Crohn病診断における類上皮細胞肉芽腫の意義

Significance of Epithelioid Cell Granuloma in the Diagnosis of Crohn's Disease

要旨●類上皮細胞肉芽腫の病理組織学的特徴を概説し，Crohn病（CD）における肉芽腫の臨床的意義と，肉芽腫が出現し鑑別が必要な疾患（腸結核，エルシニア腸炎，サルコイドーシス，肉芽腫性胃炎，慢性肉芽腫症）について述べた．類上皮細胞肉芽腫の検出はCDの確定診断に重要であり，病初期や非定型例の診断には特に有用である．肉芽腫の検出は複数回の生検や上部消化管生検の併用により検出率が向上する．肉芽腫の組織形態や分布は各疾患別に特徴があるため，CDの診断と鑑別に際しては，これらの特徴を考慮し，臨床経過，画像所見，病理組織学的所見を総合的に判断する必要がある．

　This report summarized the histopathological characteristics of epithelioid cell granulomas and discussed the clinical significance of granulomas in CD（Crohn's disease）alongside diseases in which granulomas appear, making differentiation necessary（intestinal tuberculosis, Yersinia enteritis, sarcoid granuloma, granulomatous gastritis, and chronic granulomatous disease）. Epithelioid cell granuloma detection is important for the definitive diagnosis of CD and is particularly useful in the diagnosis of the initial stages of the disease as well as atypical cases. Granuloma detection rate is improved when used in conjunction with multiple biopsies or upper gastrointestinal tract biopsy. Because the characteristics of granuloma structural morphology and distribution differ by disease, CD diagnosis and differentiation must be performed while taking these characteristics into account and based on a comprehensive judgment of clinical course, imaging findings, and histopathological findings.