胃と腸54巻13号

2019年12月発行

今月の主題 遺伝子・免疫異常に伴う消化管病変—最新のトピックスを中心に 主題

IgG4関連消化管病変

著者： 神澤輝実¹ 来間佐和子¹ 千葉和朗¹ 小泉理美¹ 吉本憲介¹ 菊山正隆¹ 能登原憲司²

所属機関： ¹東京都立駒込病院消化器内科 ²倉敷中央病院病理診断科

ページ範囲：P.1709 - P.1714

要旨●IgG4関連疾患と同様の機序が示唆される，IgG4関連消化管病変の疾患概念は確立されていない．IgG4関連消化管病変として報告されている例は，主に粘膜下に多数のIgG4陽性形質細胞浸潤と線維化を生じて，胃や食道に著明な壁肥厚を呈する例と，胃や大腸などに生じたIgG4が関連した偽腫瘍の2つのタイプに分かれる．IgG4関連消化管病変と診断するには，多数のIgG4陽性形質細胞浸潤を伴った腫瘤や壁肥厚の形成に加えて，花筵状線維化や閉塞性静脈炎などの特徴的な病理組織像，高IgG4血症や，ほかのIgG4関連疾患の合併などを含めて判断する必要がある．固有筋層内への筋状を呈したリンパ球と形質細胞の密な浸潤と，粘膜固有層深部における形質細胞の集簇は，本病変の特徴的な病理所見の可能性がある．

参考文献

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