Surawicz C M, Meisel J L, Ylvisaker T, Saunders D R, Rubin C E
Gastroenterology. 1981 Jan;80(1):66-71.
We performed a retrospective evaluation of 243 rectal biopsies from 90 patients who eventually had Crohn's disease proven clinically or by surgery. A portion of each rectal biopsy was serially sectioned. Twenty-five of the 90 patients (28%) had epithelioid granulomas. Half of these patients had an epithelioid granuloma in only one of two or more biopsies. Sixteen percent of these granulomas were so small as to be seen in only six or less successive serial 4-microM sections. This high yield of granulomas is probably attributable to the examination of at least 90 serial sections, usually from each of two rectal biopsies per patient. Using partial serial sectioning, epithelioid granulomas were found almost as frequently in grossly normal as in grossly abnormal appearing mucosa. No granulomas were seen in suitable controls including normals and patients with ulcerative colitis or other diseases. When the differential diagnosis between idiopathic ulcerative colitis and Crohn's disease is uncertain, we recommend taking two rectal biopsies and serially sectioning part of each.
我们对90例最终经临床或手术证实患有克罗恩病的患者的243份直肠活检样本进行了回顾性评估。每份直肠活检样本的一部分进行了连续切片。90例患者中有25例（28%）出现上皮样肉芽肿。这些患者中有一半仅在两份或更多活检样本中的一份中出现上皮样肉芽肿。这些肉芽肿中有16%非常小，仅在连续6个或更少的4微米切片中可见。肉芽肿的高检出率可能归因于对至少90个连续切片的检查，通常每个患者取两份直肠活检样本，每份样本都进行检查。采用部分连续切片法，在外观大体正常的黏膜中发现上皮样肉芽肿的频率与外观大体异常的黏膜中几乎相同。在包括正常人和溃疡性结肠炎或其他疾病患者在内的合适对照中未发现肉芽肿。当特发性溃疡性结肠炎和克罗恩病的鉴别诊断不明确时，我们建议取两份直肠活检样本，并对每份样本的一部分进行连续切片。
