Histiocytic Disorder Mimicking a Brain Tumor: A Report of 2 Rare Cases

Abstract

Case series Patients: Male, 65-year-old • Female, 61-year-old Final Diagnosis: Langerhans cell histiocytosis • Rosai-Dorfman disease Symptoms: The patient with LHD presented with increasing memory loss, confusion, and depression • the patient with RDD presented with dizziness and confusion for three weeks and headaches for one day Medication: — Clinical Procedure: — Specialty: Pathology Objective: Rare disease Background: Histiocytic disorders, a group of disorders with heterogeneous pathogenesis, morphology, and clinical presentation, include Rosai-Dorfman disease, Langerhans cell histiocytosis, and Erdheim-Chester disease. They can mimic primary or metastatic tumors, both clinically and radiologically, when involving the brain. Therefore, it is crucial to present and discuss cases of histiocytic disorder involving the central nervous system (CNS) to provide new information on disease presentation and diagnosis more. In this paper, we present 2 cases of histiocytic lesions involving the brain and mimicking primary brain tumors. Case Report: Case 1: A 65-year-old man presented with increasing memory loss, confusion, and depression. CT scans showed an isolated 2.9×2.0×0.6 cm intracranial hypothalamic lesion. Case 2: A 61-year-old woman presented with dizziness and confusion for 3 weeks and headaches for 1 day. MRI showed a single 5.0×4.0×3.3 cm extra-axial, dural-based, avidly enhancing, well-defined lesion along the left parietal convexity causing mass effect upon the underlying brain parenchyma, left atrial effacement, and minimal vasogenic edema. Conclusions: Histiocytic disorders are relatively rare in the CNS compared with other locations and mimic more common entities in the brain, such as glioma or metastatic tumors. Despite its rarity, one should remain aware of the condition and consider it in the differential diagnosis. This article provides a brief review and adds pivotal data to the literature.

Erdheim‐Chester disease of brain parenchyma without any systemic involvement: A case report and review of literature

“…3, which includes CNS‐ECD cases with and without systemic involvement, these two groups of cases showed similar characteristics regarding age distribution, neurological clinical findings, and cranial lesion localizations. The most striking difference between these two groups was that ECD cases limited to the CNS often presented with space‐occupying expansile lesions, and the infiltrative pattern was observed less frequently than in those with systemic disease 8,16–29 . In addition, all of the CNS‐limited ECD cases were ultimately diagnosed by cranial biopsy.…”

“…The most striking difference between these two groups was that ECD cases limited to the CNS often presented with space-occupying expansile lesions, and the infiltrative pattern was observed less frequently than in those with systemic disease. 8,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] In addition, all of the CNSlimited ECD cases were ultimately diagnosed by cranial biopsy. On the other hand, cranial biopsy has rarely been performed in ECD cases with systemic involvement, as skin, bone, or kidney biopsies were preferred in these cases because they were easier to perform.…”

A Diagnostic Dilemma and Classification Conundrum: Atypical Histiocytic Neoplasm Presenting as a Calvarial Mass

“…The breadth of diseases and pathology seen in histiocytic disorders makes the classification of such diseases a complex and difficult process. These disorders can present similarly both clinically and radiologically as primary central nervous system tumors but rarely do truly involve the CNS, providing an additional layer of involvement as a mimic [ 8 ]. Herein, we present a case of a woman who presented with a single calvarial lesion that did not fall under any of the aforementioned histiocytic categories, thus demonstrating the complexities associated with both the classification and management of such patients.…”