Difference between revisions of "Autoimmune metaplastic atrophic gastritis"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Metaplastic atrophic gastritis - body -- intermed mag.jpg | ||
| Width = | | Width = Metaplastic atrophic gastritis - body of stomach. [[H&E stains]]. | ||
| Caption = | | Caption = Atrophic gastritis (body) without appreciable parietal cells. [[H&E stain]]. | ||
| Micro = corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum | | Micro = corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[chronic gastritis]], [[intestinal metaplasia of the stomach]] | | LMDDx = [[chronic gastritis]], [[intestinal metaplasia of the stomach]], [[gastric neuroendocrine tumour]] | ||
| Stains = | | Stains = | ||
| IHC = | | IHC = | ||
| Line 21: | Line 21: | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = antibodies to parietal cells | | Bloodwork = antibodies to parietal cells & intrinsic factor, [[macrocytic anemia]], increased gastrin level | ||
| Rads = | | Rads = | ||
| Endoscopy = erythema - corpus only | | Endoscopy = erythema - corpus only | ||
| Line 28: | Line 28: | ||
| ClinDDx = diffuse chronic gastritis | | ClinDDx = diffuse chronic 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'''. | '''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> (abbreviated '''AIG'''), is a rare pathology of the [[stomach]]. It is closely associated with '''pernicious anemia'''. | ||
==General== | ==General== | ||
*Pathology: loss of parietal cells, gastric atrophy | *Pathology: loss of parietal cells, gastric atrophy. | ||
*Lab: classically considered to have [[macrocytic anemia]]; however, normocytic and microcystic more common.<ref name=pmid16239424>{{Cite journal | last1 = Hershko | first1 = C. | last2 = Ronson | first2 = A. | last3 = Souroujon | first3 = M. | last4 = Maschler | first4 = I. | last5 = Heyd | first5 = J. | last6 = Patz | first6 = J. | title = Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion. | journal = Blood | volume = 107 | issue = 4 | pages = 1673-9 | month = Feb | year = 2006 | doi = 10.1182/blood-2005-09-3534 | PMID = 16239424 }}</ref> | |||
*Etiology: autoimmune. | *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> | 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><ref>{{cite journal |authors=Salinas M, Flores E, López-Garrigós M, Leiva-Salinas C |title=High frequency of anti-parietal cell antibody (APCA) and intrinsic factor blocking antibody (IFBA) in individuals with severe vitamin B12 deficiency - an observational study in primary care patients |journal=Clin Chem Lab Med |volume=58 |issue=3 |pages=424–429 |date=February 2020 |pmid=31714882 |doi=10.1515/cclm-2019-0749 |url=}}</ref> | ||
*Parietal cells. | *Parietal cells: anti-parietal cell antibody (APCA). | ||
*Intrinsic factor. | *Intrinsic factor: intrinsic factor blocking antibody (IFBA). | ||
Others: | 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> | *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> | ||
| Line 60: | Line 61: | ||
DDx: | DDx: | ||
*[[Gastric neuroendocrine tumour]]. | *[[Gastric neuroendocrine tumour]]. | ||
*[[Intestinal metaplasia of the stomach]] with chronic inflammation. | |||
*[[Chronic gastritis]]. | |||
===Images=== | |||
<gallery> | |||
Image: Metaplastic atrophic gastritis - body -- very low mag.jpg | MAG (body) - very low mag. | |||
Image: Metaplastic atrophic gastritis - body -- low mag.jpg | MAG (body) - low mag. | |||
Image: Metaplastic atrophic gastritis - body - alt -- low mag.jpg | MAG (body) - low mag. | |||
Image: Metaplastic atrophic gastritis - body -- intermed mag.jpg | MAG (body) - intermed. mag. | |||
Image: Metaplastic atrophic gastritis - body -- high mag.jpg | MAG (body) - high mag. | |||
Image: Metaplastic atrophic gastritis - body - alt -- high mag.jpg | MAG (body) - high mag. | |||
Image: Metaplastic atrophic gastritis - body -- very high mag.jpg | MAG (body) - very high mag. | |||
Image: Metaplastic atrophic gastritis - body 2 -- very low mag.jpg | MAG (body) - very low mag. | |||
Image: Metaplastic atrophic gastritis - body 2 -- low mag.jpg | MAG (body) - low mag. | |||
Image: Metaplastic atrophic gastritis - body 2 - alt -- low mag.jpg | MAG (body) - low mag. | |||
Image: Metaplastic atrophic gastritis - body 2 -- intermed mag.jpg | MAG (body) - intermed. mag. | |||
Image: Metaplastic atrophic gastritis - body 2 -- high mag.jpg | MAG (body) - high mag. | |||
Image: Metaplastic atrophic gastritis - body 2 - alt -- high mag.jpg | MAG (body) - high mag. | |||
Image: Metaplastic atrophic gastritis - antrum -- low mag.jpg | MAG - antrum - low mag. | |||
Image: Metaplastic atrophic gastritis - antrum -- intermed mag.jpg | MAG - antrum - low mag. | |||
Image: Metaplastic atrophic gastritis - antrum - alt -- intermed mag.jpg | MAG - antrum - low mag. | |||
</gallery> | |||
==IHC== | ==IHC== | ||
| Line 67: | Line 97: | ||
**+ve in antrum. | **+ve in antrum. | ||
Images: | ===Images=== | ||
====Body==== | |||
<gallery> | |||
Image: Metaplastic atrophic gastritis - body - chromogranin A -- very low mag.jpg | MAG (body) - chromogranin A - very low mag. | |||
Image: Metaplastic atrophic gastritis - body - chromogranin A -- low mag.jpg | MAG (body) - chromogranin A - low mag. | |||
Image: Metaplastic atrophic gastritis - body - chromogranin A -- intermed mag.jpg | MAG (body) - chromogranin A - intermed. mag. | |||
Image: Metaplastic atrophic gastritis - body - chromogranin A -- high mag.jpg | MAG (body) - chromogranin A - high mag. | |||
Image: Metaplastic atrophic gastritis - body - gastrin -- low mag.jpg | MAG (body) - gastrin - low mag. | |||
Image: Metaplastic atrophic gastritis - body - alt - gastrin -- low mag.jpg | MAG (body) - gastrin - low mag. | |||
</gallery> | |||
====Antrum==== | |||
<gallery> | |||
Image: Metaplastic atrophic gastritis - antrum - gastrin -- low mag.jpg | MAG (antrum) - gastrin - low mag. | |||
Image: Metaplastic atrophic gastritis - antrum - gastrin -- intermed mag.jpg | MAG (antrum) - gastrin - intermed. mag. | |||
</gallery> | |||
====www==== | |||
*[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> | *[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. | **Findings may be seen in hypergastrinemia and nodular enterochromaffin cell-like (ECL) hyperplasia. | ||
==Sign out== | ==Sign out== | ||
<pre> | |||
Stomach, Body, Biopsy: | |||
- Gastric mucosa with INTESTINAL METAPLASIA, | |||
moderate chronic inactive inflammation and atrophic features, SEE COMMENT. | |||
- NEGATIVE for apparent parietal cells, SEE COMMENT. | |||
- NEGATIVE for Helicobacter-like organisms. | |||
- NEGATIVE for dysplasia and NEGATIVE for malignancy. | |||
Comment: | |||
Immunostains show rows of Chromogranin A positive cells and a lack of gastrin staining. | |||
These findings suggest an autoimmune (metaplastic atrophic) gastritis; correlation with blood work and clinical findings is recommended. | |||
</pre> | |||
====Listing the blood work==== | |||
<pre> | |||
If not already done, correlation with blood work (anti-parietal cell antibody, intrinsic factor blocking antibody, gastrin) and clinical findings is recommended. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
Latest revision as of 18:31, 22 April 2024
| Autoimmune metaplastic atrophic gastritis | |
|---|---|
| Diagnosis in short | |
 Atrophic gastritis (body) without appreciable parietal cells. H&E stain. | |
|
| |
| LM | corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum |
| LM DDx | chronic gastritis, intestinal metaplasia of the stomach, gastric neuroendocrine tumour |
| Site | stomach |
|
| |
| Prevalence | uncommon |
| Blood work | antibodies to parietal cells & intrinsic factor, macrocytic anemia, increased gastrin level |
| Endoscopy | erythema - corpus only |
| Clin. DDx | diffuse chronic gastritis |
Autoimmune metaplastic atrophic gastritis, also autoimmune gastritis[1] (abbreviated AIG), is a rare pathology of the stomach. It is closely associated with pernicious anemia.
General
- Pathology: loss of parietal cells, gastric atrophy.
- Lab: classically considered to have macrocytic anemia; however, normocytic and microcystic more common.[2]
- Etiology: autoimmune.
Diagnosis based on serology for antibodies to:[3][4]
- Parietal cells: anti-parietal cell antibody (APCA).
- Intrinsic factor: intrinsic factor blocking antibody (IFBA).
Others:
Note:
- Parietal cells produce intrinsic factor (important for vitamin B12 absorption) and hydrogen chloride, i.e. stomach acid.
Gross
- Erythema - corpus involved, antrum spared.
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.
Notes:
- Compare with other types of gastric atrophy.
DDx:
- Gastric neuroendocrine tumour.
- Intestinal metaplasia of the stomach with chronic inflammation.
- Chronic gastritis.
Images
MAG (body) - very low mag.
MAG (body) - low mag.
MAG (body) - low mag.
MAG (body) - intermed. mag.
MAG (body) - high mag.
MAG (body) - high mag.
MAG (body) - very high mag.
MAG (body) - very low mag.
MAG (body) - low mag.
MAG (body) - low mag.
MAG (body) - intermed. mag.
MAG (body) - high mag.
MAG (body) - high mag.
MAG - antrum - low mag.
MAG - antrum - low mag.
MAG - antrum - low mag.
IHC
Features:[7]
- Chromogranin A +ve (demonstrates nodular enterochromaffin-like cell hyperplasia).
- Gastrin -ve (body of stomach).
- +ve in antrum.
Images
Body
MAG (body) - chromogranin A - very low mag.
MAG (body) - chromogranin A - low mag.
MAG (body) - chromogranin A - intermed. mag.
MAG (body) - chromogranin A - high mag.
MAG (body) - gastrin - low mag.
MAG (body) - gastrin - low mag.
Antrum
MAG (antrum) - gastrin - low mag.
MAG (antrum) - gastrin - intermed. mag.
www
- Autoimmune gastritis - chromogranin A (nih.gov).[8]
- Findings may be seen in hypergastrinemia and nodular enterochromaffin cell-like (ECL) hyperplasia.
Sign out
Stomach, Body, Biopsy:
- Gastric mucosa with INTESTINAL METAPLASIA,
moderate chronic inactive inflammation and atrophic features, SEE COMMENT.
- NEGATIVE for apparent parietal cells, SEE COMMENT.
- NEGATIVE for Helicobacter-like organisms.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
Comment:
Immunostains show rows of Chromogranin A positive cells and a lack of gastrin staining.
These findings suggest an autoimmune (metaplastic atrophic) gastritis; correlation with blood work and clinical findings is recommended.
Listing the blood work
If not already done, correlation with blood work (anti-parietal cell antibody, intrinsic factor blocking antibody, gastrin) and clinical findings is recommended.
Block letters
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
- ↑ 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.
- ↑ Hershko, C.; Ronson, A.; Souroujon, M.; Maschler, I.; Heyd, J.; Patz, J. (Feb 2006). "Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion.". Blood 107 (4): 1673-9. doi:10.1182/blood-2005-09-3534. PMID 16239424.
- ↑ Oh, R.; Brown, DL. (Mar 2003). "Vitamin B12 deficiency.". Am Fam Physician 67 (5): 979-86. PMID 12643357.
- ↑ Salinas M, Flores E, López-Garrigós M, Leiva-Salinas C (February 2020). "High frequency of anti-parietal cell antibody (APCA) and intrinsic factor blocking antibody (IFBA) in individuals with severe vitamin B12 deficiency - an observational study in primary care patients". Clin Chem Lab Med 58 (3): 424–429. doi:10.1515/cclm-2019-0749. PMID 31714882.
- ↑ 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.
- ↑ URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512. Accessed on: 14 August 2012.
- ↑ 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.
- ↑ 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.