血管炎による虚血性腸病変の病理診断

Pathological Diagnosis of Ischemic Enterocolic Lesions Associated with Vasculitis

要旨●腸の虚血性疾患において，血管炎の占める割合は少なくない．全身性血管炎症候群である結節性多発動脈炎（PAN）やANCA関連血管炎，IgA血管炎，Behçet病などの部分症状としてみられることもあれば，IMHMV（idiopathic myointimal hyperplasia of mesenteric veins）やMIVOD（mesenteric inflammatory veno-occlusive disease），IMP（idiopathic mesenteric phlebosclerosis）などの腸管に限局した病変もまれながら存在する．さらに血管炎類縁疾患として，分節性動脈中膜融解症（SAM）や線維筋性異形成（FMD），抗リン脂質抗体症候群（APS）などもみられる．

　Vasculitis is responsible for majority of intestinal ischemic diseases. It is a partial symptom of systemic vasculitic syndromes, such as PAN（polyarteritis nodosa）, ANCA-associated vasculitis, IgA vasculitis, and Behçet's disease. Rare lesions are also found, which are limited to the intestinal tract, such as idiopathic myointimal hyperplasia of mesenteric veins, mesenteric inflammatory veno-occlusive disease, and idiopathic mesenteric phlebosclerosis. In addition, vasculitis-related diseases, such as segmental arterial medial lysis, fibromuscular dysplasia, and antiphospholipid syndrome, are observed.