每日一题_2023.08.16

A 20-year-old woman presents to the physician because of a history of bloody diarrhea and ab- dominal pain. She states that she has not traveled recently or changed her eating habits. A stool culture is negative for an infectious cause of diarrhea. Flexible sigmoidoscopy shows numerous lesions in the descending colon interrupted by normal-appearing mucosa. Which of the following features would most likely be present on a tissue biopsy of the affected region?

一名20岁女性因血性腹泻和腹痛就诊。她说她最近没有旅行，也没有改变饮食习惯。粪便培养显示感染性腹泻为阴性。乙状结肠镜检查显示降结肠中有许多病变被看似正常的黏膜打断。受累区域的组织活检最有可能出现下列哪一种特征?

(A)  Cells with loss of mucin and hyperchromatic nuclei黏蛋白缺失和细胞核深染的细胞

(B)  Crypt abscesses隐窝脓肿

(C)  Hyperplastic goblet cells杯状细胞增生

(D)  Noncaseating granulomas非干酪性肉芽肿

(E)  Ulcerated mucosa only仅黏膜溃疡

答案解析：

炎症性肠病通常在青春期晚期至成年早期出现，表现为腹痛和频繁腹泻发作。炎症性肠病的类型需要根据其临床表现、内镜和活检表现以及排除其他肠道感染性病因进行鉴别和诊断。在该患者中，外观正常的黏膜区域应立即提示诊断为克罗恩病，而不是溃疡性结肠炎。溃疡性结肠炎的特征是局限于结肠的持续黏膜炎症，总是累及直肠。隐窝脓肿和黏膜溃疡是活检的典型表现。然而，如该患者所见，克罗恩病表现为透壁性炎症，其间有正常黏膜(“跳跃性”病变)。克罗恩病可影响胃肠道的任何部分，但通常不影响直肠。非干酪性肉芽肿可在克罗恩病中发现，但在溃疡性结肠炎中未发现。

正确答案：D