Rosai-Dorfman disease

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy (SHML), is a rare benign idiopathic proliferative disease that involves phagocytic histiocytes.

The disease predominantly occurs in young adults with a mean age at presentation of 21 years. There may be a slight male predominance 7.

A vast majority of patients (~80%) present with painless massive cervical lymphadenopathy. Headaches and seizures have been described when there is intracranial involvement 8


The exact cause is unknown but disordered immune regulation and viral infections (e.g. EBV, HHV) are thought to be involved 9.


There is a very wide distribution. The condition can affect a multitude of organ systems which include:

  • nodal involvement
  • extranodal involvement (~30% 9)
    • lungs (~2.5%): nodules and perilymphatic interstitial thickening 9
    • skin
    • nasal cavity
    • orbit: ~7%
    • bone
    • intracranial and spinal disease: rare
Microscopic appearance

Histologically, it is characterised by an attenuated infiltration of lymphoplasmacytic cells and histiocytes of varying size. The large, pale histiocytic cells contain what looks like engulfed lymphocytes ("emperipolesis") within their cellular borders.

  • S100: often positive
  • CD1a: negative

Due to the wide disease spectrum, radiographic features can be variable. Nodal involvement is appreciated as lymphadenopathy on plain film and cross-sectional imaging.

  • head and neck
    • content pending
  • central nervous system (CNS) 8
    • hyperattenuating meningeal-based mass showing contrast enhancement
    • parenchymal oedema surrounding the lesion may be present 
  • head and neck
    • content pending
  • CNS 8: meningeal-based mass
    • T1: isointense to grey matter
    • T2: hyperintense to grey matter
    • T1 C+ (Gd): homogenous enhancement
Nuclear medicine

Often shows increased uptake with Gallium scanning and increased metabolism with FDG-PET.

Rosai-Dorfman disease usually follows a benign and self-limiting course with treatment largely targeted at controlling local manifestations (surgical intervention) 6.

This condition was initially described by Juan Rosai and R F Dorfman in 1969 3.

Share Article

Article Information

rID: 12299
Sections: Pathology, Syndromes
Synonyms or Alternate Spellings:
  • Sinus histiocytosis with massive lymphadenopathy
  • Rosai-Dorfmann disease (RDD)
  • Rosai-Dorfmann disease
  • Rosai-Dorfman disease (RDD)

Support Radiopaedia and see fewer ads

  • Drag
    Case 1
    Drag here to reorder.
  • Drag
    Rosai-Dorfman dis...
    Case 1: Gallium scan
    Drag here to reorder.
  • Drag
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Drag
    Case 4
    Drag here to reorder.
  • Updating… Please wait.

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.