Background: Rosai–Dorfman disease is a benign lymphatic tissue proliferative disease with slow growth and is rarely observed in the clinic. Most of these patients present clinically with enlarged lymph nodes. In patients with spinal extranodal Rosai–Dorfman disease, which is even rare than the disease of lymph nodes, patients may experience numbness and weakness in the extremities. Case presentation: We report a 32-year-old male patient with multi-segmental spinal Rosai–Dorfman disease. On admission, his left fingers had been numb for 2 months. Over a 2-month period, the limb numbness progressed from the left to the right hand. The patient underwent resection of the lesion and internal fixation of the C2–C7 spine. The postoperative outcomes were satisfied and no recurrence was observed at 1-year follow-up. Conclusion: Spinal Rosai–Dorfman disease is a relatively rare tumor of which the pathogenesis is still unclear, and most patients have no specific clinical manifestations. Characteristic imaging findings can indicate this disease, however, a definitive diagnosis still depends on a pathological examination. Currently, total surgical resection of the tumor is a relatively effective and preferred treatment.

Introduction: Cellular blue nevus is an uncommon neoplasm in the spine. Patient concerns: Here, we present a case of a 24 years old male with a 2 months history of numbness in the right upper limb and shoulder. Diagnosis: Cervical spine and subcutaneous tissue invasive cellular blue nevus. Interventions: The patient underwent C4 laminectomy and partial C3 and C5 laminectomy for total resection of the lesion. Histopathology revealed a nodular tumor with unclear boundaries, which was composed of heavily pigmented dendritic cells and more pigmented spindle cells. Outcomes: There was no recurrence during 3 years follow-up. Conclusion: Invasive cellular blue nevus of the spine can be wrongly diagnosed as spinal meningeal melanocytoma and meningeal melanoma due to its special cell behavior and rarity. Therefore, it is important to understand its pathological and clinical characteristics to avoid over-treatment.