary studies eliminated other similar pathologies such as meningioma and Langerhans cell histiocytosis.

Discussions: This case demonstrates the rare presentation of RDD as an isolated intracranial mass mimicking a meningioma. RDD is a benign condition with an unknown pathogenesis characterized by non-Langerhans cell histiocyte proliferation. Most cases occur in younger populations and classically present with cervical lymphadenopathy. In extremely rare cases, RDD can present extranodally within the brain parenchyma leading to focal neurological deficits. To the best of our knowledge, 49 previous reports of isolated intracranial RDD have been published in major scientific journals.

Conclusions:

Brain injury patients in rehabilitation often present with brain masses, but not all are due to conventional pathologies. The diagnosis of RDD during rehabilitation was impactful, as it allowed us to tailor the clinical approach with the confidence of disease non-recurrence and plan for a full recovery. The patient’s engagement in rehabilitation facilitated neurological improvement despite poor medical follow-up and also provided neuro-oncology the necessary time for detailed histopathological analysis. This case underscores the importance of considering rare diagnoses and demonstrates how rehabilitation can be pivotal in both the recovery process and achieving diagnostic clarity.