Castleman-like lymfadenopatie u pacienta se smíšenou chorobou pojiva: kazuistika a přehled literatury
Authors:
Evelina Rogges 1; Sabrina Pelliccia 2; Gianluca Lopez 3; Roberta Soscia 4; Arianna Di Napoli 3
Authors‘ workplace:
PhD School in Translational Medicine and Oncology, Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
1; Haematology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University, Rome, Italy
2; Pathology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University, Rome, Italy
3; Department of Neurosciences, Mental Health and Sensory Organs, Sapienza University of Rome, Rome, Italy
4
Published in:
Čes.-slov. Patol., 62, 2026, No. 1, p. 50-57
Category:
Overview
Odlišení reaktivních lymfadenopatií v kontextu autoimunitních onemocnění od idiopatické multicentrické Castlemanovy choroby (iMCD) představuje významnou diagnostickou výzvu. Histologické znaky podobné Castlemanově chorobě byly popsány u různých autoimunitních onemocnění, což vyžaduje striktní a komplexní integraci klinických a laboratorních nálezů k dosažení správné diagnózy. Ačkoli konsenzuální doporučení Castleman Disease Collaborative Network (CDCN) uvádějí několik autoimunitních onemocnění jako vylučovací kritéria pro diagnózu iMCD, smíšené onemocnění pojiva (MCTD) mezi nimi v současnosti uvedeno není. Popisujeme případ 77leté ženy s únavou, Raynaudovým fenoménem, sklerodaktylií a mírnou generalizovanou lymfadenopatií, u níž biopsie lymfatické uzliny prokázala histologii podobnou Castlemanově chorobě. Absence systémových zánětlivých příznaků a přítomnost vysokých titrů protilátek anti-U1-RNP však nebyly v souladu s iMCD a spíše podporovaly diagnózu reaktivní Castleman-like lymfadenitidy sekundární k MCTD. Tato kazuistika zdůrazňuje, že Castleman-like lymfadenopatie se může vyskytovat i u MCTD a může velmi těsně napodobovat iMCD. U pacientů s autoimunitními onemocněními, která nejsou výslovně uvedena mezi vylučovacími kritérii CDCN, je proto nezbytná důkladná klinicko-patologická integrace, aby se předešlo chybné diagnóze a potenciálně nevhodné terapii založené na blokádě IL-6.
Klíčová slova:
smíšené onemocnění pojiva – Castleman-like lymfadenopatie – autoimmunitní onemocnění – sklerodaktylie – Raynaudův fenomén - anti-U1-RNP
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