炎症性肠病内镜活检标本的诊断及鉴别诊断

Diagnosis and differential diagnosis of inflammatory bowel disease in endoscopic biopsies

目的探讨炎症性肠病(inflammatory bowel disease,IBD)内镜活检标本的病理诊断及鉴别诊断。方法对209例内镜下活检诊断为IBD的HE切片重新阅片,按照系统性诊断步骤,即组织结构、上皮及固有层的改变综合评估,进行病理形态分析。结果溃疡性结肠炎(ulcerative colitis,UC)108例,克罗恩病(Crohn disease,CD)19例,不能排除CD 20例,不能确定为UC或CD 27例,按系统性诊断方法,其中35例不能诊断为IBD。结论按照系统性诊断步骤,IBD不易漏诊,也不会过诊断。内镜活检标本诊断UC较容易,诊断CD较难,除非看到非干酪样上皮样肉芽肿,CD内镜活检的主要目的是排除淋巴瘤和肠结核。

Purpose To investigate diagnosis and differential diagnosis of inflammatory bowel disease （IBD） in endoscopic biopsies. Methods 209 cases of IBD were reviewed in endoscopic biopsies, according to systematicness procedure, architectural changes, epithelial changes, lamina propria changes in HE-stained paraffin sections. Results There were 108 ulcerative colitis cases, 19 Crohn＇ s disease （CD） cases, 20 cases of suspicious CD, 27 cases that were unable to distinguish ulcerative colitis （UC） from CD, and 35 cases that could not be diagnosed as IBD according to a systematic procedure. Conclusions According to the systematicness procedure, IBD is easy to be correctly diagnosed, but the diagnosis of CD is difficult unless the discovery of epithelioid granuloma. Endoscopic biopsies may be useful to exclude lymphoma and intestinal tuberculosis from CD.