Kleer C G, Appelman H D
Department of Pathology, University of Michigan Medical Center, Ann Arbor, USA.
Am J Surg Pathol. 1998 Aug;22(8):983-9. doi: 10.1097/00000478-199808000-00008.
Chronic inflammation, both endoscopic and histologic, in a contiguous and symmetric distribution is said to be important in distinguishing ulcerative colitis (UC) from Crohn's disease. Little is known whether this rule holds during the course of the disease and whether endoscopic/histologic correlation persists. In this study, we analyzed histologic patterns of UC in sequential sets of biopsy specimens to assess whether endoscopic and histologic findings correlate with time and treatment and to see whether distribution changes. Two hundred seventeen sets of colorectal biopsy specimens from 797 sites from 41 patients with clinical UC were studied and correlated with endoscopic findings. Each biopsy specimen was classified as definite or suspicious for chronic colitis or normal. Two histologic patterns of disease were identified: (1) diffuse, when all areas in all pieces from a biopsy segment had clear-cut colitis and (2) nondiffuse, when not all pieces were involved or single pieces had disease and normal mucosa both. Of 41 patients, the maximal extent of histologic disease was pancolitis in 30; 25 had less extensive disease at some point in the course. The maximal extent was left-sided in eight patients, seven of whom had less extent at some point. Of the three patients in whom the maximal extent was proctosigmoiditis, in one the inflammation disappeared. Seventy percent of the biopsy sites had diffuse patterns and 30% had nondiffuse. Histologic and endoscopic disease reverted to normal in 22 and 24 of 41 patients, respectively. Endoscopic and histologic findings were similar in 65% of the biopsy sites. Our results indicate that in long-standing UC (1) histologic disease may revert to normal mucosa, (2) because endoscopy alone may be insufficient to identify the mucosa as normal, biopsies should also be performed on the endoscopically normal mucosa, (3) the full extent of UC often is not established by a single set of biopsies, and (4) nondiffuse chronic inflammation and rectal sparing occurs in UC and are not necessarily markers of Crohn's disease.
内镜和组织学上呈连续且对称分布的慢性炎症据说是区分溃疡性结肠炎（UC）和克罗恩病的重要依据。对于这一规律在疾病过程中是否成立以及内镜/组织学相关性是否持续存在，人们知之甚少。在本研究中，我们分析了连续多组活检标本中UC的组织学模式，以评估内镜和组织学结果是否与时间和治疗相关，并观察分布是否发生变化。我们研究了41例临床诊断为UC患者的217组大肠活检标本，共797个部位，并将其与内镜检查结果进行了关联。每个活检标本被分类为慢性结肠炎确诊、可疑或正常。确定了两种疾病的组织学模式：（1）弥漫性，即活检段所有切片的所有区域均有明确的结肠炎；（2）非弥漫性，即并非所有切片均受累或单个切片既有病变又有正常黏膜。41例患者中，组织学疾病的最大范围为全结肠炎的有30例；25例在病程中的某些阶段病变范围较小。最大范围为左侧结肠炎的有8例患者，其中7例在某些阶段病变范围较小。在最大范围为直肠乙状结肠炎的3例患者中，有1例炎症消失。70%的活检部位为弥漫性模式，30%为非弥漫性。41例患者中，分别有22例和24例的组织学和内镜疾病恢复正常。65%的活检部位内镜和组织学结果相似。我们的结果表明，在长期UC中：（1）组织学疾病可能恢复为正常黏膜；（2）由于仅靠内镜检查可能不足以确定黏膜为正常，因此还应对内镜检查正常的黏膜进行活检；（3）UC的全部范围通常不能通过一组活检来确定；（4）UC中存在非弥漫性慢性炎症和直肠不受累的情况，这不一定是克罗恩病的标志。
