Difference between revisions of "Autoimmune metaplastic atrophic gastritis"

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Autoimmune metaplastic atrophic gastritis (view source)

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'''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'''.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Metaplastic atrophic gastritis - body -- intermed mag.jpg
| Width      = Metaplastic atrophic gastritis - body of stomach. [[H&E stains]].
| 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
| Subtypes  =
| LMDDx      = [[chronic gastritis]], [[intestinal metaplasia of the stomach]], [[gastric neuroendocrine tumour]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[stomach]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  = antibodies to parietal cells & intrinsic factor, [[macrocytic anemia]], increased gastrin level
| Rads      =
| Endoscopy  = erythema - corpus only
| Prognosis  =
| Other      =
| 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> (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, [[macrocytic anemia]].
*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 17: Line 47:


==Gross==
==Gross==
*Diffuse erythema.{{fact}}
*Erythema - corpus involved, antrum spared.


==Microscopic==
==Microscopic==
Line 31: 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 38: 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:
Michael
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