Difference between revisions of "Autoimmune metaplastic atrophic gastritis"

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#redirect [[Stomach#Autoimmune metaplastic atrophic gastritis]]
'''Autoimmune metaplastic atrophic gastritis''', also '''autoimmune gastritis'''<ref name=pmid16382988>{{Cite journal  | last1 = Chlumská | first1 = A. | last2 = Boudová | first2 = L. | last3 = Benes | first3 = Z. | last4 = Zámecník | first4 = M. | title = Autoimmune gastritis. A clinicopathologic study of 25 cases. | journal = Cesk Patol | volume = 41 | issue = 4 | pages = 137-42 | month = Oct | year = 2005 | doi =  | PMID = 16382988 }}</ref> is a rare pathology of the [[stomach]].  It is closely associated with '''pernicious anemia'''.


==General==
*Pathology: loss of parietal cells, gastric atrophy, [[macrocytic anemia]].
*Etiology: autoimmune.
Diagnosis based on serology for antibodies to:<ref name=pmid12643357>{{Cite journal  | last1 = Oh | first1 = R. | last2 = Brown | first2 = DL. | title = Vitamin B12 deficiency. | journal = Am Fam Physician | volume = 67 | issue = 5 | pages = 979-86 | month = Mar | year = 2003 | doi =  | PMID = 12643357 }}</ref>
*Parietal cells.
*Intrinsic factor.
Others:
*Gastrin level (increased).<ref name=pmid21947876>{{Cite journal  | last1 = Annibale | first1 = B. | last2 = Lahner | first2 = E. | last3 = Fave | first3 = GD. | title = Diagnosis and management of pernicious anemia. | journal = Curr Gastroenterol Rep | volume = 13 | issue = 6 | pages = 518-24 | month = Dec | year = 2011 | doi = 10.1007/s11894-011-0225-5 | PMID = 21947876 }}</ref>
**Normal < 100 pg/mL.<ref>URL: [http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512 http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512]. Accessed on: 14 August 2012.</ref>
Note:
*Parietal cells produce ''intrinsic factor'' (important for vitamin B12 absorption) and ''hydrogen chloride'', i.e. stomach acid.
==Microscopic==
Features:
*Corpus predominant inflammation - usu. moderate or severe - '''key feature'''.
*Loss of parietal cells.
*Increased G cells in the antrum.
**Produce gastrin to stimulate the (missing) parietal cells.
DDx:
*[[Gastric neuroendocrine tumour]].
Notes:
*Compare with other types of ''[[gastric atrophy]]''.
==IHC==
Features:<ref name=pmid20975338>{{Cite journal  | last1 = Park | first1 = JY. | last2 = Cornish | first2 = TC. | last3 = Lam-Himlin | first3 = D. | last4 = Shi | first4 = C. | last5 = Montgomery | first5 = E. | title = Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting. | journal = Am J Surg Pathol | volume = 34 | issue = 11 | pages = 1591-8 | month = Nov | year = 2010 | doi = 10.1097/PAS.0b013e3181f623af | PMID = 20975338 }}</ref>
*Chromogranin A +ve (demonstrates ''nodular enterochromaffin-like cell hyperplasia'').
*Gastrin -ve (body of stomach).
**+ve in antrum.
Images:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575912/figure/f5/ Autoimmune gastritis - chromogranin A (nih.gov)].<ref name=pmid18719002>{{Cite journal  | last1 = Pritchard | first1 = DM. | last2 = Berry | first2 = D. | last3 = Przemeck | first3 = SM. | last4 = Campbell | first4 = F. | last5 = Edwards | first5 = SW. | last6 = Varro | first6 = A. | title = Gastrin increases mcl-1 expression in type I gastric carcinoid tumors and a gastric epithelial cell line that expresses the CCK-2 receptor. | journal = Am J Physiol Gastrointest Liver Physiol | volume = 295 | issue = 4 | pages = G798-805 | month = Oct | year = 2008 | doi = 10.1152/ajpgi.00015.2008 | PMID = 18719002 }}</ref>
**Findings may be seen in hypergastrinemia and nodular enterochromaffin cell-like (ECL) hyperplasia.
==Sign out==
<pre>
STOMACH, BIOPSY:
- SEVERE CHRONIC ACTIVE GASTRITIS WITH EXTENSIVE INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
COMMENT:
Parietal cells are not apparent on the H&E stained sections. Immunostains show
rows of Chromogranin A positive cells and a lack of gastrin staining. 
These findings suggest an autoimmune gastritis; correlation with blood work
is suggested.
</pre>
==See also==
*[[Stomach]].
*[[Gastritis]].
**[[Chronic gastritis]].
*[[Anemia]].
==References==
{{Reflist|2}}
[[Category:Stomach]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Revision as of 02:03, 28 September 2013

Autoimmune metaplastic atrophic gastritis, also autoimmune gastritis[1] is a rare pathology of the stomach. It is closely associated with pernicious anemia.

General

  • Pathology: loss of parietal cells, gastric atrophy, macrocytic anemia.
  • Etiology: autoimmune.

Diagnosis based on serology for antibodies to:[2]

  • Parietal cells.
  • Intrinsic factor.

Others:

  • Gastrin level (increased).[3]
    • Normal < 100 pg/mL.[4]

Note:

  • Parietal cells produce intrinsic factor (important for vitamin B12 absorption) and hydrogen chloride, i.e. stomach acid.

Microscopic

Features:

  • Corpus predominant inflammation - usu. moderate or severe - key feature.
  • Loss of parietal cells.
  • Increased G cells in the antrum.
    • Produce gastrin to stimulate the (missing) parietal cells.

DDx:

Notes:

IHC

Features:[5]

  • Chromogranin A +ve (demonstrates nodular enterochromaffin-like cell hyperplasia).
  • Gastrin -ve (body of stomach).
    • +ve in antrum.

Images:

Sign out

STOMACH, BIOPSY:
- SEVERE CHRONIC ACTIVE GASTRITIS WITH EXTENSIVE INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
Parietal cells are not apparent on the H&E stained sections. Immunostains show 
rows of Chromogranin A positive cells and a lack of gastrin staining.  

These findings suggest an autoimmune gastritis; correlation with blood work 
is suggested.

See also

References

  1. ↑ Chlumská, A.; Boudová, L.; Benes, Z.; Zámecník, M. (Oct 2005). "Autoimmune gastritis. A clinicopathologic study of 25 cases.". Cesk Patol 41 (4): 137-42. PMID 16382988.
  2. ↑ Oh, R.; Brown, DL. (Mar 2003). "Vitamin B12 deficiency.". Am Fam Physician 67 (5): 979-86. PMID 12643357.
  3. ↑ Annibale, B.; Lahner, E.; Fave, GD. (Dec 2011). "Diagnosis and management of pernicious anemia.". Curr Gastroenterol Rep 13 (6): 518-24. doi:10.1007/s11894-011-0225-5. PMID 21947876.
  4. ↑ URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512. Accessed on: 14 August 2012.
  5. ↑ Park, JY.; Cornish, TC.; Lam-Himlin, D.; Shi, C.; Montgomery, E. (Nov 2010). "Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting.". Am J Surg Pathol 34 (11): 1591-8. doi:10.1097/PAS.0b013e3181f623af. PMID 20975338.
  6. ↑ Pritchard, DM.; Berry, D.; Przemeck, SM.; Campbell, F.; Edwards, SW.; Varro, A. (Oct 2008). "Gastrin increases mcl-1 expression in type I gastric carcinoid tumors and a gastric epithelial cell line that expresses the CCK-2 receptor.". Am J Physiol Gastrointest Liver Physiol 295 (4): G798-805. doi:10.1152/ajpgi.00015.2008. PMID 18719002.
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