Pathogenesis of aphthoid ulcers in Crohn's disease: Correlative findings by magnifying colonoscopy, electron microscopy, and immunohistochemistry
Pathogenesis of aphthoid ulcers in Crohn's disease: Correlative findings by magnifying colonoscopy, electron microscopy, and immunohistochemistry
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作者：
Fujimura, Y;Kamoi, R;Iida, M
背景-克罗恩病溃疡的机制仍不清楚。目的-为了阐明结肠淋巴结的滤泡相关上皮细胞（FAE）在克罗恩病溃疡形成中的作用。方法-通过放大结肠镜检查确定结肠淋巴结和口疮样病变后，从10例克罗恩病患者和3例结肠淋巴样增生患者中获得76例活检标本。本研究相关放大结肠镜，电子显微镜，和免疫组化结果的活检samples.Results-In克罗恩病，扫描电子显微镜淋巴结周围的红色光环没有明显的糜烂放大结肠镜，显示表面糜烂150-200 μ m的大小。光镜或电镜下观察，21例中有18例（86%）的淋巴结有小的糜烂。扫描和透射电子显微镜的相关性显示，在侵蚀的边缘，包括M细胞的FAE残留物。在免疫组化研究中，HLA-DR抗原仅限于无炎性肠病的淋巴增生患者的FAE的M细胞。然而，在缓解期克罗恩病患者中，HLA-DR抗原在内窥镜下具有红色晕的淋巴结的整个FAE上强烈表达，而在淋巴结周围的粘膜中表达较弱且不规则。HLA-DR强烈表达在整个发炎的结肠粘膜中的活动stage.Conclusion-the红色晕外观周围的淋巴滤泡似乎之前可见的口疮样溃疡，并建议溃疡在克罗恩病起源于FAE，可能与其生理作用作为一个门户网站的潜在致病剂的入口。
Background-The mechanism of ulceration in Crohn's disease remains unknown.Aims-To clarify the role of the follicle associated epithelium (FAE) of colonic lymphoid nodules in the formation of ulcers in Crohn's disease.Methods-After identification of colonic lymphoid nodules and aphthoid lesions by magnifying colonoscopy, 76 biopsy specimens were obtained from 10 patients with Crohn's disease and three patients with colonic lymphoid hyperplasia. This study correlated magnifying colonoscopic, electron microscopic, and immunohistochemical findings of biopsy specimens.Results-In Crohn's disease, scanning electron microscopy of lymphoid nodules surrounded by a red halo without visible erosions by magnifying colonoscopy, showed surface erosions 150-200 mu m in size. These lymphoid nodules with red halos had small erosiions either light microscopically or electron microscopically in 18 of 21 specimens (86%). Correlation of scanning and transmission electron microscopy showed residues of FAE including M cells at the edges of the erosions. In immunohistochemical studies, HLA-DR antigen was limited to M cells of FAE in the patients with lymphoid hyperplasia without inflammatory bowel disease. In Crohn's disease patients in remission, however, HLA-DR antigen was strongly expressed over the entire FAE of lymphoid nodules with a red halo endoscopically, while the expression was weak and irregular in the mucosa surrounding the lymphoid nodules. HLA-DR was strongly expressed in the entire inflamed colonic mucosa in the active stage.Conclusion-The red halo appearance surrounding lymphoid follicles seems to precede visible aphthoid ulcers and suggests that ulcerations in Crohn's disease originate from FAE, possibly related to its physiological role as a portal of entry for potentially pathogenic agents.