Sclerotic Lesion of the Tibia without Involvement of Lymph Nodes. Report of an Unusual Case of Rosai-Dorfman Disease*
FRANCIS R. PATTERSON, M.D.†; MICHELE T. ROONEY, M.D.†; TIMOTHY A. DAMRON, M.D.†; ANDREI I. VERMONT, M.D.†; ROBERT E. HUTCHISON, M.D.†, SYRACUSE, NEW YORK

Rosai-Dorfman disease, or sinus histiocytosis with massive lymphadenopathy, was first described in 1969 and is characterized by widespread adenopathy, fever, leukocytosis, an elevated sedimentation rate, and hypergammaglobulinemia12,13. Since 1969, extranodal involvement has been noted in 182 of the 423 patients in the registry of Rosai-Dorfman disease2,16. Osseous involvement is typically lytic and was observed in thirty-three of the 423 patients in the registry2. We report on a patient who was first seen because of symptoms due to a predominately sclerotic tibial lesion but who had no evidence of lymphadenopathy, a characteristic of Rosai-Dorfman disease.

Case Report

A seventeen-year-old black boy sustained a hyperextension injury of the left knee while playing in a high-school football game in September 1994. He was able to continue playing and did not notice any swelling about the knee until three days after the injury. He completed the football season, but he reported intermittent swelling and repeated episodes of giving-way of the knee associated with pain in the proximal part of the tibia. The pain was severe enough to awaken him at night periodically. When he was first seen in December 1994, the findings on radiographs of the knee were unremarkable. When he was seen again in March 1995, the pain had worsened progressively and continued to awaken him at night. However, he still had been able to participate in weight-training. Aspirin relieved most, but not all, of the pain for short periods. He reported occasional epistaxis and rhinorrhea, but he had no systemic symptoms. Computerized tomography scans and repeat radiographs of the knee were made, and the patient was referred for orthopaedic oncological evaluation with a presumptive diagnosis of osteosarcoma.

Physical examination revealed a robust boy who was six feet (183 centimeters) tall, weighed 240 pounds (109 …


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