Cold thyroid nodule as the sole manifestation of Rosai-Dorfman disease with mild lymphadenopathy, coexisting with chronic autoimmune thyroiditis

A case of thyroid Rosai-Dorfman disease (RDD) without apparent lymphadenopa thy in a 49-year-old woman with underlying euthyroid chronic autoimmune thy roiditis, as indicated by high thyroid autoantibodies titers, is presented. The initial presentation was that of a cold, hypoechogenic nodule of left thyroid lobe which increased in size during the two years of follow up, tog ether with new ultrasonographic findings of the right lobe. No biochemical abnormalities were found apart from mild hypercalcemia. A near total thyroi dectomy was performed. Histologically, the left robe nodule as well as the right lobe lesions consisted of typical RDD cellular population, with the p athognomonic phenomenon of emperipolesis. Infiltration to the periphery of the gland was observed and three adjacent lymph nodes were also involved. T he uninvolved thyroid parenchyma showed changes compatible with chronic aut oimmune thyroiditis. No other localizations or systemic manifestations of R DD were revealed. Normocalcemia was restored promptly and the patient remai ns free of clinically overt disease one year post-operatively. (J. Endocrin ol. Invest. 22: 866-870, 1999) (C) 1999, Editrice Kurtis.