腸管の血管性病変の病理学的鑑別診断

Pathological Differential Diagnosis of Vascular Diseases of Gastrointestinal Tract

要旨　腸管の血管性病変の名称・分類法，臨床病理像および鑑別診断につき，病理形態学立場から，概説し文献的考察を加えた．一群の病変中，特に血管異形成と動静脈奇形間には用語・分類法に多少の混乱がある．前者は後天性変性性病変で高齢者に多く，病巣は小さく多発性傾向があり，粘膜下層と粘膜に限局し，組織学的には拡張・屈曲した静脈，細静脈，毛細血管から成るという特徴を示した，これに対し後者は先天性過誤腫性病変で若年者にみられ，病巣は大きく単発性で，粘膜から漿膜までの腸壁全層に及び，光顕的には比較的大きな静脈と動脈から構成され，両血管間には吻合ないし移行像が認められるという特徴を有していた．以上から両疾患は明確に区別して診断し分類すべきと考える．

　Terminology, classification, clinicopathological features and differential diagnosis of vascular diseases of the gastrointestinal tract were reviewed from standpoint of pathology with reference of literatures. Among those diseases, angiodysplasia and arteriovenous malformation are somewhat confused in terminology and classification. Angiodysplasia was an acquired degenerative disorder and frequently seen in elderly persons. The lesion was small and often multiple and was located in the mucosa and submucosa. Histologically, it was characterized by dilated and tortuous veins, venules and capillaries. Arteriovenous malformation was a congenital hemartomatous disorder seen in younger persons. The lesion was large and often solitary and pathological change was intramural from mucosa to serosa. Microscopically, it consisted of relatively large vein and arteries and was characterized by anastomoses or transition of those vessels. Therfore, those two disorders should be definitely discriminated and separately classified.