Iacobuzio-Donahue C A, Lee E L, Abraham S C, Yardley J H, Wu T T
Division of Gastrointestinal/Liver Pathology, Department of Pathology, Johns Hopkins University School of Medicine and Hospital, Baltimore, Maryland 21205-2196, USA.
Am J Surg Pathol. 2001 Aug;25(8):1067-73. doi: 10.1097/00000478-200108000-00012.
Colchicine is an alkaloid with antimitotic ability used to treat a variety of medical conditions. Colchicine toxicity can result in multiorgan failure and death. The histopathologic features of colchicine toxicity in gastrointestinal biopsies have not been reported. Twenty-one gastrointestinal mucosal biopsies obtained from nine patients receiving oral colchicine therapy were studied. Immunohistochemical staining for Ki67 proliferation antigen was performed, and medical records of each patient were reviewed. All patients had a history of gout. Four patients with chronic renal failure also had clinical evidence of colchicine toxicity, and the other five patients did not. Distinct morphologic changes, seen as metaphase mitoses, epithelial pseudostratification, and loss of polarity, were seen in biopsy material from 4 of 4 (100%) patients with clinical colchicine toxicity. Three of these four cases (75%) also contained abundant crypt apoptotic bodies. These morphologic features were best seen in the biopsies from duodenum and gastric antrum, with relative sparing of the gastric body in the upper gastrointestinal tract. Ki67 staining demonstrated an expansion of the proliferating region in three available cases with clinical colchicine toxicity. These distinctive morphologic features were not seen in the five patients without clinical colchicine toxicity. These results indicate that colchicine toxicity can produce diagnostic morphologic features in gastrointestinal mucosal biopsies. Recognition of these features is important because colchicine toxicity can be fatal if undiagnosed clinically.
秋水仙碱是一种具有抗有丝分裂能力的生物碱，用于治疗多种病症。秋水仙碱中毒可导致多器官功能衰竭和死亡。秋水仙碱中毒在胃肠道活检中的组织病理学特征尚未见报道。我们对9例接受口服秋水仙碱治疗的患者获取的21份胃肠道黏膜活检样本进行了研究。对Ki67增殖抗原进行了免疫组化染色，并查阅了每位患者的病历。所有患者均有痛风病史。4例慢性肾衰竭患者也有秋水仙碱中毒的临床证据，另外5例患者则没有。在4例（100%）有秋水仙碱中毒临床症状的患者的活检材料中可见明显的形态学改变，表现为中期有丝分裂、上皮假复层化和极性丧失。这4例中的3例（75%）还含有丰富的隐窝凋亡小体。这些形态学特征在上消化道十二指肠和胃窦的活检中最为明显，胃体相对较少受累。在3例有秋水仙碱中毒临床症状的可用病例中，Ki67染色显示增殖区域扩大。在5例没有秋水仙碱中毒临床症状的患者中未见到这些独特的形态学特征。这些结果表明，秋水仙碱中毒可在胃肠道黏膜活检中产生具有诊断意义的形态学特征。认识到这些特征很重要，因为秋水仙碱中毒如果临床未被诊断可能会致命。
