Ishikawa Y, Ishii T, Masuda S, Asuwa N, Kiguchi H
Department of Pathology, Hachioji Medical Center, Tokyo Medical College, Japan.
Acta Pathol Jpn. 1993 Jan-Feb;43(1-2):59-64. doi: 10.1111/j.1440-1827.1993.tb02915.x.
An autopsy case of multiple penetrated colonic ulcers with secondary amyloidosis caused by rheumatoid arthritis in a 61 year old woman is reported. Amyloid deposition was conspicuous in the transverse colon with numerous penetrating ulcers that were circumferentially scattered. Deposition was mainly in the small vessel walls of the submucosal layers. In the quantitative comparison of the histological components between the colonic segments affected by severe and mild ulcer formation, occlusive vascular amyloid deposition was revealed more frequently in the severe involved portion than in the mild involved portion. In addition, submucosal fibrosis that tended to appear around ulcers was more extensive and thicker in the former than in the latter. The complete vascular occlusion caused by amyloid deposition was particularly concentrated in the submucosal layer adjacent to the ulcer. These findings indicate that peripheral circulatory disturbance by amyloid deposition in the small vascular walls leads to ulcer formation in the colon.
报告了一例61岁女性因类风湿性关节炎导致多发性穿透性结肠溃疡并继发淀粉样变性的尸检病例。淀粉样沉积在横结肠中很明显，有许多呈环形散在分布的穿透性溃疡。沉积主要在黏膜下层的小血管壁。在对严重溃疡形成和轻度溃疡形成的结肠段的组织学成分进行定量比较时，发现严重受累部分比轻度受累部分更频繁地出现闭塞性血管淀粉样沉积。此外，倾向于出现在溃疡周围的黏膜下纤维化在前者比在后者更广泛且更厚。由淀粉样沉积引起的完全血管闭塞尤其集中在与溃疡相邻的黏膜下层。这些发现表明，小血管壁中淀粉样沉积引起的外周循环障碍导致结肠溃疡形成。
