潰瘍性大腸炎の上部消化管病変の病理組織学的特徴―十二指腸病変について

Histopathological Features of Ulcerative Colitis Associated Duodenal Lesion

要旨　潰瘍性大腸炎（UC）随伴十二指腸病変（UCD）10例と非特異性十二指腸炎（NSD）40例の病理組織所見の解析・比較を行った．UCDの組織像は，活動期または再燃活動期UC大腸粘膜と同質であり，半数以上で“陰窩杯細胞粘液減少”，“陰窩底部と粘膜筋板との乖離”，“陰窩底部の形質細胞浸潤”，“好中球浸潤”，“陰窩密度の減少”，“陰窩炎”，“びまん性炎症細胞浸潤”，“陰窩のねじれ・構造不整”，がみられた．UCDとNSDでは組織像のパターンが異なり，UCDでは“陰窩底部の形質細胞浸潤”，“陰窩底部と粘膜筋板との乖離”，“陰窩密度の減少”;が，NSDでは“胃腺窩上皮化生”が，特異性の高い組織所見であった．これら組織像のパターンの違いが，UCDとNSDの炎症病態，粘膜傷害の成因の違いを反映している可能性がある．

　We investigated and compared the histopathological features of ten ulcerative colitis associated duodenal lesions (UCD) and forty non-specific cases of duodenitis (NSD). UCD showed similar histological features to those seen in the colorectal mucosa with active or recurrent active phase UC, and more than 50％ of UCD demonstrated “goblet cell mucus deplesion”, “wide separation of crypt base and muscularis mucosae”,“basal plasmacytosis”,“neutrophilic infiltration”,“decrease in crypt population”,“cryptitis”,“diffuse inflammatory infiltrates”, and “crypt distortion or disarrangments”. The histological patterns seen in UCD and NSD are different and specific findings for UCD were “basal plasmacytosis”,“wide separation of crypt base and muscularis mucosae”, and “decrease in crypt population”, while that of NSD was “gastric foveolar metaplasia”. These differences in histological patterns of UCD and NSD were suggested to be conducted by divergent conditions of inflammatory disorder and etiology of mucosal damage.