免疫不全状態における消化管病変の生検所見

Pathological Features of Digestive System Lesions in Patients with Immunodeficiency

要旨　免疫不全状態では多彩な消化管病変を形成するが，本稿では代表的な免疫不全状態であるHIV感染症および造血幹細胞移植後にみられる消化管生検所見に関して記載した．HIV感染症では，様々な日和見感染症の他，ウイルスの関与する2次性腫瘍の発生頻度も高く，多様な病態を念頭に置きながら診断すべきである．造血幹細胞移植に関連する腸管GVHD，TMAの生検診断には問題点が多く，臨床的な転帰を踏まえてそれぞれの診断根拠の検証を行う必要がある．

　Patients with immunodeficiency have various lesions in the digestive system. We describe biopsy findings of lesions in patients with typical immunodeficiency, such as HIV（human immunodeficiency virus）infection or posttransplantation of hematopoietic stem cells. As HIV infection often leads to opportunistic infection or secondary carcinoma, diverse pathologies must be considered at diagnosis.

　As there are limitations in pathological diagnosis for intestinal GVHD（graft-versus-host disease）or TMA（thrombotic microangiopathy）related to hematopoietic stem cell transplantation, individual verification based on evidence and clinical outcome is required.