Helicobacter gastritis

Helicobacter gastritis
Diagnosis in short
Helicobacter gastritis. H&E stain.
LM	helicobacter organisms, moderate chronic active gastritis (neutrophils esp. at the luminal aspect/intraepithelial, numerous plasma cell clusters)
Subtypes	Helicobacter pylori, Helicobacter heilmannii
LM DDx	chronic gastritis
Stains	Diff-Quik, Cresyl violet stain, Warthin-Starry stain
IHC	Helicobacter IHC
Site	stomach
Associated Dx	MALT lymphoma, gastric carcinoma, intestinal metaplasia of the stomach, peptic ulcer, duodenitis
Prevalence	common
Endoscopy	erythema
Prognosis	benign
Clin. DDx	normal stomach

Helicobacter gastritis, abbreviated HG, is a common form of gastritis caused by Helicobacter species.

The most common Helicobacter implicated is Helicobacter pylori, abbreviated HP.

General

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

Epidemiologic associations - Helicobacter infections are associated with:

• 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.
  • Helicobacter heilmannii:
    • Corkscrew appearance.
• Inflammation - usually moderate chronic active.
  • Clusters of (lamina propria) plasma cells.
  • Neutrophils, numerous, classically intraepithelial.

Tips:

1. 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.
2. Look for mucus - they preferentially reside there.
   • This is usually close to the opening of the gastric pits.
3. 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.
• Helicobacter don't like the intestinal mucosa or mucosa that has undergone intestinal metaplasia; you're less likely to find 'em adjacent to it. In general, Helicobacter is uncommon in the context of a case with IM... but common enough that one still ought to look for it.
• May be associated with G-cell hyperplasia.

DDx:

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

Images

• 

  H. pylori - IHC. (WC)

• 

  Gastritis due to HP. (WC)

• 

  HP visible. (WC)

• 

  HP gastritis. (WC)

www:

• Set of images - HP gastritis (WC).
• Helicobacter heilmannii (bmj.com).

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.

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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.

Antrum

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.

See also

• Stomach.
• Chronic gastritis.