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PATHOLOGY OF ULCERATIVE COLITIS: with reference to diagnostic value of colon biopsy Haruki Wakasa 1 1Department of Pathology, Tohoku University School of Medicine. pp.1519-1527
Published Date 1969/12/25
DOI https://doi.org/10.11477/mf.1403110861
  • Abstract
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 Idiopathic ulcerative colitis is a chronic disease with a clinical manifestation of a severe active phase and a remitting or relapsing period during its course. The features of the disease are so variable that many authors regard it as a syndrome rather than a disease entity. Although, in the past, it was a rather rare disease, there has been an increasing number of reports of cases manifesting clinical and pathological features since Matsunaga's detailed report in Japan. It is partly due to a remarkable progress of clinical diagnostic procedures, but mostly due to a conceptual change concerning the disease.

 In this report, it is attempted to describe pathologic features of ulcerative colitis by using biopsy specimens and surgical materials, with special attention to correlation between biopsy and surgical picture of the same cases. The authors also pointed out some confusion of terminology on ulcerative colitis in autopsy cases collected from “Annual Report for Autopsies in Japan” for the past 5 years period.

 The histopathologic features are summarized as follows;

1) Irregular arrangement of the intestinal gland and disappearance of its basal membrane.

2) Severe infiltrate of the inflammatory cells, forming a granulation tissue.

3) An appearance of cryptabscess and the formation of ulceration.

4) Edematous change and final scar formation in the submucosa.

5) Regenerating phenomenon in the mucosa.

 Among these findings, cryptabscess is considered to be the most characteristic feature for the formation of ulceration and this is also very much helpful for the diagnostic value of colon biopsy. The remaining mucosa unimpaired by ulceration makes mucosal bridge or shows a proliferation of pseudopolyps, comprising gross features of surgical materials.

 The inflammatory cells are mainly composed of plasma cells, neutrophils, eosinophils, histiocytes, and a few mast cells. In several cases, an enlargement and or a hyperplasia of lymphatic tissue in the intestinal wall are quite characteristic. They usually contain a number of large mononuclear cells with vesicular nucleus and prominent nucleolus. In a few cases, examinations of enlarged regional lymph nodes near the involved inestinal wall have revealed that numerous large cells similar to those in lymphatic tissue were proliferated particularly in medullary cord. These cells have a similarity to those found in lymph nodes with an affection of virus. An observation that a quite large nucleus like cytomegalic inclusion was revealed in the epithelium of intestinal gland also suggests this.

 There are 57 autopsies termed as ulcerative colitis in “Annual Report for Autopsies” for the past 5 years. Among them, 41 cases have severe basic diseases, such as malignant tumor, uremia, infection etc. and they are regarded to have colitis accompanied with lethal diseases. Excluding them, the remained 16 cases should be diagnosed as idiopathic ulcerative colitis from a point of narrow sense. Such a fact suggests that there would be a confusion on terminology by pathologists in Japan.

 A further study searching for etiology, which might not be simple, is necessary.


Copyright © 1969, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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