十二指腸潰瘍を併発した大腸Crohn病の1例―切除胃，生検肝組織の病理組織学的検索を中心に

Gastro-duodenal Crohn's Disease with a Long History of Colonic Crohn's Disease, Repoft of a Case: Histopathological examination of the resected stomach and wedge blopsy of the liver

要旨　大腸Crohn病で治療中の31歳の男性に十二指腸潰瘍が併発し，手術を余儀なくされた．切除胃ならびに生検肝組織の詳細な検索により以下の所見を得た．十二指腸潰瘍は通常の消化性潰瘍の形態とは異なり，fissuring ulcer，粘膜下組織を横走する膿瘍，類上皮細胞肉芽腫がみられ，一般的な大腸小腸Crohn病にみられる所見に一致すると考えられた．肉眼的に著変のない胃の胃底腺，幽門腺領域に腺頸部を中心にリンパ球を中心とする単核細胞浸潤による組織破壊巣がみられ，一部は明らかな類上皮細胞肉芽腫に連続した．肝門脈域にも同様な類上皮細胞肉芽腫を認めた．これらはCrohn病の肉芽腫形成の病理組織学的初期病変と考えられるが，臨床的に明らかな病変へ移行することは極めてまれなことと考えられた．

　Resected stomach and wedge bipsy of the liver obtained from a 31year-old man with a long history of Crohn's disease of the colon were histologically examined. Pathological findillgs were as follows:

　1) Duodenal ulcer showed scar of fissuring ulcer and irregularly-shaped abscess transversely extending to submucosal layer. Macroscopical features and many microscopical epithelioid cell granulomas were compatible with Croh's disease.

　2) By means of serial cutting method of the stomach, diffuse distribution of millute foci which showed destruction of foveolar neck with mononuclear cell infiltration and epithelioid cell granuloma was evidenced in the gastric mucosa, including pyloric and fundic gland area. Partly mononuclear cell in filtration around the destructed foveolar neck showed a relationship with epithelioid cell granuloma by serial sections.

　3) Some epithelioid cell granulomas with multi-nucleated giant cells were located in lymphatic vessels.

　4) Epithelioid cell granuloma of the portal area was detected in the liver. There was no relation with small duct.

　These findings suggest that Crohn's disease has high frequency of pathological minute foci through gastrointestianl tract and in the liver. Such minute foci in this case might be a characteristic reaction and pathological primary foci of Crohn's disease in the stomach, but not necessarily transform into typical morphological features.