case_images: PMC11289797_01
case_images: Chest X-ray showing perihilar lymphadenopathy.
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case_images: PMC11289797_01_10.1177_11795476241265279-fig1.jpg
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case_images: Chest X-ray showing bilateral hilar lymphadenopathy (Figure 1), and CT scans of the neck, chest, and abdomen. CT scan of the neck showed multiple enlarged lymph nodes in the bilateral submandibular, jugular, and posterior triangle, the lymph nodes showed homogenous contrast enhancement, the largest measuring 2 cm x 2.6 cm, CT scan of the chest showed multiple enlarged nodes in the paratracheal, subcarinal, perivascular and hilar regions and CT scan of the abdomen showed multiple mildly enlarged lymph nodes in the peri gastric, periportal and gastro-splenic region, there was no radiological Extra-nodal manifestations of disease(Figure 2).
case_images: CT images showing generalized lymphadenopathy in the mediastinal, bilateral cervical, and right inguinal regions, (A) Submandibular lymph nodes largest is 1.4 cm, (B) Right anterior and bilateral upper posterior jugular lymph nodes largest is 1.6 cm. (C)Pre-vascular lymphadenopathy, matted nodes measuring d = 2.7 cm x 2.2 cm, and (D) Right inguinal nodes, measures d = 1.7 cm.
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case_images: PMC11289797_01_10.1177_11795476241265279-fig2.jpg
case_images: fig2-11795476241265279
case_images: Chest X-ray showing bilateral hilar lymphadenopathy (Figure 1), and CT scans of the neck, chest, and abdomen. CT scan of the neck showed multiple enlarged lymph nodes in the bilateral submandibular, jugular, and posterior triangle, the lymph nodes showed homogenous contrast enhancement, the largest measuring 2 cm x 2.6 cm, CT scan of the chest showed multiple enlarged nodes in the paratracheal, subcarinal, perivascular and hilar regions and CT scan of the abdomen showed multiple mildly enlarged lymph nodes in the peri gastric, periportal and gastro-splenic region, there was no radiological Extra-nodal manifestations of disease(Figure 2).
case_images: H&E histomorphologic findings of the cervical lymph node. (A) Low power view showing a lymph node with expansion of the sinuses (pale areas) and compression of other compartments (x40 magnification). (B) Pale areas demonstrate numerous sinus histiocytes with areas of lymphoid aggregates (x100 magnification). (C and D) High power view showing numerous sinus histiocytes with abundant eosinophilic cytoplasm and emperipolesis:arrows. Engulfed lymphocytes are evident in this image (x400 magnification).
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case_images: Microscopic examination of hematoxylin and eosin (H&E) stained slides revealed an intact lymph node with a nodular architecture composed of expanded pale areas (sinuses) containing numerous histiocytes (Figure 3A and B). The sinus histiocytes had large vesicular nuclei with abundant clear to eosinophilic cytoplasm containing numerous intact lymphocytes and occasional neutrophils, a feature designated as emperipolesis or lymphocytophagocytosis (Figure 3C and D).
case_images: Immunohistochemistry staining patterns using antibodies against CD68, CD3, and S100. The sinus histiocytes demonstrate cytoplasmic immunoreactivity for CD68 and S100 while some lymphocytes, immunoreactive for CD3, are seen within the cytoplasm of the histiocytes -arrows (x400 magnification).
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case_images: This prompted the use of immunohistochemistry with antibodies against S100 and CD68, which demonstrated positive cytoplasmic immunoreactivity of the sinus histiocytes with both markers (Figure 4) thereby confirming the diagnosis of Rosai-Dorfman disease.
case_images: (A) The patient with cervical lymphadenopathy before steroid treatment, (B) a reduction in cervical nodal size after 3 weeks of steroid therapy (prednisolone at 2 mg/kg/day).
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case_images: PMC11289797_01_10.1177_11795476241265279-fig5.jpg
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case_images: There was a noted reduction in the size of the nodes at this higher dose as shown by (Figure 5).