Tripathi Prachi B, Amarapurkar Anjali D
Department of Pathology, T.N. Medical College & BYL Nair Charitable Hospital, Mumbai, India.
Trop Gastroenterol. 2009 Jan-Mar;30(1):35-9.
Gastrointestinal tuberculosis (GITB) is a great mimicker and it is often difficult to distinguish GITB from other inflammatory lesions of the intestine.
This study was carried out with the objective of analysing the entire morphological spectrum of GITB.
A total of 110 diagnosed cases of GITB were included in the study. The diagnosis was based on the presence of acid-fast bacilli (AFB) on histology, caseating or non-caseating epithelioid cell granulomas (ECGs), evidence of tuberculosis at other extraintestinal sites, and all of these along with a complete response to anti-tuberculous treatment (ATT).
The mean age was 30.9 years with M:F ratio of 1:1. On gross examination, apart from typical tuberculous lesions in the form of transverse ulcers, strictures, hyperplastic lesions and serosal tubercles, intestinal perforation (32.6%) was seen with higher frequency and ischemic bowel was also identified (7.3%). Varied morphological patterns of ECGs in the form of caseating, non-caseating, confluent, discrete and even suppurative granulomas were identified on histopathology. An important finding was the co-existence of different types of granulomas within the same case. In a significant number of cases (44.5%) granulomas were seen in a submucosal location. The predominant type of inflammation seen in the lamina propria was lymphoplasmacytic in 85.5% cases.
Pathologists should be aware of the entire spectrum of gross and histopathological features of GITB, so as to avoid misdiagnosis.
胃肠道结核（GITB）是一种极具迷惑性的疾病，常常难以将其与肠道的其他炎性病变区分开来。
本研究旨在分析胃肠道结核的整个形态学谱。
本研究共纳入110例确诊的胃肠道结核病例。诊断依据组织学检查中抗酸杆菌（AFB）的存在、干酪样或非干酪样上皮样细胞肉芽肿（ECG）、其他肠外部位的结核证据，以及所有这些特征并伴有对抗结核治疗（ATT）的完全反应。
平均年龄为30.9岁，男女比例为1:1。大体检查时，除了典型的结核病变，如横向溃疡、狭窄、增生性病变和浆膜结核结节外，还发现肠穿孔的发生率较高（32.6%），且存在缺血性肠段（7.3%）。组织病理学检查发现了多种形态的ECG，包括干酪样、非干酪样、融合性、离散性甚至化脓性肉芽肿。一个重要发现是同一病例中存在不同类型的肉芽肿。在相当数量的病例（44.5%）中，肉芽肿位于黏膜下层。在固有层中，85.5%的病例主要炎症类型为淋巴细胞浆细胞性炎症。
病理学家应了解胃肠道结核的整个大体和组织病理学特征谱，以避免误诊。
