Qap (Anatomical Pathology) 

QAP Peer Review

AP240
Case History: M/47, Pigmented lesion over right shin for 1 year, slowly increasing in size. Now it appears as a nodular lesion in skin, measuring 3x4 cm.
Intended diagnosis: Rosai Dorfman disease. Contributed by:JKCC
Code Diagnosis Comment Score
anonymous Kaposi's sarcoma (100%) nil  0
anonymous Syphilis nil  50
anonymous Dermal LYMPHOPLASMACYTIC INFILTRATION with prominent histiocytic and eosinophilic components. Haemosiderin and possible other pigments present. To exclude (1) Tattoo reaction, (2) Chronic infections: Long Ziehl-Neelsen stain for atypical mycobacteria, Warthin Starry stain for spirochetes, Grocott stain for fungus, (3) Extranodal Rosai-Dorfman disease: S-100, expect to be positive in the histiocytes. Correlation with history of tattooing  80
anonymous Rosai-Dorfman disease Suggest confirm by S100 protein immunostaining  100
anonymous Rosai-Dorfman disease. 100% Confirm by S100. Special stains to exclude infective differential eg. Warthin-Starry stain for syphilis.  100
anonymous Extranodal Rosai-Dorfman disease.(100%) Do S100 protein stain to confirm.  100
anonymous Shin biopsy - Rosai-Dorfman disease 100% nil  100
anonymous Dermal heavy lymphoplasmacytic infiltrates Infective (80%)e.g. syphilis, fungal, acid fast bacilli Necrobiosis (20%)e.g. rheumatoid nodule, necrobiosis lipoidica, granuloma annulare Bugs stains : Warthin Starry (syphilis), ZN (acid fast bacilli), PAS (fungi)  50
anonymous Rosai Dorfman disease. 100% nil  100
anonymous Rosai-Dorfman Disease. Confirm diagnosis by immunohistochemistry for S100 protein.  100
anonymous Skin lesion from right shin, incisional biopsy - Scar and reactive lymphoplasmacytic infiltration. Suggest special stains (PASD, Grocott) to rule out microorganism, immunohistochemical staining for kappa and lambda (or molecular study for light chain restriction) to rule out monotypic plasma cell proliferation, please also correlate with history of plasma cell disease (including plasma cell castleman diasese) or immunosuppression (such as post-transplant).  50
anonymous Suggestive of Rosai-Dorfman disease, with an incidental scar tissue probably due to previous biopsy Tto be confirmed by S100(+), CD1a(-) and CD68(+) immunostaining  100
anonymous Chronic inflammation with occasional foamy cells and foreign body giant cell, would perform PASD, warthin starry for fungus and spirochetes, S100 for Rosai Dorfman disease (100% probability) nil  100
anonymous Kaposi's sarcoma (100%) nil  0
anonymous SKIN - ROSAI-DORFMAN DISEASE (100%) nil  100