類上皮肉芽腫の分布と肉眼所見の対応

Distribution of Epithelioid Granuloma and Macroscopic Findings in Crohn's Disease

要旨　Crohn病における類上皮肉芽腫と潰瘍の関係およびその腸管壁における深さの分布を検討した．その結果，粘膜内に類上皮肉芽腫が存在する頻度は少なく，そのほとんどは粘膜下層，特に粘膜筋板に接してみられ，そのほかでは固有筋層あるいは漿膜下に存在していた．また潰瘍との関係ではその周囲約20mm以内に分布する頻度が高かった．以上のことから，Crohn病の生検での診断には，粘膜筋板直下までの組織を得ることが大事である．また組織学的に類上皮肉芽腫のみからCrohn病の診断は不可能で，その分布あるいは肉眼像の所見を参考にして，初めて病理学的にもその診断が可能となる．

　The relationship between epithelioid granuloma and ulcers, and distribution of granuloma by the depth of the bowel wall were evaluated. The results were summarized as follows. The incidence of epithelioid granuloma in the mucosa was low. Most epithelioid granulomas were located in the submucosa, especially adjunct to the muscular layer of mucosa. The rest of them were located in the tunica muscularis propria or submucosal layer. Epithelioid granuloma may be found less than 20 mm in length from an ulcer. Therefore, it may be important to biopsy specimens deeper than the muscular layer of mucosa. Epithelioid granuloma was not pathognomonic for Crohn's disease its distribution and macroscopic findings may help to make a diagnosis of Crohn's disease.