Endoscopical and Clinical Studies on Lymph Folllicles of the Rectum

Abstract

Although lymph follicles which are situated in the mucosa or submucosa of the bowel are not rarely seen in the terminal ileum, their true etiology and clinics are difficult to be assessed due to lack of pathological verification. On the other hand, physiology and pathology of lymph follicles of the large intestine have not been discussed enough yet. The normal lymph follicles in the large intestine are extremely small in size with a range from less than 1 to 3mm and it is difficult to inspect them by usual colonoscope of which focus is fixed.
Using dye spraying method of indigocarmine or methylene blue, however, the minute structures of lymph follicles can be observed easily and clearly as slightly elevated and whitish minute granules. Moreover, using a specially designed fiberscope (Olympus CF-MB-M) with which the mucosa can be inspected on close-up, the minute structures of lymph follicles can be also easily visualized.
Therefore, using these method, 105 cases of the rectal lymph follicles were classified into four grades by their size and number per unit area on the endoscopical point of views; 21 (20.0%) to grade 0, 57 (54.3%) to grade I, 27 (25.7%) to grade II, but none to grade III. Grades of the rectal lymph follicles correlated to age distribution, but there was no particular correlation between grades of lymph follicles and sex, underlying diseases of the patients and laboratory data such as peripheral lymphocyte count, serum γ-globulin, IgA, C3, C4, PHA skin test, Mantoux's reaction and so on. Therefore, it was suspected that the lymph follicles of the rectum have no specific clinical meanings.
In cases of"colitis aphthosa"which is an extremely rare inflammatory colon disease, however, inflammation occurs at lymph follicles. Although its etiology and clinical and/or pathological meanings have been elucidated yet, its inflammatory process is very interesting to discuss the patho-physiological meanings of the rectal lymph follicles.