대장에 발생한 Crohn 병과 Behcet 병의 형태학적 비교

Abstract

[한글]

Crohn병은 위장관의 원발성 염증성 질환으로서 대개 말단회장에 발생하지만 대장만 침범하는 예가 15-20%에 이르며, Behcet병은 주로 구강 및 외부 생식기의 궤양과 눈의 염증을 일으키는 만성 질환으로서 약 1%에서 장염을 일으킨다. 우리나라에서는 Behcet병의 발

생빈도가 매우 높기 때문에 장을 침범하는 Behcet병의 절대수는 Crohn병과 별 차이가 없으며, 두 질환 모두 주로 침범되는 위장관이 말단회장과 대장이다. 소장에 발생한 경우에는 병변의 육안적인 모양이 비교적 상이하지만 병변이 대장에 위치한 경우에는 소장 병변

을 대상으로 기술된 것과 사뭇 달라서 형태학적인 감별 진단에 어려움이 많다. 그러므로 두 질환의 감별에 도움될 수 있는 형태학적 변화를 찾아 보고자 대장을 침범한 Crohn병과 Behcet병 각 8예 및 9예를 대상으로 임상, 방사선 및 병리학적 검사를 시행하였으며, 그

결과는 다음과 같다.

1. 대장을 침범한 Crohn병 8예와 Behcet형 9예 중 대장에만 병변이 있었던 것은 각각 2예와 4예였으며, 장 침범과 관련된 임상증상에는 특별한 차이가 없었으나 Crohn병은 여자에 그리고 Behcet병은 남자에 많았다.

2. 육안소견 중 Crohn병에서만 보였던 것으로는 장막 지방조직의 creeping, 장내강의 협착 및 종축형 궤양이 있었으며, 장막 섬유화, 누공형성, 조약돌 모양의 점막변화, 궤양윤곽의 불규칙성 및 궤양변연부의 융기도 Crohn병에서 더 자주 관찰되었다.

3. Behcet병의 궤양은 대개 원형이고 변연부 융기가 없었으며, Crohn병의 궤양보다 다소 깊은 경향이었다.

4. 현미경적으로는 육아종성 염증이 Crohn병에서만 나타날 수 있는 유일한 소견이며, 유문상피화생 및 점막하 림프판 확장이 Crohn병에서 더 자주 보이는 소견이었다.

5. 현미경적인 열구형성과 림프여포형성, 림프구성 혈관염의 유무, 아프타성 궤양 및 육아조직형성의 정도는 두 질환에서 비슷하였다.

6. 방사선학적으로는 분절성 병변, 조약돌모양의 점막변화, 열구형성, 그리고 회맹판의 수축이 Crohn병에서 더 자주 보이는 소견이었다.

이상의 결과를 종합하면 장내강 협착, Skip병변, 조약돌모양의 점막변화, 종축형 궤양 및 장막 지방조직의 creeping 유무에 관한 육안소견과 궤양의 모습, 그리고 육아종 및 유문상피화생의 유무가 두 질환의 감별에 중요한 반면에 아프타성 궤양, 혈관염 및 육아조직형성 정도는 감별에 도움되지 않는 소견임을 알 수 있다.

Morphological differences between Crohn's disease and intestinal Behcet's disease

involving colon

Tae Wook Yoo

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Chanil Park)

To clarify the morphological differences between Crohn's disease and intestinal

Behcet's disease which involve colon, the clinical, radiologic and gross and

microscopic features were examined on 8 cases of Crohn's disease and 9 cases of

Behcet's disease.

The results were as follows :

1. Two out of 8 Crohn's diseases and four out of 9 Behcet's diseases involved

only the colon without small bowel involvement. The clinical symptoms related to

bowel lesions were similar in both diseases. In contrast to Crohn's disease,

Behcet's disease showed male preponderance.

2. Morphological features seen only in Crohn's diseases included creeping of the

serosal fat, stricture of the lumen and the longitudinal ulcer or groove. Mural

thickening , fistular formation, cobblestone mucosal pattern and irregular outline

and marginal elevation of ulcer were more likely to be found in Crohn's disease.

3. The ulcer of the colonic Behcet's disease tended to be round, deeper,

punched-out.

4. The epithelioid granulomas developed only in Crohn's disease, and pyloric

metaplasia as well as submucosal Iymphatic dilatation were more frequently seen in

Crohn's disease.

5. Microscopic fissure, lymphoid follicle formation, Iymphocytic vasculitis and

aphthous ulcer were found in both diseases with similar frequency, and the

thickness of granulation tissue was also not contributory.

6. Radiologically, the skip involvement appealed typical of Crohn's disease.

Cobblestone appearance of the mucosa, multiple ulcer, fissuring and ileocecal valve

retraction were more frequently noted in Crohn's disease.

In conclusion, the shale of ulcer and the presence or absence of stricture, skip

lesion, longitudinal ulcer, creeping of serosal fat, granuloma and pyloric

metaplasia appear to be useful for differentiation of the two diseases, whereas the

Iymphocytic vasculitis, aphthous ulcer or the thickness of granulation tissue seem

not to contribute to the differentiation.

[영문]

To clarify the morphological differences between Crohn's disease and intestinal Behcet's disease which involve colon, the clinical, radiologic and gross and microscopic features were examined on 8 cases of Crohn's disease and 9 cases of Behcet's disease.

The results were as follows :

1. Two out of 8 Crohn's diseases and four out of 9 Behcet's diseases involved only the colon without small bowel involvement. The clinical symptoms related to bowel lesions were similar in both diseases. In contrast to Crohn's disease, Behcet's disease showed male preponderance.

2. Morphological features seen only in Crohn's diseases included creeping of the serosal fat, stricture of the lumen and the longitudinal ulcer or groove. Mural thickening , fistular formation, cobblestone mucosal pattern and irregular outline

and marginal elevation of ulcer were more likely to be found in Crohn's disease.

3. The ulcer of the colonic Behcet's disease tended to be round, deeper, punched-out.

4. The epithelioid granulomas developed only in Crohn's disease, and pyloric metaplasia as well as submucosal Iymphatic dilatation were more frequently seen in Crohn's disease.

5. Microscopic fissure, lymphoid follicle formation, Iymphocytic vasculitis and aphthous ulcer were found in both diseases with similar frequency, and the thickness of granulation tissue was also not contributory.

6. Radiologically, the skip involvement appealed typical of Crohn's disease.

Cobblestone appearance of the mucosa, multiple ulcer, fissuring and ileocecal valve retraction were more frequently noted in Crohn's disease.

In conclusion, the shale of ulcer and the presence or absence of stricture, skip lesion, longitudinal ulcer, creeping of serosal fat, granuloma and pyloric metaplasia appear to be useful for differentiation of the two diseases, whereas the Iymphocytic vasculitis, aphthous ulcer or the thickness of granulation tissue seem not to contribute to the differentiation.