Article
115 Rosai-Dorfman Disease of the Breast Mimicking Fat Necrosis on Core Biopsy
American Journal of Clinical Pathology
(2018)
Abstract
Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy, is a rare histiocytic proliferative disorder primarily involving lymph nodes. Extranodal RDD has been reported in many organ systems. The breast involvement is very rare. We report a case of breast RDD as a potential diagnostic pitfall on needle core biopsy. The patient was a 47-year-old woman with a CT-detected mass in the right breast. On ultrasound, the mass appeared as two adjacent solid nodules, 1.5 cm and 1.6 cm, suspicious for malignancy. A diagnosis of chronic inflammation with fibrosis and fat necrosis was rendered on an ultrasound guided core biopsy. Due to the discordance with the sonographic findings, excisional biopsies of both masses were performed. Microscopic sections of both masses showed similar histological features, with many histiocytes, polymorphous mature lymphocytes and plasma cells. The histiocytes were large with voluminous foamy to eosinophilic cytoplasm. Some histiocytes display emperipolesis with intracytoplasmic lymphocytes, neutrophils, erythrocytes. The histiocytes were positive for S100 and CD68, and negative for CD1a. A diagnosis of Rosai-Dorfman disease of breast was rendered. Also noted was the increased number of IgG4 plasma cells in the inflammatory infiltrates. Subtle morphological features could be identified on the core biopsy on retrospective review. At two years follow-up, there were no additional breast masses. This is a rare example of RDD of breast presenting as breast masses posing diagnostic challenges on needle core biopsy. Excisional biopsy along with immunohistochemistry proved to be adequate for definitive diagnosis. Despite the well characterized histological features of RDD in the literature, recognition of this rare disease in unexpected sites such as breast is challenging, especially on needle core sample.
Disciplines
Publication Date
January 11, 2018
DOI
10.1093/ajcp/aqx118.114
Citation Information
Xia Chen, MD, 115 Rosai-Dorfman Disease of the Breast Mimicking Fat Necrosis on Core Biopsy, American Journal of Clinical Pathology, Volume 149, Issue suppl_1, January 2018, Page S49, https://doi.org/10.1093/ajcp/aqx118.114