Ye Ziyin, Lin Yuan, Cao Qinghua, He Yao, Xue Ling
From the Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (ZY, YL, QC, LX); and Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (YH).
Medicine (Baltimore). 2015 Dec;94(49):e2157. doi: 10.1097/MD.0000000000002157.
The incidence of Crohn's disease (CD) is increasing in Chinese populations in whom intestinal tuberculosis (ITB) is prevalent.This study aimed to identify differential diagnostic microscopic and endoscopic characteristics of CD from those of ITB.Patients with CD (N = 52) and patients with ITB (N = 16) diagnosed between 2010 and 2013 were identified. Specimens obtained via endoscopy were analyzed microscopically by a pathologist. The relationship between endoscopic appearance and histopathological features was analyzed. The χ test, Fisher's exact probability test, and the Mann-Whitney U test were used.Granulomas were present in 81.3% of ITB cases and in 67.3% of CD cases (P = 0.36). Granulomas in ITB cases were denser than those in CD cases (mean 5.29 ± 4.30 vs. 2.46 ± 3.50 granulomas per 10 low power fields; each low power field = 3.80 mm; P = 0.005). Granulomas in ITB cases were larger (mean widest diameter, 508 ± 314 μm; range, 100-1100 μm) than those in CD cases (mean widest diameter, 253 ± 197 μm; range, 50-800 μm). Basal plasmacytosis was more common in CD cases than in ITB cases (77.0% vs. 37.5%, P = 0.000). Endoscopy findings such as longitudinal ulcer, aphthous ulcer, and cobblestone appearance were only seen in CD cases (34.6%, 21.2%, and 23.1%, respectively). Granulomas were detected in the majority of cases with longitudinal ulcers (88.9%). Basal plasmacytosis was exclusively detected in cases with longitudinal ulcer and a cobblestone appearance.Characteristics of granulomas maybe the most important distinguishing features between CD and ITB. However, the histopathological characteristics of both diseases may overlap on endoscopic biopsy specimens. An accurate diagnosis should be made that considers clinical, endoscopic features, and pathologic findings.
在中国人群中，克罗恩病（CD）的发病率呈上升趋势，而肠结核（ITB）在该人群中也较为普遍。本研究旨在确定CD与ITB在显微镜检查和内镜检查方面的鉴别诊断特征。纳入了2010年至2013年间确诊的CD患者（N = 52）和ITB患者（N = 16）。由病理学家对通过内镜获取的标本进行显微镜分析。分析内镜表现与组织病理学特征之间的关系。采用χ检验、Fisher精确概率检验和Mann-Whitney U检验。81.3%的ITB病例和67.3%的CD病例存在肉芽肿（P = 0.36）。ITB病例中的肉芽肿比CD病例中的更密集（每10个低倍视野中肉芽肿的平均数分别为5.29±4.30和2.46±3.50；每个低倍视野=3.80 mm；P = 0.005）。ITB病例中的肉芽肿更大（平均最宽直径为508±314μm；范围为100 - 1100μm），而CD病例中的肉芽肿平均最宽直径为253±197μm（范围为50 - 800μm）。基底浆细胞增多在CD病例中比在ITB病例中更常见（77.0%对37.5%，P = 0.000）。内镜检查发现如纵行溃疡、阿弗他溃疡和鹅卵石样外观仅在CD病例中出现（分别为34.6%、21.2%和23.1%）。在大多数纵行溃疡病例中检测到肉芽肿（88.9%）。基底浆细胞增多仅在有纵行溃疡和鹅卵石样外观的病例中检测到。肉芽肿的特征可能是CD和ITB之间最重要的鉴别特征。然而，这两种疾病的组织病理学特征在内镜活检标本上可能会有重叠。应综合考虑临床、内镜特征和病理结果做出准确诊断。
