蚕食性角膜潰瘍の病理組織学的所見

Histopathology in a case of bilateral Mooren's corneal ulcer

　80歳，男性の両眼性の蚕食性角膜潰瘍の1症例を報告した。両眼の疼痛で，当科受診し，両角膜辺縁部にほぼ全周にわたる潰瘍を認めた。急性肺炎のため入院後まもなく死亡した。強膜を含めた角膜を摘出し，HE染色およびPAP法にて光顕的に検索したところ典型的な蚕食性角膜潰瘍の所見を呈し，炎症は上皮，実質，一部内皮に及び，炎症細胞はリンパ球，形質細胞および，マクロファージがみられた。PAP法ではIgG＞IgA細胞が多く，免疫グロブリンの上皮下，特にボーマン膜への沈着もみられ，自己免疫の関与が示唆された。

We performed post mortem histopathological studies of eyes with bilateral Mooren's ulcer from an 80-year-old male. Light microscopy showed typical features of Mooren's ulcer with an overhan-ging central lip consisting of granulation tissue covered by epithelium. Chronic inflammation with proliferation of granulation tissue was present beneath the ulcer, in the stroma and partly in the endothelial layer. The inflammatory cells consisted of lymphocytes, plasma cells, macrophages andneutrophils. Small scars were located in the sub-epithelial layer where Bowman's layer had disappeared. Papanicolaou staining showed cells bearing IgG, IgA, IgM and IgE in the descending order of frequency mainly in the granulation tissue beneath the ulcers in the active or healing stage. Immunoglobulins, particularly IgG and comple-ment C₃, were deposited beneath the epithelium. IgG was focally deposited in the still intact Bow-man's membrane near the ulcer. The findings sug-gested a possible autoimmune mechanism in the etiology of Mooren's ulcer.