血管炎による消化管病変の病理診断

Pathological Diagnosis of Vasculitis Related Gastrointestinal Lesions

要旨●血管炎による消化管病変の病理組織学的特徴と鑑別の要点について言及した．血管炎を原因とする腸病変には，原疾患が血管炎である原発性血管炎と全身疾患に血管炎が合併する二次性血管炎とがある．血管炎による消化管病変を疑う場合には，血管炎の分布，罹患血管径や動静脈の区別，浸潤する炎症細胞の種類，肉芽腫の有無に加えて，フィブリノイド変性や炎症細胞浸潤がみられる急性期，肉芽形成期，治癒瘢痕期などの血管炎の時相にも留意して組織診断を行う．しかし，これらの組織像のみでは鑑別は困難であり，臨床像，画像所見，肉眼像を加味して総合的な診断を行うことが肝要である．

　We reviewed the histopathological findings and point of discrimination of major vasculitis-related gastrointestinal lesions. The gastrointestinal lesions are caused by vasculitis, which are primary and secondary vasculitis associated with systemic disease. During histological diagnosis of vasculitis, the distribution of vasculitis, affected blood vessel diameter, distinct arteriovenous, types of inflammatory cells infiltrating separation, the presence of granulomas, and the stage of vasculitis are assessed. However, the definite diagnosis of gastrointestinal lesions due to vasculitis that depends only on the histological findings is difficult, therefore, it is crucial to make comprehensive diagnosis that includes clinical information, imaging findings, and macroscopic features.