Revision as of 21:53, 29 April 2013

Stomach is an important organ for pathologists. It is often inflamed and may be a site that cancer arises from. Gastroenterologists often biopsy the organ. Surgeon take-out the organ. It connects the esophagus to the duodenum. An introduction to gastrointestinal pathology is in the gastrointestinal pathology article.

Normal stomach

Gross anatomy

Cardia - first part of the stomach; joins with esophagus.
Fundus - superior portion - not attached directly to the esophagus.
Body - contains parietal cells.
Pylorus - distal (think pyloric stenosis); it joins with the duodenum.
- AKA antrum.

Image: Stomach anatomy (WP).

Microscopic

Foveolar cells versus intestinal goblet cells

Intestinal goblet cells - clear mucin.
Foveolar cells - eosinophilic contents.

Stomach versus intestine

A tabular comparison:^[1]

Feature	Intestine	Stomach
Spacing	Goblets cell - spaced	Foveolar cells - beside one another
Morphology of epithelial cells	columnar	tall columnar (Champagne flute)
Vesicle at luminal surface	touching/small opening	wide open
PAS-D	-ve (???)	+ve^[2]
Villin stain^[3]^[4]	+ve	-ve
Images	Tubular adenoma - goblet cells on right of image (WC)	Gastric biopsy (microscopy-uk.org.uk), Stomach with cancer - PAS (WC), Stomach (WC)

Notes:

Intraepithelial lymphocytes in the gastric mucosa have a clear halo around 'em.^[5]
Memory device: Folveolar cells have friends, i.e. they are close to other foveolar cells.

Gastric antrum versus gastric body

Cell	Body	Antrum	Histology	Image
Parietal cell	abundant	few or none	parietal cells: intensely eosinophilic cytoplasm	[1], [2]
Chief cell	present	absent	chief cells: basophilic cytoplasm, IHC: +ve for pepsinogen I	[3]
G cell	absent	present	fried egg appearance (clear cytoplasm, round nucleus); look at high power - usu. middle 1/3 of gland,^[6] IHC: +ve for gastrin.	[4]
Surface	flat	blunted villi	antrum is somewhat duodenum-like	body - flat
Gastric glands / mucosa	thick	thin	not so useful for discrimination	body - thick, body & antrum

Notes:

G cells may superficially resemble intraepithelial lymphocytes.
- G cell nucleus is usu. perfectly round and slightly larger (diameter of 12 micrometers?) than a lymphocyte nucleus (diameter ~ 9-10 micrometers?).

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Short version

STOMACH, BIOPSY:
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.

STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.

Long version

STOMACH, BIOPSY:
- BODY/ANTRAL-TYPE GASTRIC MUCOSA.
- INFLAMMATION: ABSENT.
- ATROPHY: ABSENT.
- INTESTINAL METAPLASIA: ABSENT.
- HELICOBACTER-LIKE ORGANISMS: NOT IDENTIFIED WITH ROUTINE STAINS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Sleeve gastrectomy

Indication: morbid obesity.

STOMACH, GREATER CURVE, SLEEVE GASTRECTOMY:
- STOMACH WALL WITHIN NORMAL LIMITS.

Introduction

Useful stains for stomach

Cresyl violet stain^[7] - used to find H. pylori.^[8]
Alcian blue stain - used to find mucin^[9] which is present in intestinal metaplasia
- Other mucins stains:^[10] mucicarmine, PAS, PASD (doesn't stain glycogen)

Things to look for...

Parietal cells (indicate you're in the body of the stomach) - pink (eosinophilic) cytoplasm.
- Lack of parietal cells -- DDx: Bx of antrum (pylorus), Bx of cardia, pernicious anemia.
Goblet cells = intestinal metaplasia.
Architectural distortion of gastric glands - suspect cancer.
Signet ring cells = (usually) gastric carcinoma.
- Can be very easy to miss in some biopsies.
Inflammation + small bacteria = suspect H. pylori gastritis.

Some patterns

Gastric atrophy

General

Has a wide differential diagnosis.

Microscopic

Can take three general forms:

Intestinal metaplasia - see intestinal metaplasia section.
Pseudopyloric metaplasia; gastric body looks like gastric antrum.
- Characterized by foveolar hyperplasia.
Cell loss without replacement.
- Clue is deep inflammation in the body.

Plasma cells in the stomach

DDx of plasmacytosis:

Granulomatous gastritis

Usual DDx of granulomatous disease (see Basics article):
- DNF AAII:
  - Drugs, Neoplasms, Foreign body, Autoimmune, Allergic, Infectious, Idiopathic.

Important ones:

Autoimmune - Crohn's disease.
Infectious - Tuberculosis.
Idiopathic - Sarcoidosis.

Non-neoplastic disease

Peptic ulcer disease

Abbreviated PUD.

For duodenal manifestations see Peptic duodenitis.

General

Benign.

Complications:

Hemorrhage.
Obstruction.
Perforation - can be fatal.

Etiology - typically:^[11]

Helicobacter pylori.

Gross

Features:

Typically in the duodenum; duodenum:stomach = ~4:1.
- Epithelial defect with punched-out edges (suggestive of a benign process).

Note:

Heaped edges - suggestive of cancer.

Image:

Gastric ulcer (WC).

Microscopic

Features:

Loss of epithelium.
Inflammation.
+/-Helicobacter organisms - see Helicobacter gastritis.

Gastritis

Etiology

A specific cause is uncommonly identified histologically.

Gastritis causes:^[12]

Infectious:
- H. pylori infection.
- Tuberculosis.
- Salmonellosis.
- CMV.
Endocrine-related:
- Pernicious anemia.
- Diabetes mellitus - gastric atony.
Trauma, e.g. NG tube.
Vascular, ischemia.
Autoimmune:
- Crohn's disease.
Toxins:
- Alcohol.
- Medications, especially NSAIDs.
- Uremia.
- Smoking (heavy).
Radiation.

Endoscopic appearance

Erythematous.

Microscopic

Inflammatory cells - see below.

Acute gastritis

AKA active gastritis.

Features:

Neutrophils - especially when intraepithelial.

Focal active gastritis

DDx:

Drugs,^[13] esp. NSAIDs.
Infectious.
Inflammatory bowel disease.

Chronic gastritis

Features:

Plasma cells (in lamina propria).
- Various criteria:
  1. Two plasma cells kissing, i.e. two plasma cells touching/overlapping.
  2. Three is a crowd, i.e. three plasma cells in close proximity.

Note:

Approximately 20% of cases with an inflamed cardia will have intestinal metaplasia.^[14]

Lymphocytic gastritis

General

The DDx is limited:

Microscopic

Features:^[15]

25 lymphocytes / 100 epithelial cells.

Sydney criteria for gastritis

A bunch of pathologists in Sydney came-up with criteria... and these were revised in Houston.^[16]

Classification

Updated Sydney classification:^[16]

Feature	Non-atrophic Helicobacter	Atrophic Helicobacter	Autoimmune
Inflammation pattern	antral or diffuse	antrum & corpus, mild inflammation	corpus only
Atrophy & metaplasia	nil	atrophy present, metaplasia at incisura	corpus only

Notes:

Corpus = gastric body.
Incisura = angular incisure, incisura angularis (Latin) - notched transition point on lesser curvature of the stomach between pylorus and body.^[17]

Severity

The Sydney group suggests grading severity with the following language:^[16]

Mild.
Moderate.
Marked.

These terms are applied to the parameters described in a biopsy. The Sydney criteria lists H. pylori, neutrophils, mononuclear cells, antrum (atrophy), corpus (atrophy) and intestinal metaplasia. The paper that discusses this also give a visual analogue scale.

Parameters & Severity (adapted from Dixon et al.^[16]):

Feature	Mild	Moderate	Marked
H. pylori	few touching	many touching	piles
Neutrophils	few	bunches	crowded
Mononuclear cells	not touching	kissing	partying

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Mild chronic

STOMACH, BIOPSY: 
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MILD CHRONIC INFLAMMATION. 
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS. 
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Moderate chronic active

STOMACH, BIOPSY: 
- BODY AND ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION. 
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR HELICOBACTOR-LIKE ORGANISMS. 
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show gastric body type mucosa with small clusters of plasma cells. There are no intraepithelial neutrophils. Goblet cells are not identified. The epithelium matures normally to the surface. No Helicobacter organisms are seen.

Helicobacter gastritis

Often abbreviated HP.

General

Several Helicobacter species can cause gastritis:
- Helicobacter pylori - most common.
- Helicobacter heilmannii.

Epidemiologic associations - Helicobacter infections are associated with:^[18]

Gastritis.
Peptic ulcers.
Cancer.
- Carcinoma.
- MALT lymphoma.

Gross

Thickened gastric folds.
Erythema.

Microscopic

Features:

Helicobacter organisms - key feature.
- Helicobacter pylori:
  - Usually have v-shape (seagull-like shape).
    - May have a curved shape (comma-like shape) or U-shape.^[19]
- Helicobacter heilmannii:^[20]
  - Corkscrew appearance.
Inflammation - usually moderate chronic active.
- Clusters of (lamina propria) plasma cells.
- Neutrophils, numerous, classically intraepithelial.

Tips:

One needs to look at 400x magnification. Even at 400x they are possible to miss.
- Helicobacter are damn small. They are smaller than the nucleus of the gastric foveollar cell.
Look for mucus - they preferentially reside there.
- This is usually close to the opening of the gastric pits.
Helicobacter are found in groups. When you see several that are the same size and shape you can be sure they are real.

Notes:

Helicobacter can be in antrum and/or body.^[21]
Helicobacter don't like the intestinal mucosa or mucosa that has undergone intestinal metaplasia; you're unlikely to find 'em there.

DDx:

Dirt - material has a variable size.
Contamination from oropharynx - bacilli straight, not associated with gastric mucosa.

Images:

H. pylori - IHC (WC).
Helicobacter gastritis:
- Gastritis due to HP (WC).
- HP visible (WC).
Set of images - HP gastritis (WC).
Helicobacter heilmannii (bmj.com).^[22]

Stains

Cresyl violet stain - background and organisms blue.
Warthin-Starry stain - background yellow, organisms black.

IHC

Helicobacter pylori IHC stain +ve.

Note:

Reportly also stains Helicobacter heilmannii.^[20]

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Body

STOMACH, BIOPSY:
- BODY-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Body

STOMACH, BIOPSY:
- ANTRAL-TYPE MUCOSA WITH MODERATE CHRONIC ACTIVE GASTRITIS.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Micro

The sections show antral-type gastric mucosa with abundant lamina propria plasma cells and focal intraepithelial neutrophils. Cocci and bacilli are present. Some of the bacilli are Helicobactor-like. The epithelium matures normally to the surface. No goblet cells are identified.

Intestinal metaplasia of the stomach

AKA gastric intestinal metaplasia.
Abbreviated IM.

General

Often part of surgical pathology report, e.g. "negative for intestinal metaplasia" or "intestinal metaplasia present".
May be associated with Helicobacter spp. infection -- though Helicobacter don't like intestinal type mucosa, i.e. H. pylori are not typically found in regions with intestinal metaplasia.
May be reversible - some epidemiological evidence.^[23]
Associated with gastric carcinomas of Lynch syndrome;^[24] however, surveillance may not be worthwhile.^[25]

Significance:

Moderate risk increase for carcinoma; risk less than for Barrett's esophagus.^[26]
- Odds ratio for corpus (~5.8x) higher than antrum (2.3x) when compared to individuals without IM.^[27]

Microscopic

Features:

Goblet cells are present in the stomach - key feature.^[28]
- In H&E sections the vacuole often stains light grey.
- Foveolar epithelium should be present in the same fragment.
+/-Paneth cells - deep in the glands.^[29]
- Very rarely present.
- Very uncommon in isolation.

Note:

Intestinal metaplasia (IM) is occasionally subdivided:^[30]
- Complete IM = goblet cells and (intestinal) brush border.
- Incomplete IM = mucus vacuoles of various sizes, no (intestinal) brush border.

DDx:

Normal small bowel mucosa - no foveolar epithelium present.
Gastric dysplasia, intestinal type.

Image:

Intestinal metaplasia in the stomach - crappy quality (WC).

Stains

Alcian blue (pH 2.5)/PAS +ve.^[31]
- May be used to divide into complete (type I) and incomplete (type II).^[32]^[33]
Alican blue stain +ve.^{[citation needed]}

Image:

Barrett's mucosa - Alcian blue stain (WC).

IHC

CDX2 +ve (-ve in normal stomach).^[23]
- Strong assoc. with Helicobacter gastritis as well as IM.^[34]

Others:

Lysozyme +ve - marks paneth cells.^[29]

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STOMACH, BIOPSY:
- BODY-TYPE MUCOSA WITH INTESTINAL METAPLASIA, FOCAL.
- MINIMAL CHRONIC GASTRITIS (BODY OF STOMACH).
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

STOMACH, BIOPSY:
- ANTRAL-TYPE MUCOSA WITH INTESTINAL METAPLASIA, EXTENSIVE.
- MILD CHRONIC (ANTRAL) GASTRITIS.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Inflammatory bowel disease & the stomach

See inflammatory bowel disease.

Histopathologic findings are usually non-specific.
Conventional thinking was upper GI involvement = Crohn's disease; this is changing.^[35]

Microscopic

Features:^[36]

Focal inflammation.
- Common finding - non-specific.
+/-Granulomas.

Miscellaneous

This is a grab bag of stuff seen in the stomach. Some of it is quite rare.

Gastric antral vascular ectasia

Abbreviated GAVE.
AKA watermelon stomach - due to characteristic endoscopic appearance.^[37]

General

Lesion of the antrum - due to dilated capillaries.

Gross/endoscopic appearance

Linear red streaks in antrum - oriented toward the pyloric valve... vaguely resembles a watermelon.

Endoscopic images:

Microscopic

Features:^[38]

Fibrin thrombi - characteristic feature.
Dilated capillaries in lamina propria.
+/-Foveollar hyperplasia.^[39]

DDx:

Portal hypertensive gastropathy - predominantly in the gastric body, usu. associated with cirrhosis, do not have fibrin thrombi.^[40]

Images:

Sign out

STOMACH, BIOPSY: 
- GASTRIC ANTRAL VASCULAR ECTASIA WITH FOVEOLAR HYPERPLASIA.
- MILD CHRONIC ACTIVE ANTRAL GASTRITIS.
- NEGATIVE FOR INTESTINAL METAPLASIA. 
- NEGATIVE FOR DYSPLASIA. 
- NEGATIVE FOR HELICOBACTER ORGANISMS.

Micro

The sections show antral-type gastric mucosa with dilated lamina propria blood vessels and intravascular fibrin thrombi. There is mild foveolar hyperplasia. Numerous neutrophils are present between the foveollar cells and within the lamina propria. Several large clusters of plasma cells are present in the lamina propria.

Reactive gastropathy

AKA chemical gastropathy,^[41] incorrectly referred to as chemical gastritis (see below).

General

May be seen in the context of a previous resection/surgical reconstruction, e.g. Billroth II.

Epidemiology

General assocations:

Increases with age.^[42]

Etologic factors - associated with:^[43]

Excess acid.
EtOH.
Bile.
H. pylori.
Drugs:^[41]
- Iron (brown pigment on histology).
- NSAIDs - synergistic effect with corticosteroids.

Drugs that cause erosions and/or ulcers -- adapted from Genta:^[41]

Drug	Comment	Indication for Rx
NSAIDs	common cause	pain, reduce cardiovascular risk
Corticosteroids	synergistic effect with NSAIDs	rheumatologic diseases + others
Potassium (KCl)	common cause	renal failure
Bisphophonates	uncommon cause	osteoporosis
Ferrous sulfate	very common if symptomatic	iron deficiency anemia
Chloroquine	uncommon	only in the context of malaria
Sodium polystyrene sulfonate (Kayexalate)	rare	renal failure patients

Relation to gastritis

May mimic a (true) gastritis symptomatically and visually in an endoscopic examination.
"Chemical gastritis" is misnomer. Etymologically, the -itis in gastritis, implies an inflammatory process. Chemical gastropathy is not (predominantly) an inflammatory process.
- This type of confusion is not uncommon. Steatohepatitis is another example of this; it is not a process with significant inflammation yet, confusingly, carries the -itis ending.

Gross/endoscopic

Features:^[44]

Antral erythema +/- erosions.
+/-Bile.

Microscopic

Features - triad:^[45]^[41]

Foveolar hyperplasia.
- Tortuosity of glands in the "neck" region of the gastric glands.
- Associated with "mucin depletion" - cytoplasm not clear -- as is usual.
Smooth muscle fibre hyperplasia.
- Abundant eosinophilic lamina propria.
Scant acute & chronic inflammatory cells.

Additional features.

+/-Edema.
+/-Erosions.

Notes:

Triad rarely present; mild inflammation common.

DDx:

Images:

Sign out

STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH REACTIVE GASTROPATHY, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
This nonspecific finding may be due to a number of causes, including medications (especially NSAIDs), alcohol and bile reflux.

Not well-developed

STOMACH, BIOPSY:
- BODY-TYPE GASTRIC MUCOSA WITHIN NORMAL LIMITS.
- ANTRAL-TYPE GASTRIC MUCOSA WITH SMOOTH MUSCLE HYPERPLASIA AND FOCAL GASTRIC GLAND TORTUOSITY, SEE COMMENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
These findings are suggestive of a reactive gastropathy; however, gland corkscrewing is not evident.

STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH PROMINENT SMOOTH MUSCLE, OTHERWISE WITHIN NORMAL
LIMITS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Autoimmune metaplastic atrophic gastritis

Pernicious anemia redirects here.

AKA autoimmune gastritis.^[47]

General

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

Diagnosis based on serology for antibodies to:^[48]

Parietal cells.
Intrinsic factor.

Others:

Gastrin level (increased).^[49]
- Normal < 100 pg/mL.^[50]

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:^[51]

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

Images:

Autoimmune gastritis - chromogranin A (nih.gov).^[52]
- Findings may be seen in hypergastrinemia and nodular ECL cell hyperplasia.

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.

Collagenous gastritis

General

Very rare.
Associated with collagenous colitis.

Microscopic

Features:

Eosinophilic material (collagen) expands lamina propria.
- Band of collagen must be ~thick as RBC diameter.
  - Proven by trichrome stain that highlights collagen.

Gastritis cystitis profunda

AKA Gastritic cystica profunda.^{[citation needed]}

General

May be associated with glandular proliferation as well.^[53] (???)
Super rare.
Similar to cystitis cystica.

Microscopic

Features:

Cystic spaces lined by foveolar epithelium.

Ménétrier's disease

AKA diffuse foveolar cell hyperplasia.^[54]

General

Super rare.
Increased risk of gastric adenocarcinoma.^[54]

Clinical:^[55]

Classical: nausea, emesis, abdominal pain and peripheral edema.
- Emesis (intractable) - most important.

Other:

Gastric mass (may mimic cancer).
Hypochlorhydria.
Protein loss (hypoalbuminemia) - leads to peripheral edema.

Epidemiology:

Men > women.
Adults usually 50s.
Associated with ulcerative colitis.

Treatment:

EGFR inhibitors.^[56]
Gastrectomy.

Gross

"Bag of worms" appearance - very thick gastric folds.

Microscopic

Features:^[54]

Foveolar cell hyperplasia - key feature.
Decreased parietal cells.
+/-Inflammation.

DDx:

Images:

Ménétrier's disease - crappy images (upmc.edu).

Gastric xanthoma

Abbreviated GX.
AKA xanthelasma.
AKA stomach lipidosis.

General

Uncommon.
Benign.

Gross/endoscopic

Yellowish nodule or plaque.^[58]
- Classically lesser curvature and antrum.^[59]

Microscopic

Features:^[58]

Collections of gastric lamina propria with lipid-laden macrophages.

DDx:

Images:

IHC

CD68 +ve.
Panker (AE1/AE3) -ve.

Gastric ischemia

Gastric necrosis redirects here.

General

Rare.
May arise due to:
- Small bowel obstruction.^[60]
- Therapeutic embolization.^[61]

Microscopic

Features:

+/-Pseudomembrane formation.^[62]
Necrosis of the epithelium lining the gastric pits.

Image:

Gastric necrosis (thieme-connect.com).^[61]

Portal hypertensive gastropathy

Abbreviated PHG.

General

Due to portal hypertension.
- Usually secondary to liver cirrhosis which is typically due to alcoholism.
  - Reported in approximately 65% of cirrhotics with portal hypertension in one paper.^[63]

Gross

Features:^[64]

Mosaic-like pattern.
- May be referred to as snakeskin-like pattern.^[65]
- Usu. body of stomach.
+/-Red spots.

Note:

May mimic eosinophilic gastritis.^[65]

Microscopic

Features:^[40]

Dilated capillaries in the submucosa (prominent) and to a lesser extent in the lamina propria - key feature.

Notes:

May be associated with hyperplastic-like polyps.^[66]
- Subepithelial granulation tissue and vascular proliferation.
Findings in mucosal biopsies are often nonspecific, i.e. not diagnostic.^[40]

DDx:

Gastric antral vascular ectasia - have thrombi in the dilated blood vessels.

Sign out

STOMACH, BIOPSY:
- ANTRAL-TYPE AND BODY-TYPE GASTRIC MUCOSA WITH PROMINENT CAPILLARIES 
AND MODERATE CHRONIC INACTIVE INFLAMMATION.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

COMMENT:
No fibrin thrombi are seen.  The findings are compatible with portal hypertension.
Clinical correlation is required.

Gastric polyps

Similar to colonic polyps - see intestinal polyps.

DDx polyp (similar to colon & rectum):

Hyperplastic - most common, characterised by abundant elongated foveola + glands.
Hamartomatous - weriod stuff.
Inflammatory fibroid polyp - inflammation, myxoid stroma.
Fundic gland polyp - cystic dilation, flat epithelium.
Gastric adenoma - polypoid gastric dysplasia.

Inflammatory fibroid polyp

General

Benign.
Through-out GI tract.
Can be thought of as granulation tissue-like.^[67]

Microscopic

Features:^[68]

Proliferating spindle cells (fibroid) - key feature.
- Loosely arranged, concentrically, around blood vessels.^[69]
- Perivascular hypocellular zones.^[67]
Inflammation:
- Eosinophils - often prominent.
+/-Leiomyoma/schwannoma-like areas - with nuclear palisading.^[67]
+/-Vascular for fibrous tissue.
Poorly circumscribed/infiltrates into the lamina propria.

DDx:

Inflammatory myofibroblastic tumour.
GIST - usually sharply demarcated border.

Notes:

Concentric = share the same centre.^[70]

Images:

IHC

Features:^[68]

CD34 +ve.
- There is a CD34 -ve variant.
Vimentin +ve -- diffuse.^[71]

Others:

CD117 -ve.^[72]
S100 -ve.

Molecular

A subset have mutations in PDGFRA.^[68]

Hyperplastic polyp of the stomach

Main article: Hyperplastic polyp

AKA gastric hyperplastic polyp.

General

Benign.
Most common gastric polyp.^[73]

Microscopic

Features:^[74]

Abundant foveolar cells and elongated glands - key feature.
+/-Gland dilation.

Negatives:

No atypical nuclei.
No hyperchromasia.
No loss of pseudostratification.

Notes:

No serrations - as in the colon.

DDx:

Ménétrier's disease^[75] (hyperplastic hypersecretory gastropathy).
Juvenile polyp^[73] - abundant lamina propria, dilated glands may have neutrophils.^[76]
Peutz-Jeghers polyp - thick superficial muscle.
Fundic gland polyp - doesn't have foveolar hyperplasia.

Images:

Fundic gland polyp

Abbreviated FGP.

General

Most common stomach polyp.^[77]
Fundic location usually.
- May be in the body.^[77]

Clinical significance

Weak association with FAP (familial adenomatous polyposis).^[77]^[78]
Associated with chronic proton pump inhibitors (PPI) use -- approximately 4x risk.^[79]

Notes:

Animal studies suggested PPIs cause neuroendocrine tumours -- but this has not been found in humans.^[80]

Microscopic

Features:^[81]

Polypoid shape (may not be appreciated on microscopy).
Dilated gastric glands.
- Flatted epithelial lining (consisting of normal foveolar epithelium) - key feature.

Notes:

The presence of dysplastic changes should prompt consideration of FAP.

DDx:

Hyperplastic polyp of the stomach - has foveolar hyperplasia, gland dilation may be present.

Image:

Fundic gland polyp (ouhsc.edu).

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POLYP, STOMACH, BIOPSY:
- FUNDIC GLAND POLYP.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Neoplastic

The spectrum from benign to malignant is divided into five:^[30]

Benign.
Indefinite for gastric epithelial dysplasia.
Low-grade gastric epithelial dysplasia.
High-grade gastric epithelial dysplasia.
Gastric carcinoma.

Gastric dysplasia

Gastric adenoma directs here.

AKA gastric columnar dysplasia.

General

Lesions that protrude into the lumen and are macroscopically apparent are known as: adenomas.^[30]
Polypoid forms are grouped various ways.^[75]

Grading

Like in the colon - they are divided into:

Low grade.
High grade.

Subclassification

One subclassification:^[82]

Intestinal: goblet cells or Paneth cells.
- Not associated with FAP.
Gastric: foveolar epithelium.
- Associated with familial adenomatous polyposis (FAP).

Microscopic

Histologic criteria similar to columnar dysplasia in the esophagus.
- The threshold is much lower than in the colon and rectum.

Foveolar type

Features:

Hyperchromasia at the surface - key feature.
Cytoplasm with (shortened) champagne flute-like luminal aspect (apical mucin caps).
Nuclear changes:
- Hyperchromasia.
- Enlargement.
No intestinal metaplasia.

DDx:

Intestinal type

Features - intestinal:

Intestinal metaplasia.
Hyperchromasia of cytoplasm.
Nuclear changes:
- Loss of nuclear polarity.
- Increased NC ratio.
- Elongation of nucleus and pseudostratification.

DDx:

Images:

Grading

Low-grade gastric dysplasia

Features:

Nuclear changes:
- Nuclear crowding/pseudostratification with hyperchromasia.
- Elongation of nuclei (cigar-shaped nuclei).
- Nuclear stratification intact; nuclei close to the basement membrane.
Architecture:
- Focal irregularities in the glandular contours.

Negatives:

No desmoplasia.
No necrosis.
No surface maturation.

DDx:

Indefinite for dysplasia.
High-grade gastric columnar dysplasia - see below.
- The threshold is much lower than in the colon and rectum!

Images:

Low-grade gastric columnar dysplasia - several images (upmc.edu).

High-grade gastric dysplasia

Features:

Nuclear changes:
- Round hyperchromatic nuclei.
- Loss of normal nuclear stratification.
Architecture:
- Irregularities in the glandular contours.
- Back-to-back glands.
- Cribriforming of the glands.
- +/-Necrosis.

Negatives:

No desmoplasia.

DDx:

Low-grade gastric columnar dysplasia.
Gastric adenocarcinoma.

Images:

Sign out

Foveolar type

 STOMACH POLYP, BIOPSY:
- ADENOMATOUS POLYP, FOVEOLAR TYPE.
- NEGATIVE FOR HIGH-GRADE DYSPLASIA. 
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.

Gastric neuroendocrine tumour

AKA neuroendocrine tumour of the stomach.

General

Behaviour dependent on the subtype.
Uncommon.

Overview of subtypes

Divided into four types:^[84]

Tumour type	Relative prevalence	Multifocality	Tumour size	Typical location	Clinical	Other	Histology
Type 1	~75%	yes	small (5-10 mm)	body	benign typically, female:male ~ 4:1, 50-60 years	chronic atrophic gastritis - usu. autoimmune	WDNET, WDNEC
Type 2	rare	yes	small ~15 mm	body	aggressive, ~50 years old	assoc. MEN I, hyperchlorhydia	WDNEC, WDNET
Type 3	10-15%	no	small and large	variable location	aggressive if >2.0 cm, males > females	normal gastrin levels	WDNET
Type 4	extremely rare	no	large	variable location	aggressive (mets usu. at time of Dx), males > females	elevated gastrin d/t parietal cell dysfunction	PDNEC

Notes:

WDNET = well-differentiated neuroendocrine tumour.
WDNEC = well-differentiated neuroendocrine carcinoma.
PDNEC = poorly-differentiated neuroendocrine carinoma.

Microscopic

See neuroendocrine tumours

Neoplastic rare

Gastric calcifying fibrous tumour

Main article: Calcifying fibrous tumour

Gastric cancer

Gastric lymphoma

Main article: MALT lymphoma

General

Associated with helicobacter infection.^[85]
Usually MALT lymphoma (mucosa-associated lymphoid tissue lymphoma).

Microscopic

Features:

Sheets of lymphoid cells.
"Lymphoepithelial lesion" - gastric crypts invaded by a monomorphous population of lymphocytes.^[86]
- Features:
  1. Cluster of lymphocytes - three cells or more - key feature.
    - Single lymphocytes don't count.
  2. Clearing around the lymphocyte cluster.
- Associated with MALT lymphoma;^[87] however, not specific.

DDx:

Reactive lymphoid hyperplasia.
Syphilis.^[88]^[89]

IHC

Panker -- most useful.

Others:

CD3 (T cells) - scatter positivity.
CD20 (B cells) +ve.
CD138 (plasma cells).
kappa, lambda -- often one is predominant, suggesting clonality.
BCL2 +ve.

Treatment

Triple therapy (two antibiotics, proton pump inhibitor (PPI)).^[90]
Surgery - if triple therapy fails.

Review paper: PMID 16950858.

Hereditary gastric cancer

Several syndromes are associated with gastric cancer:^[91]

Disease	Gene	Histology	Other
Hereditary diffuse gastric cancer (HDGC) syndrome	CDH1 (E-cadherin)^[92]	diffuse - more specifically signet ring cell carcinoma	most important; assoc. invasive lobular carcinoma^[93]
Lynch syndrome	MSH2, MLH1, others	?	colorectal carcinoma, endometrial carcinoma
Familial adenomatous polyposis	APC	?	adenomatous polyps
Peutz-Jeghers syndrome	STK11	?	stomach hamartomas - not precursor
Li-Fraumeni syndrome	TP53 (p53)	?	AKA SBLA syndrome = sarcomas, breast, brain, leukemia, laryngeal, lung, adrenocortical carcinoma
Familial breast and ovarian cancer 2^[94]	BRCA2	?	?

Gastric adenocarcinoma

General

Epidemiology:

Prognosis is often poor as it is discovered at a late stage.
Higher prevalence in countries in the far east (e.g. Japan) - thought to be environmental, e.g. diet.

Risk factors:

Associated with helicobacter infections, i.e. Helicobacter gastritis.
Alcohol - heavy use.^[95]
Genetic syndromes - see hereditary gastric cancer.

Note:

Possible association with tobacco use - dependent on the study.^[96]

Treatment:

Surgical excision.
- Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.

Classification

Two different classification schemes.
- Lauren^[97] - two types:
  - Intestinal type (mass forming).
  - Diffuse type (infiltrative).
- WHO classification - 6 subtypes for adenocarcinoma:^[98]
  1. Papillary carcinoma.
  2. Tubular carcinoma.
  3. Mucinous carcinoma.
  4. Signet-ring carcinoma.
  5. Undifferentiated carcinoma.
  6. Adenosquamous carcinoma.

Lame memory device STOMACH:

Signet ring, Tubular, Oh papillary, Mucinous, Adenosquamouas, Crappy High grade (Undifferentiated).

Gross

Location:

Large carcinomas preferentially involve the lesser curvature.^[99]
Ulceration with heaped (raised) edges.
- Appearance of the typical intestinal type tumour.
Diffuse wall thickening with loss of the rugae - called linitis plastica.
- Typically due to diffuse carcinoma.

Main DDx of ulcer:

Peptic ulcer disease - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa.

Images:

Microscopic

Features - variable, either of the two following:

"Typical adenocarcinoma":
- Gland-forming lesion that infiltrates into the lamina propria or beyond.
- Nuclear pleomorphism - common.
+/-Signet ring carcinoma.
- Scattered single cells in the lamina propria or beyond with:
  - Abundant cytoplasm containing one large (mucin-filled) vacuole.
  - A peripheral nucleus (displaced by the vacuole).

DDx:

Gastric xanthoma - may mimic signet ring cell carcinoma.

Images:

Stains

Mucicarmine +ve.

IHC

CK7 +ve.
CK20 -ve, occasionally +ve.

Others:

p53 +ve in upto 75% of cases.^[100]

Molecular

May have HER2 over expression - more common in intestinal-type tumours.^[101]
- Poor prognosis - like in breast cancer.
- Scoring system different than in breast cancer - complete membrane staining is not required.

Sign out

Biopsy

Intestinal type

STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED.
- Gastric mucosa with moderate chronic active inflammation and extensive
   intestinal metaplasia.
- Benign small bowel mucosa with erosions.

Diffuse type

STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE.

COMMENT:
A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the
lamina propria.

Micro

The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric nuclei with mild nuclear atypia.

References

↑ ALS. 4 Feb 2009.
↑ Rubio, CA. (Jun 2007). "Gastric duodenal metaplasia in duodenal adenomas.". J Clin Pathol 60 (6): 661-3. doi:10.1136/jcp.2006.039388. PMC 1955048. PMID 16837629. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955048/.
↑ Osborn M, Mazzoleni G, Santini D, Marrano D, Martinelli G, Weber K (1988). "Villin, intestinal brush border hydrolases and keratin polypeptides in intestinal metaplasia and gastric cancer; an immunohistologic study emphasizing the different degrees of intestinal and gastric differentiation in signet ring cell carcinomas". Virchows Arch A Pathol Anat Histopathol 413 (4): 303–12. PMID 2459839.
↑ Braunstein, EM.; Qiao, XT.; Madison, B.; Pinson, K.; Dunbar, L.; Gumucio, DL. (May 2002). "Villin: A marker for development of the epithelial pyloric border.". Dev Dyn 224 (1): 90-102. doi:10.1002/dvdy.10091. PMID 11984877.
↑ Sternberg H4P 2nd Ed., P.484
↑ URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm. Accessed on: 3 December 2010.
↑ http://www.histology-world.com/stains/stains.htm
↑ Goggin N, Rowland M, Imrie C, Walsh D, Clyne M, Drumm B (December 1998). "Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease". Arch. Dis. Child. 79 (6): 502-5. PMC 1717771. PMID 10210995. http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10210995.
↑ http://www.histology-world.com/stains/stains.htm
↑ http://www.histology-world.com/stains/stains.htm
↑ Malfertheiner, P.; Chan, FK.; McColl, KE. (Oct 2009). "Peptic ulcer disease.". Lancet 374 (9699): 1449-61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 812-3. ISBN 0-7216-0187-1.
↑ Parfitt, JR.; Driman, DK. (Apr 2007). "Pathological effects of drugs on the gastrointestinal tract: a review.". Hum Pathol 38 (4): 527-36. doi:10.1016/j.humpath.2007.01.014. PMID 17367604.
↑ Voutilainen, M.; Färkkilä, M.; Mecklin, JP.; Juhola, M.; Sipponen, P. (Nov 1999). "Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group.". Am J Gastroenterol 94 (11): 3175-80. doi:10.1111/j.1572-0241.1999.01513.x. PMID 10566710.
↑ El-Zimaity. 18 October 2010.
↑ ^16.0 ^16.1 ^16.2 ^16.3 Dixon MF, Genta RM, Yardley JH, Correa P (October 1996). "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994". Am. J. Surg. Pathol. 20 (10): 1161-81. PMID 8827022. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161.
↑ http://en.wikipedia.org/wiki/Angular_incisure
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 814. ISBN 0-7216-0187-1.
↑ Mobley, HLT.; Mendz, GL.; Hazell, SL.; Andersen, LP.; Wadström, T.. Basic Bacteriology and Culture. PMID 21290743. http://www.ncbi.nlm.nih.gov/books/NBK2444/.
↑ ^20.0 ^20.1 Singhal, AV.; Sepulveda, AR. (Nov 2005). "Helicobacter heilmannii gastritis: a case study with review of literature.". Am J Surg Pathol 29 (11): 1537-9. PMID 16224223.
↑ Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L (October 1990). "The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample". Scand. J. Gastroenterol. 25 (10): 1010-7. PMID 2263873.
↑ URL: http://gut.bmj.com/content/58/12/1669.extract. Accessed on: 2 March 2012.
↑ ^23.0 ^23.1 Walker, MM. (Jan 2003). "Is intestinal metaplasia of the stomach reversible?". Gut 52 (1): 1-4. PMC 1773527. PMID 12477745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773527/. Cite error: Invalid <ref> tag; name "pmid12477745" defined multiple times with different content
↑ Cristofaro, G.; Lynch, HT.; Caruso, ML.; Attolini, A.; DiMatteo, G.; Giorgio, P.; Senatore, S.; Argentieri, A. et al. (Jul 1987). "New phenotypic aspects in a family with Lynch syndrome II.". Cancer 60 (1): 51-8. PMID 3581033.
↑ Renkonen-Sinisalo, L.; Sipponen, P.; Aarnio, M.; Julkunen, R.; Aaltonen, LA.; Sarna, S.; Järvinen, HJ.; Mecklin, JP. (May 2002). "No support for endoscopic surveillance for gastric cancer in hereditary non-polyposis colorectal cancer.". Scand J Gastroenterol 37 (5): 574-7. PMID 12059060.
↑ Correa P, Piazuelo MB, Wilson KT (March 2010). "Pathology of gastric intestinal metaplasia: clinical implications". Am. J. Gastroenterol. 105 (3): 493–8. doi:10.1038/ajg.2009.728. PMC 2895407. PMID 20203636. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895407/?tool=pubmed.
↑ Sakitani, K.; Hirata, Y.; Watabe, H.; Yamada, A.; Sugimoto, T.; Yamaji, Y.; Yoshida, H.; Maeda, S. et al. (Oct 2011). "Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration.". J Gastroenterol Hepatol 26 (10): 1570-5. doi:10.1111/j.1440-1746.2011.06767.x. PMID 21575058.
↑ URL: http://esynopsis.uchc.edu/eAtlas/GI/1280.htm. Accessed on: 16 August 2010.
↑ ^29.0 ^29.1 Rubio, CA.; Befrits, R. (2009). "Increased lysozyme expression in gastric biopsies with intestinal metaplasia and pseudopyloric metaplasia.". Int J Clin Exp Med 2 (3): 248-53. PMID 19918317.
↑ ^30.0 ^30.1 ^30.2 Rugge, M.; Correa, P.; Dixon, MF.; Hattori, T.; Leandro, G.; Lewin, K.; Riddell, RH.; Sipponen, P. et al. (Feb 2000). "Gastric dysplasia: the Padova international classification.". Am J Surg Pathol 24 (2): 167-76. PMID 10680883.
↑ Rivera-Hueto, F.; Lag-Asturiano, E.; Utrilla-Alcolea, JC.; Herrerías-Gutiérrez, JM. (Feb 2004). "Advanced gastric carcinoma with a complete intestinal metaplasia phenotype associated with early intestinal-type carcinoma.". Arch Pathol Lab Med 128 (2): 218-21. doi:10.1043/1543-2165(2004)128218:AGCWAC2.0.CO;2. PMID 14736279.
↑ Iida, F.; Kusama, J. (Dec 1982). "Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma.". Cancer 50 (12): 2854-8. PMID 7139576.
↑ Odze, Robert D.; Goldblum, John R. (2009). Surgical pathology of the GI tract, liver, biliary tract and pancreas (2nd ed.). Saunders. pp. 276. ISBN 978-1416040590.
↑ Satoh, K.; Mutoh, H.; Eda, A.; Yanaka, I.; Osawa, H.; Honda, S.; Kawata, H.; Kihira, K. et al. (Jun 2002). "Aberrant expression of CDX2 in the gastric mucosa with and without intestinal metaplasia: effect of eradication of Helicobacter pylori.". Helicobacter 7 (3): 192-8. PMID 12047325.
↑ Lin J, McKenna BJ, Appelman HD (November 2010). "Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study". Am. J. Surg. Pathol. 34 (11): 1672–7. doi:10.1097/PAS.0b013e3181f3de93. PMID 20962621.
↑ RK. 13 December 2010.
↑ Chatterjee S (July 2008). "Watermelon stomach". CMAJ 179 (2): 162. doi:10.1503/cmaj.080461. PMC 2443230. PMID 18625989. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18625989.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 118. ISBN 978-0443066573.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 119. ISBN 978-0443066573.
↑ ^40.0 ^40.1 ^40.2 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 120-1. ISBN 978-0443066573.
↑ ^41.0 ^41.1 ^41.2 ^41.3 Genta, RM. (Nov 2005). "Differential diagnosis of reactive gastropathy.". Semin Diagn Pathol 22 (4): 273-83. PMID 16939055.
↑ Maguilnik, I.; Neumann, WL.; Sonnenberg, A.; Genta, RM. (Aug 2012). "Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract.". Aliment Pharmacol Ther. doi:10.1111/apt.12031. PMID 22928604.
↑ ALS. 5 February 2009.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.
↑ El-Zimaity. 18 October 2010.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.
↑ 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.
↑ Oh, R.; Brown, DL. (Mar 2003). "Vitamin B12 deficiency.". Am Fam Physician 67 (5): 979-86. PMID 12643357.
↑ 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.
↑ URL: http://www.springerlink.com/content/u2v2525241754557/ Accessed on: 19 November 2010.
↑ ^54.0 ^54.1 ^54.2 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 410. ISBN 978-1416054542.
↑ Rich, A.; Toro, TZ.; Tanksley, J.; Fiske, WH.; Lind, CD.; Ayers, GD.; Piessevaux, H.; Washington, MK. et al. (Dec 2010). "Distinguishing Ménétrier's disease from its mimics.". Gut 59 (12): 1617-24. doi:10.1136/gut.2010.220061. PMID 20926644.
↑ Toubia, N.; Schubert, ML. (Apr 2008). "Menetrier's Disease.". Curr Treat Options Gastroenterol 11 (2): 103-8. PMID 18321437.
↑ Junnarkar SP, Sloan JM, Johnston BT, Laird JD, Irwin ST (May 2001). "Cronkhite-Canada syndrome". The Ulster medical journal 70 (1): 56–8. PMC 2449205. PMID 11428328. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449205/.
↑ ^58.0 ^58.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 111. ISBN 978-0443066573.
↑ ^59.0 ^59.1 Drude, RB.; Balart, LA.; Herrington, JP.; Beckman, EN.; Burns, TW. (Jun 1982). "Gastric xanthoma: histologic similarity to signet ring cell carcinoma.". J Clin Gastroenterol 4 (3): 217-21. PMID 6284833.
↑ Steen, S.; Lamont, J.; Petrey, L. (Jan 2008). "Acute gastric dilation and ischemia secondary to small bowel obstruction.". Proc (Bayl Univ Med Cent) 21 (1): 15-7. PMC 2190544. PMID 18209748. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190544/.
↑ ^61.0 ^61.1 Papanikolaou, IS.; Foukas, PG.; Sioulas, A.; Beintaris, I.; Panagopoulos, P.; Karamanolis, G.; Panayiotides, IG.; Dimitriadis, G. et al. (2011). "A case of gastric ischemic necrosis.". Endoscopy 43 Suppl 2 UCTN: E342. doi:10.1055/s-0030-1256795. PMID 22020717.
↑ Herman, J.; Chavalitdhamrong, D.; Jensen, DM.; Cortina, G.; Manuyakorn, A.; Jutabha, R. (Apr 2011). "The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy.". Endoscopy 43 (4): 365-8. doi:10.1055/s-0030-1256040. PMID 21360426.
↑ Mesihovic, R.; Prohic, D.; Gribajcevic, M.; Vanis, N.; Gornjakovic, S.; Sarac, A. (2004). "Portal hypertensive gastropathy (PHG).". Med Arh 58 (6): 377-9. PMID 15648238.
↑ Thuluvath, PJ.; Yoo, HY. (Dec 2002). "Portal Hypertensive gastropathy.". Am J Gastroenterol 97 (12): 2973-8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.
↑ ^65.0 ^65.1 Sikanderkhel, S.; Luthra, M.; Chavalitdhamrong, D. (Jan 2012). "Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis.". Dig Endosc 24 (1): 53. doi:10.1111/j.1443-1661.2011.01155.x. PMID 22211417.
↑ Lam, MC.; Tha, S.; Owen, D.; Haque, M.; Chatur, N.; Gray, JR.; Yoshida, EM. (Nov 2011). "Gastric polyps in patients with portal hypertension.". Eur J Gastroenterol Hepatol 23 (12): 1245-9. doi:10.1097/MEG.0b013e32834c15cf. PMID 22002002.
↑ ^67.0 ^67.1 ^67.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 138. ISBN 978-0470519035.
↑ ^68.0 ^68.1 ^68.2 Daum, O.; Hatlova, J.; Mandys, V.; Grossmann, P.; Mukensnabl, P.; Benes, Z.; Michal, M. (May 2010). "Comparison of morphological, immunohistochemical, and molecular genetic features of inflammatory fibroid polyps (Vanek's tumors).". Virchows Arch 456 (5): 491-7. doi:10.1007/s00428-010-0914-8. PMID 20393746.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 115. ISBN 978-0443066573.
↑ URL: http://dictionary.reference.com/browse/concentric. Accessed on: 29 November 2011.
↑ Kolodziejczyk, P.; Yao, T.; Tsuneyoshi, M. (Nov 1993). "Inflammatory fibroid polyp of the stomach. A special reference to an immunohistochemical profile of 42 cases.". Am J Surg Pathol 17 (11): 1159-68. PMID 8214261.
↑ Ozolek, JA.; Sasatomi, E.; Swalsky, PA.; Rao, U.; Krasinskas, A.; Finkelstein, SD. (Mar 2004). "Inflammatory fibroid polyps of the gastrointestinal tract: clinical, pathologic, and molecular characteristics.". Appl Immunohistochem Mol Morphol 12 (1): 59-66. PMID 15163021.
↑ ^73.0 ^73.1 Jain, R.; Chetty, R. (Sep 2009). "Gastric hyperplastic polyps: a review.". Dig Dis Sci 54 (9): 1839-46. doi:10.1007/s10620-008-0572-8. PMID 19037727.
↑ URL: http://pathologyoutlines.com/stomach.html#hyperplastic. Accessed on: 26 July 2011.
↑ ^75.0 ^75.1 Park, do Y.; Lauwers, GY. (Apr 2008). "Gastric polyps: classification and management.". Arch Pathol Lab Med 132 (4): 633-40. doi:10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2. PMID 18384215. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2.
↑ Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 102. ISBN 978-0443066573.
↑ ^77.0 ^77.1 ^77.2 Spiegel, A.; Stein, P.; Patel, M.; Patel, R.; Lebovics, E. (Jan 2010). "A report of gastric fundic gland polyps.". Gastroenterol Hepatol (N Y) 6 (1): 45-8. PMID 20567540.
↑ Freeman HJ (March 2008). "Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis". World J. Gastroenterol. 14 (9): 1318-20. PMID 18322941. http://www.wjgnet.com/1007-9327/14/1318.asp.
↑ Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH (November 2006). "Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy". Aliment. Pharmacol. Ther. 24 (9): 1341-8. doi:10.1111/j.1365-2036.2006.03127.x. PMID 17059515.
↑ Masaoka T, Suzuki H, Hibi T (May 2008). "Gastric epithelial cell modality and proton pump inhibitor". J Clin Biochem Nutr 42 (3): 191-6. doi:10.3164/jcbn.2008028. PMC 2386521. PMID 18545640. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386521/.
↑ URL: http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm. Accessed on: 19 October 2010.
↑ URL: http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html. Accessed on: 18 December 2012.
↑ Correa, P.; Piazuelo, MB. (Jan 2012). "The gastric precancerous cascade.". J Dig Dis 13 (1): 2-9. doi:10.1111/j.1751-2980.2011.00550.x. PMID 22188910.
↑ URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/StomachNET_11protocol.pdf. Accessed on: 29 March 2012.
↑ Mbulaiteye, SM.; Hisada, M.; El-Omar, EM. (2009). "Helicobacter Pylori associated global gastric cancer burden.". Front Biosci 14: 1490-504. PMID 19273142.
↑ Bailey, D. 6 August 2010.
↑ Papadaki, L.; Wotherspoon, AC.; Isaacson, PG. (Nov 1992). "The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study.". Histopathology 21 (5): 415-21. PMID 1452124.
↑ Kim, K.; Kim, EJ.; Kim, MJ.; Song, HJ.; Lee, YS.; Jung, KW.; Yu, E. (Dec 2009). "Clinicopathological features of syphilitic gastritis in Korean patients.". Pathol Int 59 (12): 884-9. doi:10.1111/j.1440-1827.2009.02462.x. PMID 20021615.
↑ Long, BW.; Johnston, JH.; Wetzel, W.; Flowers, RH.; Haick, A. (Sep 1995). "Gastric syphilis: endoscopic and histological features mimicking lymphoma.". Am J Gastroenterol 90 (9): 1504-7. PMID 7661178.
↑ Zullo, A.; Hassan, C.; Andriani, A.; Cristofari, F.; De Francesco, V.; Ierardi, E.; Tomao, S.; Morini, S. et al. (Aug 2009). "Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis.". Am J Gastroenterol 104 (8): 1932-7; quiz 1938. doi:10.1038/ajg.2009.314. PMID 19532131.
↑ Sereno, M.; Aguayo, C.; Guillén Ponce, C.; Gómez-Raposo, C.; Zambrana, F.; Gómez-López, M.; Casado, E. (Sep 2011). "Gastric tumours in hereditary cancer syndromes: clinical features, molecular biology and strategies for prevention.". Clin Transl Oncol 13 (9): 599-610. PMID 21865131.
↑ Online 'Mendelian Inheritance in Man' (OMIM) 192090
↑ Guilford, P.; Hopkins, J.; Harraway, J.; McLeod, M.; McLeod, N.; Harawira, P.; Taite, H.; Scoular, R. et al. (Mar 1998). "E-cadherin germline mutations in familial gastric cancer.". Nature 392 (6674): 402-5. doi:10.1038/32918. PMID 9537325.
↑ Online 'Mendelian Inheritance in Man' (OMIM) 600185
↑ Duell, EJ.; Travier, N.; Lujan-Barroso, L.; Clavel-Chapelon, F.; Boutron-Ruault, MC.; Morois, S.; Palli, D.; Krogh, V. et al. (Nov 2011). "Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.". Am J Clin Nutr 94 (5): 1266-75. doi:10.3945/ajcn.111.012351. PMID 21993435.
↑ Nomura, A.; Grove, JS.; Stemmermann, GN.; Severson, RK. (Nov 1990). "Cigarette smoking and stomach cancer.". Cancer Res 50 (21): 7084. PMID 2208177.
↑ LAUREN P (1965). "THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION". Acta Pathol Microbiol Scand 64: 31–49. PMID 14320675.
↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 823. ISBN 0-7216-0187-1.
↑ Yamagawa, H.; Onishi, T. (Sep 1989). "[A clinicopathological study of early gastric cancers with a diameter larger than five centimeters].". Gan No Rinsho 35 (10): 1114-8. PMID 2550682.
↑ Zali, MR.; Moaven, O.; Asadzadeh Aghdaee, H.; Ghafarzadegan, K.; Ahmadi, KJ.; Farzadnia, M.; Arabi, A.; Abbaszadegan, MR. (Jul 2009). "Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma.". J Res Med Sci 14 (4): 239-47. PMID 21772890.
↑ Romiti, A.; Di Rocco, R.; Milione, M.; Ruco, L.; Ziparo, V.; Zullo, A.; Duranti, E.; Sarcina, I. et al. (Jan 2012). "Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma.". Anticancer Res 32 (1): 115-9. PMID 22213295.

[1] ALS. 4 Feb 2009.

[2] Rubio, CA. (Jun 2007). "Gastric duodenal metaplasia in duodenal adenomas.". J Clin Pathol 60 (6): 661-3. doi:10.1136/jcp.2006.039388. PMC 1955048. PMID 16837629. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955048/.

[pmid2459839-3] Osborn M, Mazzoleni G, Santini D, Marrano D, Martinelli G, Weber K (1988). "Villin, intestinal brush border hydrolases and keratin polypeptides in intestinal metaplasia and gastric cancer; an immunohistologic study emphasizing the different degrees of intestinal and gastric differentiation in signet ring cell carcinomas". Virchows Arch A Pathol Anat Histopathol 413 (4): 303–12. PMID 2459839.

[4] Braunstein, EM.; Qiao, XT.; Madison, B.; Pinson, K.; Dunbar, L.; Gumucio, DL. (May 2002). "Villin: A marker for development of the epithelial pyloric border.". Dev Dyn 224 (1): 90-102. doi:10.1002/dvdy.10091. PMID 11984877.

[5] Sternberg H4P 2nd Ed., P.484

[6] URL: http://www.lab.anhb.uwa.edu.au/mb140/CorePages/GIT/git.htm. Accessed on: 3 December 2010.

[7] ttp://www.histology-world.com/stains/stains.htm

[pmid10210995-8] Goggin N, Rowland M, Imrie C, Walsh D, Clyne M, Drumm B (December 1998). "Effect of Helicobacter pylori eradication on the natural history of duodenal ulcer disease". Arch. Dis. Child. 79 (6): 502-5. PMC 1717771. PMID 10210995. http://adc.bmj.com/cgi/pmidlookup?view=long&pmid=10210995.

[9] ttp://www.histology-world.com/stains/stains.htm

[10] ttp://www.histology-world.com/stains/stains.htm

[pmid19683340-11] Malfertheiner, P.; Chan, FK.; McColl, KE. (Oct 2009). "Peptic ulcer disease.". Lancet 374 (9699): 1449-61. doi:10.1016/S0140-6736(09)60938-7. PMID 19683340.

[Ref_PBoD812-3-12] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 812-3. ISBN 0-7216-0187-1.

[13] Parfitt, JR.; Driman, DK. (Apr 2007). "Pathological effects of drugs on the gastrointestinal tract: a review.". Hum Pathol 38 (4): 527-36. doi:10.1016/j.humpath.2007.01.014. PMID 17367604.

[pmid10566710-14] Voutilainen, M.; Färkkilä, M.; Mecklin, JP.; Juhola, M.; Sipponen, P. (Nov 1999). "Chronic inflammation at the gastroesophageal junction (carditis) appears to be a specific finding related to Helicobacter pylori infection and gastroesophageal reflux disease. The Central Finland Endoscopy Study Group.". Am J Gastroenterol 94 (11): 3175-80. doi:10.1111/j.1572-0241.1999.01513.x. PMID 10566710.

[15] El-Zimaity. 18 October 2010.

[pmid8827022-16] 16.0 ^16.1 ^16.2 ^16.3 Dixon MF, Genta RM, Yardley JH, Correa P (October 1996). "Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994". Am. J. Surg. Pathol. 20 (10): 1161-81. PMID 8827022. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=20&issue=10&spage=1161.

[17] ttp://en.wikipedia.org/wiki/Angular_incisure

[18] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 814. ISBN 0-7216-0187-1.

[pmid21290743-19] Mobley, HLT.; Mendz, GL.; Hazell, SL.; Andersen, LP.; Wadström, T.. Basic Bacteriology and Culture. PMID 21290743. http://www.ncbi.nlm.nih.gov/books/NBK2444/.

[pmid16224223-20] 20.0 ^20.1 Singhal, AV.; Sepulveda, AR. (Nov 2005). "Helicobacter heilmannii gastritis: a case study with review of literature.". Am J Surg Pathol 29 (11): 1537-9. PMID 16224223.

[21] Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L (October 1990). "The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample". Scand. J. Gastroenterol. 25 (10): 1010-7. PMID 2263873.

[22] URL: http://gut.bmj.com/content/58/12/1669.extract. Accessed on: 2 March 2012.

[pmid12477745-23] 23.0 ^23.1 Walker, MM. (Jan 2003). "Is intestinal metaplasia of the stomach reversible?". Gut 52 (1): 1-4. PMC 1773527. PMID 12477745. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773527/. Cite error: Invalid <ref> tag; name "pmid12477745" defined multiple times with different content

[pmid3581033-24] Cristofaro, G.; Lynch, HT.; Caruso, ML.; Attolini, A.; DiMatteo, G.; Giorgio, P.; Senatore, S.; Argentieri, A. et al. (Jul 1987). "New phenotypic aspects in a family with Lynch syndrome II.". Cancer 60 (1): 51-8. PMID 3581033.

[pmid12059060-25] Renkonen-Sinisalo, L.; Sipponen, P.; Aarnio, M.; Julkunen, R.; Aaltonen, LA.; Sarna, S.; Järvinen, HJ.; Mecklin, JP. (May 2002). "No support for endoscopic surveillance for gastric cancer in hereditary non-polyposis colorectal cancer.". Scand J Gastroenterol 37 (5): 574-7. PMID 12059060.

[pmid20203636-26] Correa P, Piazuelo MB, Wilson KT (March 2010). "Pathology of gastric intestinal metaplasia: clinical implications". Am. J. Gastroenterol. 105 (3): 493–8. doi:10.1038/ajg.2009.728. PMC 2895407. PMID 20203636. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895407/?tool=pubmed.

[pmid21575058-27] Sakitani, K.; Hirata, Y.; Watabe, H.; Yamada, A.; Sugimoto, T.; Yamaji, Y.; Yoshida, H.; Maeda, S. et al. (Oct 2011). "Gastric cancer risk according to the distribution of intestinal metaplasia and neutrophil infiltration.". J Gastroenterol Hepatol 26 (10): 1570-5. doi:10.1111/j.1440-1746.2011.06767.x. PMID 21575058.

[28] URL: http://esynopsis.uchc.edu/eAtlas/GI/1280.htm. Accessed on: 16 August 2010.

[pmid19918317-29] 29.0 ^29.1 Rubio, CA.; Befrits, R. (2009). "Increased lysozyme expression in gastric biopsies with intestinal metaplasia and pseudopyloric metaplasia.". Int J Clin Exp Med 2 (3): 248-53. PMID 19918317.

[pmid10680883-30] 30.0 ^30.1 ^30.2 Rugge, M.; Correa, P.; Dixon, MF.; Hattori, T.; Leandro, G.; Lewin, K.; Riddell, RH.; Sipponen, P. et al. (Feb 2000). "Gastric dysplasia: the Padova international classification.". Am J Surg Pathol 24 (2): 167-76. PMID 10680883.

[pmid14736279-31] Rivera-Hueto, F.; Lag-Asturiano, E.; Utrilla-Alcolea, JC.; Herrerías-Gutiérrez, JM. (Feb 2004). "Advanced gastric carcinoma with a complete intestinal metaplasia phenotype associated with early intestinal-type carcinoma.". Arch Pathol Lab Med 128 (2): 218-21. doi:10.1043/1543-2165(2004)128218:AGCWAC2.0.CO;2. PMID 14736279.

[pmid7139576-32] Iida, F.; Kusama, J. (Dec 1982). "Gastric carcinoma and intestinal metaplasia. Significance of types of intestinal metaplasia upon development of gastric carcinoma.". Cancer 50 (12): 2854-8. PMID 7139576.

[33] Odze, Robert D.; Goldblum, John R. (2009). Surgical pathology of the GI tract, liver, biliary tract and pancreas (2nd ed.). Saunders. pp. 276. ISBN 978-1416040590.

[pmid12047325-34] Satoh, K.; Mutoh, H.; Eda, A.; Yanaka, I.; Osawa, H.; Honda, S.; Kawata, H.; Kihira, K. et al. (Jun 2002). "Aberrant expression of CDX2 in the gastric mucosa with and without intestinal metaplasia: effect of eradication of Helicobacter pylori.". Helicobacter 7 (3): 192-8. PMID 12047325.

[pmid20962621-35] Lin J, McKenna BJ, Appelman HD (November 2010). "Morphologic findings in upper gastrointestinal biopsies of patients with ulcerative colitis: a controlled study". Am. J. Surg. Pathol. 34 (11): 1672–7. doi:10.1097/PAS.0b013e3181f3de93. PMID 20962621.

[36] RK. 13 December 2010.

[pmid18625989-37] Chatterjee S (July 2008). "Watermelon stomach". CMAJ 179 (2): 162. doi:10.1503/cmaj.080461. PMC 2443230. PMID 18625989. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=18625989.

[Ref_GLP118-38] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 118. ISBN 978-0443066573.

[Ref_GLP119-39] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 119. ISBN 978-0443066573.

[Ref_GLP120-1-40] 40.0 ^40.1 ^40.2 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 120-1. ISBN 978-0443066573.

[pmid16939055-41] 41.0 ^41.1 ^41.2 ^41.3 Genta, RM. (Nov 2005). "Differential diagnosis of reactive gastropathy.". Semin Diagn Pathol 22 (4): 273-83. PMID 16939055.

[pmid22928604-42] Maguilnik, I.; Neumann, WL.; Sonnenberg, A.; Genta, RM. (Aug 2012). "Reactive gastropathy is associated with inflammatory conditions throughout the gastrointestinal tract.". Aliment Pharmacol Ther. doi:10.1111/apt.12031. PMID 22928604.

[43] ALS. 5 February 2009.

[44] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.

[45] El-Zimaity. 18 October 2010.

[Ref_GLP69-46] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 69. ISBN 978-0443066573.

[pmid16382988-47] 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.

[pmid12643357-48] Oh, R.; Brown, DL. (Mar 2003). "Vitamin B12 deficiency.". Am Fam Physician 67 (5): 979-86. PMID 12643357.

[pmid21947876-49] 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.

[50] URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512. Accessed on: 14 August 2012.

[pmid20975338-51] 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.

[pmid18719002-52] 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.

[53] URL: http://www.springerlink.com/content/u2v2525241754557/ Accessed on: 19 November 2010.

[Ref_PCPBoD8_410-54] 54.0 ^54.1 ^54.2 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 410. ISBN 978-1416054542.

[pmid20926644-55] Rich, A.; Toro, TZ.; Tanksley, J.; Fiske, WH.; Lind, CD.; Ayers, GD.; Piessevaux, H.; Washington, MK. et al. (Dec 2010). "Distinguishing Ménétrier's disease from its mimics.". Gut 59 (12): 1617-24. doi:10.1136/gut.2010.220061. PMID 20926644.

[pmid18321437-56] Toubia, N.; Schubert, ML. (Apr 2008). "Menetrier's Disease.". Curr Treat Options Gastroenterol 11 (2): 103-8. PMID 18321437.

[pmid11428328-57] Junnarkar SP, Sloan JM, Johnston BT, Laird JD, Irwin ST (May 2001). "Cronkhite-Canada syndrome". The Ulster medical journal 70 (1): 56–8. PMC 2449205. PMID 11428328. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2449205/.

[Ref_GLP111-58] 58.0 ^58.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 111. ISBN 978-0443066573.

[pmid6284833-59] 59.0 ^59.1 Drude, RB.; Balart, LA.; Herrington, JP.; Beckman, EN.; Burns, TW. (Jun 1982). "Gastric xanthoma: histologic similarity to signet ring cell carcinoma.". J Clin Gastroenterol 4 (3): 217-21. PMID 6284833.

[pmid18209748-60] Steen, S.; Lamont, J.; Petrey, L. (Jan 2008). "Acute gastric dilation and ischemia secondary to small bowel obstruction.". Proc (Bayl Univ Med Cent) 21 (1): 15-7. PMC 2190544. PMID 18209748. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190544/.

[pmid22020717-61] 61.0 ^61.1 Papanikolaou, IS.; Foukas, PG.; Sioulas, A.; Beintaris, I.; Panagopoulos, P.; Karamanolis, G.; Panayiotides, IG.; Dimitriadis, G. et al. (2011). "A case of gastric ischemic necrosis.". Endoscopy 43 Suppl 2 UCTN: E342. doi:10.1055/s-0030-1256795. PMID 22020717.

[pmid21360426-62] Herman, J.; Chavalitdhamrong, D.; Jensen, DM.; Cortina, G.; Manuyakorn, A.; Jutabha, R. (Apr 2011). "The significance of gastric and duodenal histological ischemia reported on endoscopic biopsy.". Endoscopy 43 (4): 365-8. doi:10.1055/s-0030-1256040. PMID 21360426.

[pmid15648238-63] Mesihovic, R.; Prohic, D.; Gribajcevic, M.; Vanis, N.; Gornjakovic, S.; Sarac, A. (2004). "Portal hypertensive gastropathy (PHG).". Med Arh 58 (6): 377-9. PMID 15648238.

[pmid12492178-64] Thuluvath, PJ.; Yoo, HY. (Dec 2002). "Portal Hypertensive gastropathy.". Am J Gastroenterol 97 (12): 2973-8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.

[pmid22211417-65] 65.0 ^65.1 Sikanderkhel, S.; Luthra, M.; Chavalitdhamrong, D. (Jan 2012). "Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis.". Dig Endosc 24 (1): 53. doi:10.1111/j.1443-1661.2011.01155.x. PMID 22211417.

[pmid22002002-66] Lam, MC.; Tha, S.; Owen, D.; Haque, M.; Chatur, N.; Gray, JR.; Yoshida, EM. (Nov 2011). "Gastric polyps in patients with portal hypertension.". Eur J Gastroenterol Hepatol 23 (12): 1245-9. doi:10.1097/MEG.0b013e32834c15cf. PMID 22002002.

[Ref_DCHH138-67] 67.0 ^67.1 ^67.2 Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 138. ISBN 978-0470519035.

[pmid20393746-68] 68.0 ^68.1 ^68.2 Daum, O.; Hatlova, J.; Mandys, V.; Grossmann, P.; Mukensnabl, P.; Benes, Z.; Michal, M. (May 2010). "Comparison of morphological, immunohistochemical, and molecular genetic features of inflammatory fibroid polyps (Vanek's tumors).". Virchows Arch 456 (5): 491-7. doi:10.1007/s00428-010-0914-8. PMID 20393746.

[Ref_GLP115-69] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 115. ISBN 978-0443066573.

[70] URL: http://dictionary.reference.com/browse/concentric. Accessed on: 29 November 2011.

[71] Kolodziejczyk, P.; Yao, T.; Tsuneyoshi, M. (Nov 1993). "Inflammatory fibroid polyp of the stomach. A special reference to an immunohistochemical profile of 42 cases.". Am J Surg Pathol 17 (11): 1159-68. PMID 8214261.

[pmid15163021-72] Ozolek, JA.; Sasatomi, E.; Swalsky, PA.; Rao, U.; Krasinskas, A.; Finkelstein, SD. (Mar 2004). "Inflammatory fibroid polyps of the gastrointestinal tract: clinical, pathologic, and molecular characteristics.". Appl Immunohistochem Mol Morphol 12 (1): 59-66. PMID 15163021.

[pmid19037727-73] 73.0 ^73.1 Jain, R.; Chetty, R. (Sep 2009). "Gastric hyperplastic polyps: a review.". Dig Dis Sci 54 (9): 1839-46. doi:10.1007/s10620-008-0572-8. PMID 19037727.

[74] URL: http://pathologyoutlines.com/stomach.html#hyperplastic. Accessed on: 26 July 2011.

[pmid18384215-75] 75.0 ^75.1 Park, do Y.; Lauwers, GY. (Apr 2008). "Gastric polyps: classification and management.". Arch Pathol Lab Med 132 (4): 633-40. doi:10.1043/1543-2165(2008)132[633:GPCAM]2.0.CO;2. PMID 18384215. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165(2008)132%5B633:GPCAM%5D2.0.CO;2.

[Ref_GLP102-76] Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 102. ISBN 978-0443066573.

[pmid20567540-77] 77.0 ^77.1 ^77.2 Spiegel, A.; Stein, P.; Patel, M.; Patel, R.; Lebovics, E. (Jan 2010). "A report of gastric fundic gland polyps.". Gastroenterol Hepatol (N Y) 6 (1): 45-8. PMID 20567540.

[pmid18322941-78] Freeman HJ (March 2008). "Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis". World J. Gastroenterol. 14 (9): 1318-20. PMID 18322941. http://www.wjgnet.com/1007-9327/14/1318.asp.

[79] Jalving M, Koornstra JJ, Wesseling J, Boezen HM, DE Jong S, Kleibeuker JH (November 2006). "Increased risk of fundic gland polyps during long-term proton pump inhibitor therapy". Aliment. Pharmacol. Ther. 24 (9): 1341-8. doi:10.1111/j.1365-2036.2006.03127.x. PMID 17059515.

[80] Masaoka T, Suzuki H, Hibi T (May 2008). "Gastric epithelial cell modality and proton pump inhibitor". J Clin Biochem Nutr 42 (3): 191-6. doi:10.3164/jcbn.2008028. PMC 2386521. PMID 18545640. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386521/.

[81] URL: http://moon.ouhsc.edu/kfung/jty1/opaq/PathQuiz/A2B001-PQ01-M.htm. Accessed on: 19 October 2010.

[82] URL: http://surgpathcriteria.stanford.edu/gitumors/gastric-adenoma/printable.html. Accessed on: 18 December 2012.

[pmid22188910-83] Correa, P.; Piazuelo, MB. (Jan 2012). "The gastric precancerous cascade.". J Dig Dis 13 (1): 2-9. doi:10.1111/j.1751-2980.2011.00550.x. PMID 22188910.

[84] URL: http://www.cap.org/apps/docs/committees/cancer/cancer_protocols/2011/StomachNET_11protocol.pdf. Accessed on: 29 March 2012.

[pmid19273142-85] Mbulaiteye, SM.; Hisada, M.; El-Omar, EM. (2009). "Helicobacter Pylori associated global gastric cancer burden.". Front Biosci 14: 1490-504. PMID 19273142.

[86] Bailey, D. 6 August 2010.

[pmid1452124-87] Papadaki, L.; Wotherspoon, AC.; Isaacson, PG. (Nov 1992). "The lymphoepithelial lesion of gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT): an ultrastructural study.". Histopathology 21 (5): 415-21. PMID 1452124.

[pmid20021615-88] Kim, K.; Kim, EJ.; Kim, MJ.; Song, HJ.; Lee, YS.; Jung, KW.; Yu, E. (Dec 2009). "Clinicopathological features of syphilitic gastritis in Korean patients.". Pathol Int 59 (12): 884-9. doi:10.1111/j.1440-1827.2009.02462.x. PMID 20021615.

[pmid7661178-89] Long, BW.; Johnston, JH.; Wetzel, W.; Flowers, RH.; Haick, A. (Sep 1995). "Gastric syphilis: endoscopic and histological features mimicking lymphoma.". Am J Gastroenterol 90 (9): 1504-7. PMID 7661178.

[pmid19532131-90] Zullo, A.; Hassan, C.; Andriani, A.; Cristofari, F.; De Francesco, V.; Ierardi, E.; Tomao, S.; Morini, S. et al. (Aug 2009). "Eradication therapy for Helicobacter pylori in patients with gastric MALT lymphoma: a pooled data analysis.". Am J Gastroenterol 104 (8): 1932-7; quiz 1938. doi:10.1038/ajg.2009.314. PMID 19532131.

[91] Sereno, M.; Aguayo, C.; Guillén Ponce, C.; Gómez-Raposo, C.; Zambrana, F.; Gómez-López, M.; Casado, E. (Sep 2011). "Gastric tumours in hereditary cancer syndromes: clinical features, molecular biology and strategies for prevention.". Clin Transl Oncol 13 (9): 599-610. PMID 21865131.

[92] Online 'Mendelian Inheritance in Man' (OMIM) 192090

[pmid9537325-93] Guilford, P.; Hopkins, J.; Harraway, J.; McLeod, M.; McLeod, N.; Harawira, P.; Taite, H.; Scoular, R. et al. (Mar 1998). "E-cadherin germline mutations in familial gastric cancer.". Nature 392 (6674): 402-5. doi:10.1038/32918. PMID 9537325.

[omim600185-94] Online 'Mendelian Inheritance in Man' (OMIM) 600185

[pmid21993435-95] Duell, EJ.; Travier, N.; Lujan-Barroso, L.; Clavel-Chapelon, F.; Boutron-Ruault, MC.; Morois, S.; Palli, D.; Krogh, V. et al. (Nov 2011). "Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.". Am J Clin Nutr 94 (5): 1266-75. doi:10.3945/ajcn.111.012351. PMID 21993435.

[96] Nomura, A.; Grove, JS.; Stemmermann, GN.; Severson, RK. (Nov 1990). "Cigarette smoking and stomach cancer.". Cancer Res 50 (21): 7084. PMID 2208177.

[pmid14320675-97] LAUREN P (1965). "THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION". Acta Pathol Microbiol Scand 64: 31–49. PMID 14320675.

[Ref_PBoD823-98] Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 823. ISBN 0-7216-0187-1.

[pmid2550682-99] Yamagawa, H.; Onishi, T. (Sep 1989). "[A clinicopathological study of early gastric cancers with a diameter larger than five centimeters].". Gan No Rinsho 35 (10): 1114-8. PMID 2550682.

[pmid21772890-100] Zali, MR.; Moaven, O.; Asadzadeh Aghdaee, H.; Ghafarzadegan, K.; Ahmadi, KJ.; Farzadnia, M.; Arabi, A.; Abbaszadegan, MR. (Jul 2009). "Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma.". J Res Med Sci 14 (4): 239-47. PMID 21772890.

[pmid22213295-101] Romiti, A.; Di Rocco, R.; Milione, M.; Ruco, L.; Ziparo, V.; Zullo, A.; Duranti, E.; Sarcina, I. et al. (Jan 2012). "Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma.". Anticancer Res 32 (1): 115-9. PMID 22213295.

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@@ Line 1,354: / Line 1,354: @@
 ===Sign out===
 ====Biopsy====
+=====Intestinal type=====
 <pre>
 STOMACH, BIOPSY:
@@ Line 1,361: / Line 1,362: @@
 - Benign small bowel mucosa with erosions.
 </pre>
+=====Diffuse type=====
+<pre>
+STOMACH, BIOPSY:
+- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE.
+COMMENT:
+A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the
+lamina propria.
+</pre>
+=====Micro=====
+The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric
+nuclei with mild nuclear atypia.
 =See also=

Difference between revisions of "Stomach"

Revision as of 21:53, 29 April 2013

Normal stomach

Gross anatomy

Microscopic

Foveolar cells versus intestinal goblet cells

Stomach versus intestine

Gastric antrum versus gastric body

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Short version

Long version

Sleeve gastrectomy

Introduction

Useful stains for stomach

Things to look for...

Some patterns

Gastric atrophy

General

Microscopic

Plasma cells in the stomach

Granulomatous gastritis

Non-neoplastic disease

Peptic ulcer disease

General

Gross

Microscopic

Gastritis

Etiology

Endoscopic appearance

Microscopic

Acute gastritis

Focal active gastritis

Chronic gastritis

Lymphocytic gastritis

General

Microscopic

Sydney criteria for gastritis

Classification

Severity

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Mild chronic

Moderate chronic active

Micro

Helicobacter gastritis

General

Gross

Microscopic

Stains

IHC

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Body

Body

Micro

Intestinal metaplasia of the stomach

General

Microscopic

Stains

IHC

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Inflammatory bowel disease & the stomach

Microscopic

Miscellaneous

Gastric antral vascular ectasia

General

Gross/endoscopic appearance

Microscopic

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Micro

Reactive gastropathy

General

Epidemiology

Relation to gastritis

Gross/endoscopic

Microscopic

Sign out

Not well-developed

Autoimmune metaplastic atrophic gastritis

General

Microscopic

IHC