Kirsch R, Pentecost M, Hall P de M, Epstein D P, Watermeyer G, Friederich P W
Department of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
J Clin Pathol. 2006 Aug;59(8):840-4. doi: 10.1136/jcp.2005.032383.
The histological differential diagnosis of Crohn's disease and intestinal tuberculosis can be very challenging, as both are chronic granulomatous disorders with overlapping histological features.
To evaluate selected clinical and histological parameters in colonic biopsy specimens for their ability to discriminate between Crohn's disease and intestinal tuberculosis.
25 patients with Crohn's disease and 18 patients with intestinal tuberculosis were selected for this study on the basis of established clinical, radiological and histological criteria. Clinical data and selected histological parameters in colonoscopic biopsy specimens were assessed retrospectively. A total of 103 and 41 biopsy sites were evaluated in patients with Crohn's disease and intestinal tuberculosis, respectively.
Clinical parameters helpful in differentiating intestinal tuberculosis from Crohn's disease included chest radiographic features of tuberculosis (56% v 0%), perianal fistulae (0% v 40%) and extraintestinal manifestations of Crohn's disease (0% v 40%). Histopathological features that seemed to reliably differentiate between intestinal tuberculosis and Crohn's disease included confluent granulomas, > or =10 granulomas per biopsy site and caseous necrosis (in biopsy samples of 50%, 33% and 22% of patients with intestinal tuberculosis, respectively, v 0% of patients with Crohn's disease). Features that were observed more often in patients with intestinal tuberculosis than in those with Crohn's disease included granulomas exceeding 0.05 mm(2) (67% v 8%), ulcers lined by conglomerate epithelioid histiocytes (61% v 8%) and disproportionate submucosal inflammation (67% v 10%).
Clinical features and selected histological parameters in colonoscopic biopsy specimens can help in differentiating between Crohn's disease and intestinal tuberculosis.
克罗恩病与肠结核的组织学鉴别诊断极具挑战性，因为二者均为具有重叠组织学特征的慢性肉芽肿性疾病。
评估结肠活检标本中选定的临床和组织学参数区分克罗恩病与肠结核的能力。
基于既定的临床、放射学和组织学标准，选取25例克罗恩病患者和18例肠结核患者进行本研究。回顾性评估结肠镜活检标本中的临床数据和选定的组织学参数。分别对克罗恩病患者和肠结核患者的103个和41个活检部位进行了评估。
有助于鉴别肠结核与克罗恩病的临床参数包括结核的胸部X线特征（56% 对0%）、肛周瘘管（0% 对40%）以及克罗恩病的肠外表现（0% 对40%）。似乎能可靠区分肠结核与克罗恩病的组织病理学特征包括融合性肉芽肿、每个活检部位≥10个肉芽肿以及干酪样坏死（分别见于50%、33%和22%的肠结核患者活检样本，而克罗恩病患者为0%）。在肠结核患者中比在克罗恩病患者中更常观察到的特征包括直径超过0.05 mm²的肉芽肿（67% 对8%）、由聚集的上皮样组织细胞衬里的溃疡（61% 对8%）以及不成比例的黏膜下炎症（67% 对10%）。
结肠镜活检标本中的临床特征和选定的组织学参数有助于区分克罗恩病与肠结核。
