腸管子宮内膜症の病理

Pathology of Intestinal Endometriosis

要旨　子宮内膜症に起因する腸管の肉眼形態変化とその成因となる組織所見，および腸管子宮内膜症の病理診断について検討・考察した．腸管の肉眼形態変化の中で，狭窄と(粘膜下腫瘍様)隆起の一部は，子宮内膜組織が固有筋層に進展することにより生じ，筋層の変形(アーチ状屈曲と肥厚)がその主たる形成要因になると考えられた．潰瘍・びらん，発赤粘膜など粘膜面の変化は，子宮内膜組織が粘膜下層以浅に進展することにより生じ，粘膜内に子宮内膜組織が進展することでそれらの所見を呈する場合は，上皮性腫瘍様隆起を随伴する．子宮内膜症の病理診断に際しては，子宮内膜組織に特有な上皮と問質成分の同定に努めると同時に，vimentin，EMA，estrogen receptor染色などの免疫組織化学が有用と考えられた．

　Based on the pathological examination of nine cases of intestinal endometriosis, their macroscopic changes with underlying histological findings and pathological diagnosis were discussed. Intestinal stenosis and some exophytic mass formations were generated mainly due to dome shaped deformity (to the intestinal luminal side) and hypertrophy of the proper muscle coat, caused by the implantation of endometrial tissue. Ulceration, erosion and erythema are developed due to extension of endometriosis into the intestinal submucosa and/or mucosa. Such findings are associated with epithelial tumor-like elevation when endometriosis is involved in the mucosa. For histopathological diagnosis of intestinal endometriosis, we emphasized the importance recognizing its characteristic epithelial and stromal elements and the usefulness of vimentin, EMA, estrogen receptor immunohistochemistry.