Table 1 Common differential diagnosis for Rosai Dorfman disease
From: ROSE in Rosai–Dorfman–Destombes (RDD) disease: a cytological diagnosis
| Disease | Clinical features | Cytology | IHC |
|---|---|---|---|
| Rosai Dorfman disease | Children’s and young adults, M > F, painless lymphadenopathy, extra-nodal presentation seen | Histiocytes with vesicular nucleus and abundant clear cytoplasm, with fine vacuoles and lymphocytes, reactive background of lymphocytes, plasma cells, neutrophils | S100, CD68 positive, CD1a negative |
| Reactive lymph node hyperplasia | Malaise, painless lymphadenopathies, self-limited disease | Neutrophils, histocytes may or may not be present, | Histiocytes negative for S100 |
| LCH | Localized or multiple lesions with disseminated disease. Nodal involvement may be sole manifestation, bone lesion may be seen | Polymorphic infiltrate with eosinophils and histiocytes with cleaved nucleus | CD1a positive |
| Hemophagocytic lymphohistiocytosis | May be associated with malignancy of hematological origin, multi organ failure, pancytopenia, Hepatosplenomegaly | Benign histiocytes with engulfed platelets and RBCs | CD68 positive |
| Non-Hodgkin's lymphoma | Lymphadenopathy, B symptoms weight loss, fever, loss of appetite | Monotonous population of lymphoid cells | Depends of cell of origin |
| Hodgkin lymphoma | Lymphadenopathy with B symptoms | Polymorphic population with small lymphocytes, eosinophils, plasma cells, and RS cells | RS cell positive for CD15 and CD30 |
| Metastatic carcinomas | Primary in any organ | Lymphoid population with metastatic tumor cells resemblance to primary organ morphology | Depends on organ of origin |