好酸球性食道炎の病理診断

Histological Diagnosis of Eosinophilic Esophagitis

要旨●好酸球性食道炎の診断には食道生検が必須であり，その組織学的所見の特徴は，①食道上皮に15〜20/HPFを超える高度な好酸球浸潤を認め，好酸球浸潤は食道に限局すること，②浸潤する好酸球は上皮表層優位で，時に集簇巣（好酸球性微小膿瘍）を形成すること，③上皮は炎症により浮腫を来し，時に上皮の落屑を伴うこと，④上皮基底細胞の反応性過形成を示すことが挙げられ，この4つの特徴を満たすものは高い確率で好酸球性食道炎と考えられる．ほかに粘膜固有層の線維化や肥満細胞の浸潤を伴うこともある．食道上皮に好酸球浸潤を来す疾患は好酸球性食道炎以外にもあり，それらの疾患（GERD，カンジダ食道炎，アカラシア，好酸球性胃腸炎）の生検組織像も合わせて提示した．

　Both clinical and pathological findings are imperative for the diagnosis of EoE（eosinophilic esophagitis）because it is a clinicopathological disorder. Histological characteristics of EoE include massive eosinophilia in the epithelium（>15-20/HPF）and localized eosinophilia in the esophagus, superficial predominant layering and/or eosinophilic microabscess formation, epithelial spongiosis or desquamating epithelial cells associating with eosinophilic predominant inflammation, and reactive basal-cell hyperplasia. The presence of these four characteristics appears to highly support the possibility of EoE. Biopsy specimens of patients with EoE often exhibit lamina propria fibrosis or mast cell infiltration.

　EoE has been reported in various eosinophilic gastrointestinal disorders, such as GERD, Candida esophagitis, and achalasia. In the present article, we demonstrated histological findings of other esophageal eosinophilia.