Hackzell-Bradley M, Hedblad M A, Stephansson E A
Department of Dermatology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
Arch Dermatol. 1996 Aug;132(8):928-32. doi: 10.1001/archderm.132.8.928.
Metastatic Crohn's disease is a rare, often unrecognized cutaneous disorder lacking definite histopathologic criteria. The purpose of this study was to document clinicopathologic and immunologic findings in 3 patients with metastatic Crohn's disease. The histopathologic findings are evaluated in correlation to those reported in the literature in an attempt to better define the histopathologic features.
None of the patients showed signs of depressed cell-mediated immune response as evaluated with skin tests and T-cell subtyping of blood samples. One of the patients had antineutrophil cytoplasmic antibodies. Polymerase chain reaction, a highly efficient method of amplifying low levels of specific DNA sequences, did not show mycobacterial DNA in the samples studied. Granulomas of the sarcoid type with numerous foreign body and Langhans giant cells were the dominating features. In accordance with previous results, we found vascular involvement in 2 cases, manifested as granulomatous perivasculitis in both. We also found necrobiotic areas in all 3 cases.
We propose that both necrobiosis and granulomatous perivasculitis be added to the histopathologic characteristics of metastatic Crohn's disease. Patients may even have a positive antineutrophil cytoplasmic antibody test result.
转移性克罗恩病是一种罕见的、常未被认识的皮肤疾病，缺乏明确的组织病理学标准。本研究的目的是记录3例转移性克罗恩病患者的临床病理和免疫学发现。对组织病理学发现与文献报道的结果进行相关性评估，以更好地界定组织病理学特征。
通过皮肤试验和血液样本的T细胞亚群分析评估，所有患者均未显示细胞介导免疫反应降低的迹象。其中1例患者存在抗中性粒细胞胞浆抗体。聚合酶链反应是一种高效扩增低水平特定DNA序列的方法，在所研究的样本中未显示分枝杆菌DNA。以大量异物巨细胞和朗汉斯巨细胞为特征的结节病样肉芽肿是主要表现。与先前结果一致，我们在2例中发现血管受累，均表现为肉芽肿性血管周炎。我们还在所有3例中发现了渐进性坏死区域。
我们建议将渐进性坏死和肉芽肿性血管周炎纳入转移性克罗恩病的组织病理学特征。患者甚至可能抗中性粒细胞胞浆抗体检测结果呈阳性。
