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結節性紅斑及びバザン硬結性紅斑が,皮下脂肪組織及び真皮の炎症,つまりDermopanniculitisであるのに対して,主として皮下脂肪組織だけに限局した炎症性病変を,脂肪織炎(Panniculitis)という。ここではそのうちの脂肪融解(Lipolyse)を一次的な病変とする脂肪織炎を中心として述べる。
一般に皮下脂肪組織の炎症の病理組織標本を見る場合には,一次的な病変が主として葉間結合織にあるか,脂肪細胞の集団の中にあるかを判断する必要がある。何故ならば葉間結合織の炎症は,比較的容易に真皮にまで拡大波及して,Dermo-panniculitisの形となり,われわれが真皮で通常遭遇する炎症と同じ過程をたどるのであるが,一方脂肪細胞集固の炎症は,脂肪細胞の破潰,すなわちLipolyseをおこし,その修復機転として脂肪喰食細胞(Lipophagen)が出現し,脂肪肉芽腫(Lipogranulom)を生ずる傾向がある。
There were two main independent processes in so-called panniculitis-dermopanniculitis and lipolysis. The former was an inflammatory process of a stroma which extended from the dermis to the septa of the panniculus, and could introduce secondary degeneration of fatt cells. The latter was primary disorganization of fatt cells which could induce a secondary inflammatory process of a stroma. The histologic sites of the two pathologic processes were completely different.
The cell membrane of fatt cells played important roles in prevention of diffusion of lysed lipid from fatt cells and in keeping emigrating histiocytes close to them.
As there were no pathognomonic changes in various entities of panniculitis, histopathologic differential diagnosis of them was impossible.
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