(18) F-fluoro-2-deoxyglucose positron emission-computed tomography in a rare cutaneous form of Rosai-Dorfman disease: A case report

Joya Hadchiti 1Francois G Kamar 2Jean Abi Ghosn 3Mohamad Haidar 4Ahmad Younes 5Antoine Obeid 1Marwan Haddad 3Fadi Farhat 2Feras Chehade 4

Affiliations

1Faculty of Medical Science, Lebanese University, Hadas, Lebanon.

2Department of Oncology, Mount Lebanon Hospital, Beirut, Lebanon.

3Department of Radiology, Mount Lebanon Hospital, Beirut, Lebanon.

4Department of Nuclear Medicine, Mount Lebanon Hospital, Beirut, Lebanon.

5Department of Oncology, Central Military Hospital, Beirut, Lebanon.

PMID: 29435284

PMCID: PMC5774347

DOI: 10.3892/mco.2017.1507

Free PMC article

Abstract

Rosai-Dorfman disease (RDD), or sinus histiocytosis with massive lymphadenopathy, commonly involves the lymph nodes but may secondarily involve the skin. Purely cutaneous disease without lymphatics or internal organ involvement occurs rarely. The present report detailed a rare case of 18F-fluoro-2-deoxyglucose positron emission-computed tomography (18FDG PET-CT) performed in a 33-year-old male soldier with a purely cutaneous form of RDD. Staging with 18FDG PET-CT was ordered prior to excisional biopsies of the aforedescribed masses and pathology reported RDD. The case demonstrated accurate localization of increased radioglucose metabolism. The present case was also discussed in light of literature data in terms of clinical features, etiologies, histology, medical imaging, therapy planning and prognosis.

Keywords: 18F-fluoro-2-deoxyglucose positron emission-computed tomography; Rosai-Dorfman disease; histiocytes; lymph nodes; medical imaging.

Figure 1. RDD diagnosis by 18FDG PET-CT. (A) Baseline whole-body three-dimensional 18FDG PET-CT revealed the two hot spots of hypermetabolism located along the left cheek (red arrow) and the right gluteal region (green arrow), representing the subcutaneous masses of RDD. Axial cross-sections of (B) PET and (C) fused PET-CT of the head/neck revealed the left cheek subcutaneous hypermetabolic mass of RDD (red arrow). Axial cross-sections of (D) PET and (E) fused PET-CT of the pelvis revealed the right gluteal sub-cutaneous hypermetabolic mass of RDD (green arrow). RDD, Rosai-Dorfman disease; 18FDG PET-CT, 18F-fluoro-2-deoxyglucose positron emission-computed tomography; PET, positron emission tomography; CT, computed tomography.
Figure 2. Follow-up 18FDG PET-CT after 8 months. (A) Whole body three-dimensional 18FDG PET-CT realized 8 months after surgical resection of the Rosai-Dorfman disease subcutaneous masses of the left cheek and the right gluteal region, with disappearance of the hypermetabolic hot spots previously observed on the baseline study. Axial cross-sections of (B) PET and (C) fused PET-CT of the head/neck. Axial cross-sections of (D) PET and (E) fused PET-CT of the pelvis. PET and fused PET-CT images revealed subcutaneous tissue thickening without increased uptake, a pattern consistent with post-intervention changes. 18FDG PET-CT, 18F-fluoro-2-deoxyglucose positron emission-computed tomography; PET, positron emission tomography; CT, computed tomography.
Figure 3. Follow-up 18FDG PET-CT after 24 months. (A) Whole body three-dimensional 18FDG PET-CT realized at 24 months. The patient had received a second surgical resection of the RDD subcutaneous mass of the right gluteal region within this time. Active foci were noted along the upper mediastinum (right paratracheal lymph node, blue arrow) and the right gluteal region (green arrow). The surgical bed of the left cheek was completely inactive following the initial and single surgical act. Axial cross-sections of (B) PET, (C) CT and (D) fused PET-CT of the thorax revealed the right upper paratracheal hypermetabolic lymph node (blue arrow). Axial cross-sections of (E) PET, (F) CT and (G) fused PET-CT of the pelvis revealed the subcutaneous hypermetabolic mass of RDD that relapsed following a second surgical excision (green arrow), instead of the initiation of steroid therapy. 18FDG PET-CT, 18F-fluoro-2-deoxyglucose positron emission-computed tomography; PET, positron emission tomography; CT, computed tomography; RDD, Rosai-Dorfman disease.