Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Center for Inflammatory Bowel Disease, Department of Gastroenterology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Diagn Pathol. 2024 Oct 22;19(1):139. doi: 10.1186/s13000-024-01566-2.
Crohn's disease (CD) is a chronic intestinal inflammatory disorder, the etiology of which remains unknown, and is characterized by symptoms such as chronic abdominal pain, diarrhea, obstruction, and perianal lesions. Histopathology is widely regarded as the preferred method for diagnosing CD, although the histological diagnosis may lack specificity. The identification of granulomas is commonly believed to be the most reliable diagnostic indicator for CD, surpassing all other clinical features in significance. Nevertheless, research indicates that the detection rate of granulomas in CD exhibits considerable variability. Furthermore, granulomas can manifest in various specific infections including tuberculosis and Yersinia, as well as in a range of diseases characterized by macrophage reactions such as sarcoidosis and drug-induced enteritis. Granulomas associated with CD typically do not exhibit necrosis. However, the formation of caseous granulomas may occur as a result of secondary infections related to anti-CD drug treatment or perforation of the intestinal wall.
In this study, we present a case of a 28-year-old female patient diagnosed with CD exhibiting histologic granulomas, including both caseating and non-caseating forms, which demonstrated a positive response to medical treatment.
In clinical practice, various forms of granulomas may indicate diverse underlying diseases, yet lack specificity. It is suggested that the presence of caseous granulomas should not be considered as a definitive exclusion criterion for the diagnosis when clinical, endoscopic, imaging and other histopathological features are consistent with CD. This study is the first report of caseous granulomas in CD without concomitant tuberculosis infection.
克罗恩病（CD）是一种慢性肠道炎症性疾病，其病因仍不清楚，其特征为慢性腹痛、腹泻、梗阻和肛周病变。组织病理学被广泛认为是诊断 CD 的首选方法，尽管组织学诊断可能缺乏特异性。通常认为，肉芽肿的识别是 CD 最可靠的诊断指标，其意义超过所有其他临床特征。然而，研究表明，CD 中肉芽肿的检出率存在很大的可变性。此外，肉芽肿可以出现在包括结核病和耶尔森菌在内的各种特定感染中，以及表现为巨噬细胞反应的各种疾病中，如结节病和药物性肠炎。与 CD 相关的肉芽肿通常不表现为坏死。然而，在与抗 CD 药物治疗相关的继发性感染或肠壁穿孔的情况下，可能会形成干酪样肉芽肿。
在本研究中，我们报告了一例 28 岁女性患者，诊断为 CD 并表现出组织学肉芽肿，包括干酪样和非干酪样，对药物治疗有阳性反应。
在临床实践中，各种形式的肉芽肿可能表明存在不同的潜在疾病，但缺乏特异性。当临床、内镜、影像学和其他组织病理学特征与 CD 一致时，不应该将干酪样肉芽肿的存在视为诊断的明确排除标准。本研究首次报告了无结核感染的 CD 中的干酪样肉芽肿。
