潰瘍性大腸炎にみられる敷石様所見の臨床病理学的検討

Clinicopathological Study of Ulcerative Colitis in which Cobblestone-like Appearance Was Seen by Colonoscopy

要旨　潰瘍性大腸炎の経過中に，頻度は低いが画像上敷石様所見を呈することがある．対象は1992年から6年間に入院治療を行った潰瘍性大腸炎123例中の14例（11.4％）である．左側大腸炎型5例，全大腸炎型9例であり，5例は初発時に，また9例は再燃増悪時に敷石様所見が認められ，重症例や難治例が多かった．内視鏡的に敷石様所見が認められた部位は，左側大腸が12例（86％）と高頻度であった．炎症性ポリープの特徴は小型（5mm未満）で密度が高く，表面は発赤と細顆粒状を呈した．介在する潰瘍の型はすべて不整形で4例に縦走潰瘍が混在して認められた．外科手術は9例に行われ，7例の切除標本上敷石様所見がみられた．組織学的に下掘れ傾向のあるUl-Ⅱ以上の深い潰瘍が多く，炎症性ポリープの高さは最高6.0mmまでであった．炎症性ポリープの形成機序と敷石様所見の考え方やCrohn病の敷石像との鑑別などについて述べた．

　In the course of ulcerative colitis, it is only on rare occasions that cobblestone-like appearance can be seen by colonoscopy.

　The objects of this study were 14 cases (11.4％) in 123 cases of ulcerative colitis which were admitted for treatment from 1992 to 1997. There were five cases of left sided colitis and nine cases of total colitis. Cobblestone-like appearance was seen by colonoscopy in five cases suffering a first attack and nine cases suffering relapse during the clinical course.

　The locations of cobblestone-like appearance were recognized in 12 cases (86％) at the rectum or the left side colon.

　The characteristics of inflammatory polyposis are lesions small in size, high in density with reddening and granular surface.

　The shape of surrounding ulcerations were irregular in all cases and mixed in longitudinal fashion in four cases.

　Cobblestone-like appearance was also noticed macroscopically in seven cases of surgical specimens.

　The size of inflammatory polyps in surgical specimens ranged from small to large (over 10 mm in diameter). Microscopically, the height of inflammatory polyps was greater (3.7±1.0 mm) in emergent operation cases (p＜0.005) than in elective operation cases (2.6±0.7 mm).

　We discussed for differential diagnosis of cobblestone appearance that which was seen in Crohn's colitis.