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嗜酸性细胞性肌间神经节炎的组织学特征:慢性假性肠梗阻的一个被低估的原因。

Histological characteristics of eosinophilic myenteric ganglionitis: an under-recognised cause of chronic intestinal pseudo-obstruction.

机构信息

Department of Human Pathology, School of Medicine, Juntendo University, 1-1-19 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.

Department of Gastroenterology, School of Medicine, Juntendo University, Tokyo, 113-8421, Japan.

出版信息

Virchows Arch. 2019 Mar;474(3):395-400. doi: 10.1007/s00428-018-02513-5. Epub 2019 Jan 4.

Abstract

Eosinophilic myenteric ganglionitis (EMG) is characterised by eosinophilic infiltration of the myenteric plexus. EMG has been rarely reported as a cause of chronic intestinal pseudo-obstruction (CIPO), and its histopathological features are not fully elucidated. We analysed seven patients with CIPO. Three of them were diagnosed with EMG and four patients were categorised as non-EMG. Clinicopathological features were similar in both groups. These features included subtle to mild lymphocytic infiltration at the myenteric ganglia/muscularis propria, loss of myenteric ganglions and interstitial cells of Cajal (ICC), and no significant findings in the mucosa. The exceptions were moderate to severe degree of eosinophilic infiltration at the myenteric ganglia/muscularis propria in EMG. Functional gastrointestinal obstruction may be associated with inflammatory cell infiltration at the myenteric ganglia/muscularis propria, leading to subsequent hypoganglionosis and deficiency of ICC in EMG. Pathologists and clinicians should be aware of this distinction during differential diagnosis of patients with CIPO.

摘要

嗜酸性细胞性肌间神经节炎(EMG)的特征是肌间神经丛嗜酸性细胞浸润。EMG 作为慢性肠假性梗阻(CIPO)的病因很少见,其组织病理学特征尚未完全阐明。我们分析了 7 例 CIPO 患者。其中 3 例诊断为 EMG,4 例归类为非 EMG。两组的临床病理特征相似。这些特征包括肌间神经节/固有肌层的轻微至轻度淋巴细胞浸润、肌间神经节和 Cajal 间质细胞(ICC)丢失,以及黏膜无明显异常。例外的是 EMG 肌间神经节/固有肌层的嗜酸性细胞浸润程度为中度至重度。功能性胃肠道梗阻可能与肌间神经节/固有肌层的炎症细胞浸润有关,导致 EMG 中随后的神经节减少和 ICC 缺乏。病理学家和临床医生在对 CIPO 患者进行鉴别诊断时应注意这一区别。

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