大腸Crohn病―非典型例の病理

Pathological Diagnosis Macroscopically Atypical Crohn's Disease of the Colon and Rectum

要旨　肉眼的病変を有する大腸Crohn病の外科切除41例（代表的病変数44個）を用いて，その肉眼的典型像・非典型像の診断について病理形態学的に検討した．縦走潰瘍型17病変，玉石敷石（＋炎症性ポリポーシス）型19病変（うち，7病変の盲腸Crohn病はすべてこの肉眼型），炎症性ポリポーシス型3病変，不整潰瘍型5病変であった．非典型の不整潰瘍型は，いずれもその一部に縦走潰瘍を有していたことから，縦走潰瘍型の進行した型と考えられた．肉眼的に非典型大腸Crohn病と判断された病変－帯状粘膜萎縮像，潰瘍性大腸炎様像－は組織学的に検査すると，縦走潰瘍型や不整潰瘍型であった．肉眼的非典型像は内科的治療による肉眼像の修飾，感染性大腸炎の合併，虚血や腸管狭窄に伴う二次変化，粘膜下の裂溝が二次感染で迷路状の膿瘍を形成すること，などに起因していた．

　We studied on pathological diagnosis of macroscopically atypical Crohn's disease of the colon and rectum, using 41 intestinal Crohn's disease first resected surgitally.

　Typical macroscopic type of colorectal Crohn's disease was defind here as longitudinal ulcers with cohblestone and/or inflammatory polyposis (17 lesions in 41 cases), or cobblestone appearance (+inflammatory polyposis) (19 lesions), or aphthoid ulcers predominantly arranged along the colonic teniae in the edematous mucosa (early stage of Crohn's disease, No cases in this study).

　Atypical gross type was a circular irregular ulcer (or a circular atrophic mucosa) with cobblestone appearance and/or inflammatory polyposis (5 lesions) or inflammatory polyposis (3 lesions). In addition, there could be seen atypical gross findings, such as redcolored mucosa, rough-surfaced mucosa and so on.

　All of the atypical lesions had active and/or healed longitudinal ulcers in the lesion or at the periphery of the lesion, and non-caseating epithelioid cell granulomas typical of Crohn's disease.

　The macroscopically atypical findings were caused by preoperative internal medication, secondary mucosal infection, multifocal submucosal abscesses, ischemic change, and secondary change by stenosis.