十二指腸の非腫瘍性びまん性病変，特に十二指腸炎の病理

Non-neoplastic Duodenal Lesions―With Special Reference to the Pathology of Duodenitis

要旨　十二指腸炎の概念と分類，その主体をなす非特異性十二指腸炎（NSD）の病因と形態像，および生検で確診可能な代表的特異性十二指腸炎（SD）の病理像について，文献的考察を加えながら概説した．同時にSDの代表格であるCrohn病（CD）十二指腸病変の病変別肉芽腫陽性率について，自験249例を用いて検討した．そして，NSDの生検診断に重要な組織像は，粘膜のびらん，好中球浸潤，リンパ球・形質細胞増加，胃上皮化生，および絨毛の扁平・短縮化であると総括した．さらにCD患者の十二指腸生検での肉芽腫検出率は9.2％と低いことと，内視鏡的にほぼ正常部（2.0％）に比べ病変部（5.9％），特に潰瘍（14.3％）（瘢痕：16.7％）～びらん（7.6％）部からの陽性率が高いことを指摘し，確診に不可欠な肉芽腫の検出率を高めるためには，病変部からの生検と連続切片の検索が必要であると結論した．

　Referring to the medical literature on the subject, we described briefly; 1) The concept and classification of duodenitis. 2) The etiology and morphologic features of non-specific duodenitis (NSD), which is the most frequent disorder among various cases of duodenitis. 3) The pathological features of representative cases of specific duodenitis (SD). We also discussed the detectability of granulomas in duodenal lesions of Crohn's disease, which is the most representative disorder among cases of SD. We referred especially to 249 cases of Crohn's disease encountered at my institute and affiliated centers. As a result, it was concluded that histological features important for pathological diagnosis of NSD by biopsy specimens were mucosal erosion, infiltration of neutrophils, increase of lymphocytes and plasmacytes, gastric foveolar metaplasia and flattening and shortening of villi. It was also concluded that the detectability rate of granulomas in biopsy specimens of the duodenum in Crohn's disease was low (9.2％), but was higher in specimens which had been taken from lesions (5.9％), as compared with those taken from mucosa with normal appearance (2.0％). It was highest when specimens were taken from ulcers (14.3％). Therefore, it can be concluded that biopsy specimens taken from lesions, and pathological examination of serial sections are necessary to increase detectability of granulomas, the detection of which is indispensable for diagnosis.