48,830
edits
Difference between revisions of "Autoimmune metaplastic atrophic gastritis"
Jump to navigation
Jump to search
Autoimmune metaplastic atrophic gastritis (view source)
Revision as of 02:03, 28 September 2013
, 02:03, 28 September 2013split-out
(redirect) |
(split-out) |
||
| Line 1: | Line 1: | ||
'''Autoimmune metaplastic atrophic gastritis''', also '''autoimmune gastritis'''<ref name=pmid16382988>{{Cite journal | last1 = Chlumská | first1 = A. | last2 = Boudová | first2 = L. | last3 = Benes | first3 = Z. | last4 = Zámecník | first4 = M. | title = Autoimmune gastritis. A clinicopathologic study of 25 cases. | journal = Cesk Patol | volume = 41 | issue = 4 | pages = 137-42 | month = Oct | year = 2005 | doi = | PMID = 16382988 }}</ref> is a rare pathology of the [[stomach]]. It is closely associated with '''pernicious anemia'''. | |||
==General== | |||
*Pathology: loss of parietal cells, gastric atrophy, [[macrocytic anemia]]. | |||
*Etiology: autoimmune. | |||
Diagnosis based on serology for antibodies to:<ref name=pmid12643357>{{Cite journal | last1 = Oh | first1 = R. | last2 = Brown | first2 = DL. | title = Vitamin B12 deficiency. | journal = Am Fam Physician | volume = 67 | issue = 5 | pages = 979-86 | month = Mar | year = 2003 | doi = | PMID = 12643357 }}</ref> | |||
*Parietal cells. | |||
*Intrinsic factor. | |||
Others: | |||
*Gastrin level (increased).<ref name=pmid21947876>{{Cite journal | last1 = Annibale | first1 = B. | last2 = Lahner | first2 = E. | last3 = Fave | first3 = GD. | title = Diagnosis and management of pernicious anemia. | journal = Curr Gastroenterol Rep | volume = 13 | issue = 6 | pages = 518-24 | month = Dec | year = 2011 | doi = 10.1007/s11894-011-0225-5 | PMID = 21947876 }}</ref> | |||
**Normal < 100 pg/mL.<ref>URL: [http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512 http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512]. Accessed on: 14 August 2012.</ref> | |||
Note: | |||
*Parietal cells produce ''intrinsic factor'' (important for vitamin B12 absorption) and ''hydrogen chloride'', i.e. stomach acid. | |||
==Microscopic== | |||
Features: | |||
*Corpus predominant inflammation - usu. moderate or severe - '''key feature'''. | |||
*Loss of parietal cells. | |||
*Increased G cells in the antrum. | |||
**Produce gastrin to stimulate the (missing) parietal cells. | |||
DDx: | |||
*[[Gastric neuroendocrine tumour]]. | |||
Notes: | |||
*Compare with other types of ''[[gastric atrophy]]''. | |||
==IHC== | |||
Features:<ref name=pmid20975338>{{Cite journal | last1 = Park | first1 = JY. | last2 = Cornish | first2 = TC. | last3 = Lam-Himlin | first3 = D. | last4 = Shi | first4 = C. | last5 = Montgomery | first5 = E. | title = Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting. | journal = Am J Surg Pathol | volume = 34 | issue = 11 | pages = 1591-8 | month = Nov | year = 2010 | doi = 10.1097/PAS.0b013e3181f623af | PMID = 20975338 }}</ref> | |||
*Chromogranin A +ve (demonstrates ''nodular enterochromaffin-like cell hyperplasia''). | |||
*Gastrin -ve (body of stomach). | |||
**+ve in antrum. | |||
Images: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2575912/figure/f5/ Autoimmune gastritis - chromogranin A (nih.gov)].<ref name=pmid18719002>{{Cite journal | last1 = Pritchard | first1 = DM. | last2 = Berry | first2 = D. | last3 = Przemeck | first3 = SM. | last4 = Campbell | first4 = F. | last5 = Edwards | first5 = SW. | last6 = Varro | first6 = A. | title = Gastrin increases mcl-1 expression in type I gastric carcinoid tumors and a gastric epithelial cell line that expresses the CCK-2 receptor. | journal = Am J Physiol Gastrointest Liver Physiol | volume = 295 | issue = 4 | pages = G798-805 | month = Oct | year = 2008 | doi = 10.1152/ajpgi.00015.2008 | PMID = 18719002 }}</ref> | |||
**Findings may be seen in hypergastrinemia and nodular enterochromaffin cell-like (ECL) hyperplasia. | |||
==Sign out== | |||
<pre> | |||
STOMACH, BIOPSY: | |||
- SEVERE CHRONIC ACTIVE GASTRITIS WITH EXTENSIVE INTESTINAL METAPLASIA. | |||
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. | |||
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. | |||
COMMENT: | |||
Parietal cells are not apparent on the H&E stained sections. Immunostains show | |||
rows of Chromogranin A positive cells and a lack of gastrin staining. | |||
These findings suggest an autoimmune gastritis; correlation with blood work | |||
is suggested. | |||
</pre> | |||
==See also== | |||
*[[Stomach]]. | |||
*[[Gastritis]]. | |||
**[[Chronic gastritis]]. | |||
*[[Anemia]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Stomach]] | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||