THE PROBLEM OF COEXISTENCE OF SYSTEMIC SCLEROSIS, SCLERODERMA-LIKE PARANEOPLASTIC SYNDROME AND NEOPLASTIC DISEASES: REVIEW OF LITERATURE AND CLINICAL CASES ANALYSIS
Summary. The article describes three clinical cases of diagnosis of systemic scleroderma and malignant neoplasms, as well as analysis of coexistence of systemic sclerosis, paraneoplastic reactions and malignant tumors. Immune reactions involved in systemic sclerosis pathogenesis can contribute to the development of cancer pathology; thus, patients with risk factors for this disease require careful monitoring of a possible neoplastic process. On the other hand, the symptoms of systemic sclerosis can be a mask for various types of malignant neoplasms. The differentiation between the idiopathic form of systemic scleroderma, scleroderm-like paraneoplastic syndrome, and the development of cancer on the background of autoimmune pathology causes many difficulties. In the first described clinical case, an idiopathic systemic scleroderma was diagnosed in an elderly patient. Despite the deep diagnostic search and atypical course of the disease, malignant neoplasm wasn't identified. In the second case, scleroderm-like paraneoplastic syndrome appeared on the background of colorectal cancer and outstripped it in clinical manifestations. In the third clinical case, the development of non-Hodgkin’s lymphoma is described in the setting of primary systemic sclerosis. In addition, the article presents analysis of differential diagnostic procedures that were conducted and led to a definitive diagnosis; covers the types of malignant tumors associated with systemic sclerosis; offers an algorithm for monitoring patients for early detection of oncological pathology. Patients with systemic scleroderma, especially the elderly, with high disease activity, rapid progression and atypical flow, high antibody titer to autoantibodies, atypical capillaroscopic pattern should be subjected to more thorough diagnostic search and control for oncological pathology, especially if a patient shows signs and symptoms of both states.
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