四肢におけるらいの末梢神経病変に関する病理学的研究

第1報 神経病変度分類ならびにボーダーライン群の神経病変について

抄録

The involvements of peripheral nerve in both extremities were histopathologically classified into five grades by changes of nerve tissue elements based on the demyelination, axonal degeneration and nerve thickening as shown in Fig. 1.
The nerve change grade could be correlated with the clinical course of leprosy. Except Grade 1 from infection to early stage, in general, Grade 2 corresponding to the early stage, Grade 3 to the developing stage, Grade 4 to the resorbing stage and Grade 5 to the terminal stage respectively.
Pathological and histopathological investigation was made from active, early resorbing and inactive (reactional) BL of 3 autopsy cases. Each autopsy case could be said to be very rare in Japan.
The active case of BL was of 92 yrs. old, male, who died at the short period of about 6 months from onset. It was during chemotherapy of CIBA for 3 months after admission. Leprous lesions of skin and peripheral nerves of this case were demonstrated BL lesion as shown in Fig. 8 to Fig. 15. The histopathological findings of peripheral nerves in common with skin were characterized by less leprosy bacilli than that of LL lesion and lymphocytic infiltration in the leprous lesion. And the nerve fibers were markedly affected by the invasion of the leprous lesion developed in the intrafunicular interstice. In these nerve tissues Schwann cells contained leprosy bacilli which were short rod and/or granulated less in number as compared with those of regular LL lesion.
The BL case of an early resorting stage was of 31 yrs. old, male, hospitalized for a long duration of 16 years. The chemotherapy of promin was continued for 6 years. The leprous lesions in skin as well as peripheral nerves represeented the characteristic feature of BL. The nerve changes showed considerable remains of scattered leprosy bacilli in the nerve bundles, while, the infiltration of lymphocytes was more markedly proliferated. It was also characteristic of the early resorbing stage that homogenized and elongated acid-fast substances were demonstrated in the Schwann cells as shown in Fig. 19, and more proliferated lymphocytes, some rupture and collagenous-fibrotic proliferation of nerve fibers were found.
The inactive and reactional BL case was of 27 yrs. old, male, admitted about 6 years ago and committed suicide during chemotherapy of Promin for one year. It was considered that a reversal reaction occurred in this case judzing from marked edema, obious dilatation of blood-capillaries and some lymphocytic infiltration in the nerve interstice, Atrophy and fragmentation was seen in the nerve fibers. Also, as another finding, foreign body giant cells containing acid-fast substances char-acteristically appeared in the nerve interstice in this reactional case