Crohn hastalığının patolojik özellikleri

Crohn hastalığı patolojik ve klinik bir kavram olarak 1932’de yayınlanmış olmasına rağmen ve günümüze değin patogenezini saptamak amacıyla çok yoğun çabalar harcanmasına karşın, hala nedeni bilinmeyen bir hastalıktır. Diğer taraftan Crohn hastalığı, hastalar bazında oldukça heterojen bir tablo oluşturmaktadır. Viyana sınıflaması temel alındığında, hastalar fenotipik olarak 24 alt grubu ayrılmaktadır. Sonuç olarak Crohn hastalığı hem klinik hem de patolojik açıdan bir problem olarak önümüzde durmaktadır. Bu makalede patolojik bulgu ve patolojik tanı üzerinde en son görüş birliği oluşturulmuş durumlar ile Cerrahpaşa Tıp Fakültesi Patoloji Anabilim Dalı’nın bu alandaki deneyimi birlikte tartışıldı.

The pathologic features of the Crohn’s disease

Despite that Crohn’s disease has first been published as a pathologic and clinical entity in 1932, and enormous progress has been made in understanding its pathogenesis since then, there still remain unknown aspects of its etiology. Furthermore Crohn’s disease is a heterogeneous entity with, for example, 24 phenotyping subgroups according to the Vienna classification. Hence Crohn’s disease is still a problematic area in both the clinical and pathological terms. In this review, the recent consensus reached on the pathologic findings and diagnosis of Crohn’s disease is discussed, combined with the experience of the Pathology Department of the Cerrahpasa Medical Faculty.

PDF

___

1. Crohn BB, Ginsberg L, Oppenheimer G. Regional ileitis. A pathological and clinical entity. JAMA 1932; 99: 1323-1329.
2. Crohn BB. An historic note on ulcerative colitis. Gastroenterology 1962; 42: 366-367.
3. Price AB. Overlap in the spectrum of non-specific inflammatory bowel disease-‘colitis indeterminate’. J Clin Pathol 1978; 31: 567-577.
4. Janowitz HD. Burrill B. Crohn (1884-1983). Mt Sinai J Med 2000; 67: 12-13.
5. Stange EF, Travis SP, Vermeire S, et al; European Crohn's and Colitis Organisation. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut 2006; 55: 1-15.
6. Crohn BB. Granulomatous diseases of the small and large bowel. A historical survey. Gastroenterology 1967; 52: 767-772.
7. Crohn BB. The early days of regional ileitis at the Mount Sinai Hospital; reminiscences. J Mt Sinai Hosp NY 1955; 22: 143-146.
8. Crohn BB, Janowitz HD. Reflections on regional ileitis, twenty years later. J Am Med Assoc 1954; 156: 1221- 1225.
9. Harmer M. One fortunate old man. Lancet 1998; 352: 813-814.
10. Crohn BB, Abraham L. Levin Memorial Lecture: regional ileitis; ileojejunitis; combined ileocolitis. Am J Gastroenterol 1959; 31: 536-550.
11. Crohn BB. Rectal complications of inflammatory disease of the small and large bowel. Dis Colon Rectum 1960; 3: 99-102.
12. Crohn BB. The pathology of acute regional ileitis. Am J Dig Dis 1965; 10: 565-572.
13. Crohn BB. Acute regional ileitis; clinical aspects and follow-up studies. N Y State J Med 1965; 65: 641-4.
14. Crohn BB, Yarnis H. Granulomatous colitis: an attempt at clarification. J Mt Sinai Hosp N Y 1966; 33: 503-513.
15. Crohn B. Segmental (granulomatous) colitis. A historical survey. Bibl Gastroenterol 1970; 9: 85-89.
16. Lust FJ, Crohn BB, Hartman J. Nonspecific granulomatous disease involving duodenum, jejunum and ileum. Am J Gastroenterol 1965; 43: 40-48.
17. Kyle J. Dalzeil's disease-66 years on. Br Med J 1979; 1: 876-877.
18. Lichtarowicz AM, Mayberry JF. Antoni Lesniowski and his contribution to regional enteritis (Crohn's disease). J R Soc Med 1988; 81: 468-470.
19. Cigerciogullar› E, Goksel S, Bulbul Dogusoy G, et al. An analysis of the reliability of detection and diagnostic value of various pathological features in Crohn’s disease. Virchows Arch 2005; 447: 391-392.
20. Ferrante M, de Hertogh G, Hlavaty T, et al. The value of myenteric plexitis to predict early postoperative Crohn's disease recurrence. Gastroenterology 2006; 130: 1595-1606.
21. Schappi MG, Smith VV, Milla PJ, Lindley KJ. Eosinophilic myenteric ganglionitis is associated with functional intestinal obstruction. Gut 2003; 52: 752-755.
22. Knutson H, Lunderquist A, Lunderquist A. Vascular changes in Crohn's disease. Am J Roentgenol Radium Ther Nucl Med 1968; 103: 380-385.
23. Yokoyama K, Mitomi H, Kobayashi K, Katsumata T, Saigenji K, Okayasu I. Obliterative arteritis with nitric oxide synthase and HLA-DR expression in Crohn's colitis. Hepatogastroenterology 2001; 48:401-407.
24. Wakefield AJ, Sankey EA, Dhillon AP, et al. Granulomatous vasculitis in Crohn's disease. Gastroenterology 1991; 100: 1279-1287.
25. Blumstein GI, Johnson J. Gastrointestinal allergy simulating regional enteritis; report of a case. J Am Med Assoc 1951; 147: 1441-1443.
26. Haeberle MG, Griffen WO Jr. Eosinophilia and regional enteritis. A possible diagnostic aid. Am J Dig Dis 1972; 17: 200-204.
27. Korzenik JR, Dieckgraefe BK. Is Crohn's disease an immunodeficiency? A hypothesis suggesting possible early events in the pathogenesis of Crohn's disease. Dig Dis Sci 2000; 45: 1121-1129.
28. Bourna G, Strober W. The immunological and genetic basis of inflammatory bowel disease. Nature 2003; 3: 521-533.
29. Abreu MT, Sparrow MP. Translational research in inflammatory bowel disease. Mount Sinai J Med 2006; 73: 1067-1073.
30. Sands BE. Infl ammatory bowel disease: past, present, and future. J Gastroenterol 2007; 42: 16-25.
31. Takahashi H, Ando T, Watanabe O, et al. Usefulness of an elemental diet in Crohn's disease. Inflammopharmacology 2007; 15: 15-177.
32. Eisenberg RL, Montgomery CK, Margulis AR. Colitis in the elderly: ischemic colitis mimicking ulcerative and granulomatous colitis. Am J Roentgenol 1979; 133: 1113-1118.
33. Korotinski S, Katz A, Malnick SD. Chronic ischaemic bowel diseases in the aged--go with the flow. Age Ageing 2005; 34: 10-16.
34. Clark AW, Llyod-Mostyn RH, Sadler MR, De C. "Ischaemic" Colitis in Young Adults Brt Med J 1972; 4: 70-722.
35. Swart B, Dingendorf W. Incomplete mesenteric vascular occlusion as possible cause of Crohn's regional enteritis. Fortschr Geb Rontgenstr Nuklearmed 1972; 45-46.
36. Miller MH, Lunderquist A, Tylen U. Angiographic spectrum in Crohn's disease of the small intestine and colon. Surg Gynecol Obstet 1975; 141: 907-914.
37. Yassinger S, Adelman R, Cantor D, Halsted CH, Bolt RJ. Association of inflammatory bowel disease and large vascular lesions. Gastroenterology 1976; 71: 844-846.
38. Wakefield AJ, Sawyerr AM, Dhillon AP, et al. Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet 1989; 2: 1057-1062.
39. Wakefield AJ, Sawyerr AM, Hudson M, Dhillon AP, Pounder RE. Smoking, the oral contraceptive pill, and Crohn's disease. Dig Dis Sci 1991; 36: 1147-1150.
40. Pounder RE. The pathogenesis of Crohn's disease. J Gastroenterol 1994; 29: 11-15.
41. Anthony A, Dhillon AP, Pounder RE, Wakefield AJ. Ulceration of the ileum in Crohn's disease: correlation with vascular anatomy. J Clin Pathol 1997; 50: 1013-1017.
42. Loffeld RJ, Overtoom HA, Balk AT. Diffuse jejunoileitis with vasculitic abnormalities in the mesenteric arteries: a rare manifestation of Crohn's disease. Neth J Med 1996; 48: 85-88.
43. Gobbele R, Reith W, Block F. Cerebral vasculitis as a concomitant neurological illness in Crohn's disease. Nervenarzt 2000; 71: 299-304.
44. Gan SI, Urbanski S, Coderre SP, Panaccione R. Isolated visceral small artery fibromuscular hyperplasia-induced ischemic colitis mimicking inflammatory bowel disease. Am J Gastroenterol 2004; 99: 2058-2062.
45. Kao PC, Vecchio JA, Hyman NH, West AB, Blaszyk H. Idiopathic myointimal hyperplasia of mesenteric veins: a rare mimic of idiopathic inflammatory bowel disease. J Clin Gastroenterol 2005; 8: 704-708.
46. Fagin RR, Straus FH 2nd, April E, Kirsner JB. An unusual case of ischemic enteritis mimicking regional enteritis. Gastroenterology 1970; 6: 917-920.
47. Willeke P, Domagk D, Floer M, et al. Ischaemic colitis mimicking inflammatory bowel disease in a young adult receiving oral anticoagulation. Scand J Gastroenterol 2005; 7: 878-880.
48. Kasahara Y, Tanaka S, Nishino M, Umemura H, Shiraha S, Kuyama T. Intestinal involvement in Behcet's disease: review of 136 surgical cases in the Japanese literature. Dis Colon Rectum 1981; 24: 103-106.
49. Sayek I, Aran O, Uzunalimoglu B, Hersek E. Intestinal Behcet's disease: surgical experience in seven cases. Hepatogastroenterology 1991; 38: 81-83.
50. Masugi J, Matsui T, Fujimori T, Maeda S. A case of Behcet's disease with multiple longitudinal ulcers all over the colon. Am J Gastroenterol 1994; 89: 778-780.
51. Korman U, Cantasdemir M, Kurugoglu S, et al. Enteroclysis findings of intestinal Behcet disease: a comparative study with Crohn disease. Abdom Imaging 2003; 28: 308-12.
52. Fresko I, Ugurlu S, Ozbakir F, et al. Anti-Saccharomyces cerevisiae antibodies (ASCA) in Behcet's syndrome. Clin Exp Rheumatol 2005; 23: 67-70.
53. Ahmad T, Zhang L, Gogus F, et al. CARD15 polymorphisms in Behcet's disease. Scand J Rheumatol 2005; 34: 233-237.
54. Koksal AS, Ertugrul I, Disibeyaz S, et al. Crohn's and Behcet's disease association presenting with superior vena cava thrombosis. Dig Dis Sci 2005; 50: 1698-1701.
55. Gastrointestinal pathology. ECCO consensus on diagnosis and therapy of Crohn’s disease. Geboes K, Warren B (chairpersons). Business meeting. 20th European Congress of Pathology 2005; September 3-8: Paris-France.
56. Harsch IA, Wiest GH, Hahn EG, Nusko G. Ileocecal manifestation of Schoenlein-Henoch purpura as a rare differential Crohn disease diagnosis. Z Gastroenterol 2000; 38: 905-908.
57. Saulsbury FT, Hart MH. Crohn's disease presenting with Henoch-Schonlein purpura. J Pediatr Gastroenterol Nutr 2000; 31: 173-175.
58. Codish S, Abu-Shakra M, Depsames R, Sion-Vardy N, Benharroch D, Sukenik S. Wegener's granulomatosis in a patient with Crohn's disease. Isr Med Assoc J 2000; 2: 630.
59. Levitsky J, Harrison JD, Cohen RD. Crohn’s Disease and Takayasu’s Arteritis J Clin Gastroenterol 2002; 34: 454-456.
60. Reny JL, Paul JF, Lefebvre C, et al. Association of Takayasu’s arteritis and Crohn’s disease. Results of a study on 44 Takayasu patients and review of the literature. Ann Med Interne 2003; 154: 85-90.
61. Maksimowicz-Mckinnon K, Hoffman GS. Crohn’s disease plus Takayasu’s arteritis: more than coincidence? Ann Med Intern 2003; 154: 75-76
62. Tuvlin JA, Raza SS, Bracamonte S, et al. Smoking and inflammatory bowel disease: Trends in familial and sporadic Cohorts, Inflamm Bowel Dis 2007.
63. Lois E, Michel V, Hugot JP, et al. Early development of stricturing or penetrating pattern in Crohn’s disease is influenced by disease location, number of flares, and smoking but not by NOD2/CARD15 genotype. Gut 2003; 52: 552-557
64. Sonnenberg A. Geographic and temporal variations of sugar and margarine consumption in relation to Crohn's disease. Digestion 1988; 41: 161-171.
65. Rellecke P, Strauer BE. Chronic inflammatory bowel disease and cardiovascular complications. Med Klin 2006; 101: 56-60.
66. Lavu K, Minocha A. Mesenteric inflammatory venoocclusive disorder: a rare entity mimicking inflammatory bowel disorder. Gastroenterology 2003; 125: 236-239.
67. Tempia-Caliera AA, Renzulli P, Z'graggen K, Lehmann T, Ruchti C, Buchler MW. Mesenteric inflammatory veno-occlusive disease: a rare cause of intestinal ischemia. The first description of recurrent disease. Digestion 2002; 66: 262-264.
68. Cho YP, Kwon YM, Kwon TW, Kim GE. Mesenteric Buerger's disease. Ann Vasc Surg 2003; 17: 221-223.
69. Magalhaes Ede P, Trevisan M, Mochizuki M, Sachetto Z, Samara AM, Fernandes SR. Intestinal ischemia as a single manifestation of thromboangiitis obliterans-a case report. Angiology 2005; 56: 789-792.
70. Cormier F, Cormier JM. Thirty-eight cases of dysplasia of the superior mesenteric artery. J Mal Vasc 2005; 30: 150-161.
71. Meacham PW, Brantley B. Familial fibromuscular dysplasia of the mesenteric arteries. South Med J 1987; 80: 1311-1316.
72. Togao O, Mihara F, Yoshiura T, et al. Prevalence of Stenoocclusive Lesions in the Renal and Abdominal Arteries in Moyamoya Disease: AJR 2004; 183: 119-122.
73. Dvorak AM, Onderdonk AB, McLeod RS, et al. Axonal necrosis of enteric autonomic nerves in continent ileal pouches. Possible implications for pathogenesis of Crohn's disease. Ann Surg 1993; 217: 260-271.
74. Cornet A, Savidge TC, Cabarrocas J, et al. Enterocolitis induced by autoimmune targeting of enteric glial cells: a possible mechanism in Crohn's disease? Proc Natl Acad Sci USA 2001; 98: 13306-13311.
75. von Boyen GB, Steinkamp M, Geerling I, et al. Proinflammatory cytokines induce neurotrophic factor expression in enteric glia: a key to the regulation of epithelial apoptosis in Crohn's disease. Inflamm Bowel Dis 2006; 12: 346-354.
76. Wang XY, Zarate N, Soderholm JD, Bourgeois JM, Liu LW, Huizinga JD. Ultrastructural injury to interstitial cells of Cajal and communication with mast cells in Crohn's disease. Neurogastroenterol Motil 2007; 19: 349-364.
77. Ohlsson B, Veress B, Lindgren S, Sundkvist G. Enteric ganglioneuritis and abnormal interstitial cells of Cajal: Features of inflammatory bowel disease. Inflamm Bowel Dis 2007; 13: 721-726.
78. Phillip J. Morbus Crohn (enteritis regionalis). Fortschr Med 1975; 93: 1114-1117.
79. Sibartie V, Kirwan WO, O'mahony S, Stack W, Shanahan F. Intestinal tuberculosis mimicking Crohn's disease: lessons relearned in a new era. Eur J Gastroenterol Hepatol 2007; 19: 347-349.
80. Mahadeva U, Martin JP, Patel NK, Price AB. Granulomatous ulcerative colitis: a re-appraisal of the mucosal granuloma in the distinction of Crohn's disease from ulcerative colitis. Histopathology 2002; 41: 50-55.
81. Odze R. Diagnostic problems and advances in inflammatory bowel disease. Mod Pathol 2003; 16: 347-58.
82. Jess T, Jess P. Acute terminal ileitis, yersiniosis, and Crohn's disease: a long-term follow-up study of the relationships. Eur J Intern Med 2001; 12: 98-100.
83. Homewood R, Gibbons CP, Richards D, Lewis A, Duane PD, Griffiths AP. Ileitis due to Yersinia pseudotuberculosis in Crohn's disease. J Infect 2003; 47: 328- 332.
84. Mufti A, Al Kaabi NA, Rubin SZ, Suh KN. Intestinal obstruction complicating Yersinia enterocolitica serotype O:21 infection in an infant. Pediatr Infect Dis J 2005; 24: 1120-1121.
85. Sojo Aguirre A, Alvarez Pitti J, Morteruel Arizkuren E, et al. Terminal ileitis due to Yersinia enterocolitica in infants. An Pediatr 2005; 63: 555-557.
86. Saebo A, Vik E, Lange OJ, Matuszkiewicz L. Inflammatory bowel disease associated with Yersinia enterocolitica O:3 infection. Eur J Intern Med 2005; 16: 176-182.
87. Zippi M, Colaiacomo MC, Marcheggiano A, et al. Mesenteric adenitis caused by Yersinia pseudotubercolosis in a patient subsequently diagnosed with Crohn's disease of the terminal ileum. World J Gastroenterol 2006; 12: 3933-3935.
88. Gasche C, Scholmerich J, Brynskov J, et al. A simple classification of Crohn's disease: report of the Working Party for the World Congresses of Gastroenterology, Vienna 1998. Inflamm Bowel Dis 2000; 6: 8-15.
89. Leiss O, Borner N. Vienna classification of Crohn's disease: helpful or dispensable? A critical view. Z Gastroenterol 2007; 45: 265-272.
90. Cortot A, Gower-Rousseau C, Marti R, Colombel JF. Homogeneous groups of patients in Crohn's disease: reality or imagination? Gastroenterol Clin Biol 1998; 22: 591-593.