Adam Zdeněk, Řehák Zdeněk, Adamová Zuzana, Koukalová Renata, Pour Luděk, Krejčí Marta, Boichuk Ivanna, Krejčí Martin, Štork Martin, Ševčíková Sabina, Král Zdeněk
Vnitr Lek. 2021 Winter;67(8):465-473.
Castleman disease (CD) includes a group of rare and heterogeneous disorders with characteristic lymph node histopathological abnormalities. CD can occur in a single lymph node station, which is referred to as unicentric CD (UCD). CD can also involve multicentric lymphadenopathy and inflammatory symptoms - multicentric Castleman disease. The first-ever diagnostic and treatment guidelines were recently developed for UCD and published 2020. Complete surgical resection is often curative and is therefore the preferred first-line therapy, if possible. The management of unresectable UCD is more challenging. Existing evidence supports that asymptomatic unresectable UCD may be observed. The anti-interleukin-6 monoclonal antibody siltuximab should be considered for unresectable UCD patients with an inflammatory syndrome. Unresectable UCD that is symptomatic because of compression of vital neighbouring structures may be rendered amenable to resection by medical therapy (rituximab, steroids), radiotherapy, or embolization. In this article, we report about the symptoms of this disease and about the diagnostics recommendation published in the International, evidence-based consensus diagnostic criteria for HHV-8-negative/ idiopathic multicentric Castleman disease and about the therapeutic recommendation published in International evidence-based consensus diagnostic and treatment guidelines for unicentric Castleman disease published in the year 2020.
Castleman病(CD)包括一组罕见且异质性的疾病,具有特征性的淋巴结组织病理学异常。CD可发生于单个淋巴结部位,称为单中心Castleman病(UCD)。CD也可累及多中心淋巴结病及炎症症状,即多中心Castleman病。最近首次制定了UCD的诊断和治疗指南,并于2020年发布。完整的手术切除通常可治愈,因此如果可能,是首选的一线治疗方法。不可切除的UCD的管理更具挑战性。现有证据支持,对于无症状的不可切除UCD可进行观察。对于有炎症综合征的不可切除UCD患者,应考虑使用抗白细胞介素-6单克隆抗体司妥昔单抗。因邻近重要结构受压而出现症状的不可切除UCD,可通过药物治疗(利妥昔单抗、类固醇)、放疗或栓塞使其适合切除。在本文中,我们报告了这种疾病的症状、国际上基于循证的HHV-8阴性/特发性多中心Castleman病共识诊断标准中发布的诊断建议,以及2020年发布的国际基于循证的单中心Castleman病共识诊断和治疗指南中发布的治疗建议。