Difference between pages "Autoimmune metaplastic atrophic gastritis" and "Chronic sialadenitis"

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Chronic sialadenitis (view source)

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{{ Infobox diagnosis
'''Chronic sialadenitis''' is a chronic inflammatory process involving a [[salivary glands|salivary gland]].
| Name      = {{PAGENAME}}
 
| Image      = Metaplastic atrophic gastritis - body -- intermed mag.jpg
'''Chronic sailolithiasis''' redirects here.
| Width      = Metaplastic atrophic gastritis - body of stomach. [[H&E stains]].
'''Sialadenitis''' redirects here.  
| 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.
*Occasionally associated with malignancy, e.g. [[adenoid cystic carcinoma]].<ref name=pmid21159490>{{cite journal |author=Hasegawa M, Cheng J, Maruyama S, ''et al.'' |title=Complication of adenoid cystic carcinoma and sialolithiasis in the submandibular gland: report of a case and its etiological background |journal=Int J Oral Maxillofac Surg |volume=40 |issue=6 |pages=647–50 |year=2011 |month=June |pmid=21159490 |doi=10.1016/j.ijom.2010.11.009 |url=}}</ref>
*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.


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>
Etiology:<ref>URL: [http://emedicine.medscape.com/article/882358-overview http://emedicine.medscape.com/article/882358-overviewhttp://emedicine.medscape.com/article/882358-overview]. Accessed on: 10 January 2011.</ref>
*Parietal cells.
*Infection.
*Intrinsic factor.  
*Autoimmune (e.g. [[Sjögren syndrome]], [[systemic lupus erythematosus]]).
*Other.


Others:
Associations:
*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>
*[[Smoking]].<ref name=pmid2037973>{{cite journal |author=Eliasson L, Heyden G, Landahl S, Steen B |title=Effects of tobacco and diuretics on human palatal salivary glands |journal=J. Oral Pathol. Med. |volume=20 |issue=3 |pages=126–9 |year=1991 |month=March |pmid=2037973 |doi= |url=}}</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.


==Gross==
==Gross==
*Erythema - corpus involved, antrum spared.
Features:
*Typical location: submandibular salivary gland.
*Salivary gland swelling.<ref name=pmid21159490/>


==Microscopic==
==Microscopic==
Features:
Features:
*Corpus predominant inflammation - usu. moderate or severe - '''key feature'''.
*Non-neoplastic mononuclear inflammatory infiltrate (lymphocytes, [[plasma cell]]s).
*Loss of parietal cells.
*Fibrosis.
*Increased G cells in the antrum.
*+/-Calcifications.
**Produce gastrin to stimulate the (missing) parietal cells.


Notes:
Note:
*Compare with other types of ''[[gastric atrophy]]''.
*If the infiltrate is predominantly lymphocytes Sjögren's is a possibility, and reporting a ''[[Focus score]]'' should be considered.


DDx:
DDx:
*[[Gastric neuroendocrine tumour]].
*[[Lymphoma]] - especially [[MALT lymphoma]].<ref name=pmid22475637>{{Cite journal  | last1 = Beasley | first1 = MJ. | title = Lymphoma of the Thyroid and Head and Neck. | journal = Clin Oncol (R Coll Radiol) | volume =  | issue =  | pages =  | month = Apr | year = 2012 | doi = 10.1016/j.clon.2012.02.010 | PMID = 22475637 }}</ref>
*[[Intestinal metaplasia of the stomach]] with chronic inflammation.
*[[IgG4-related systemic diseases|IgG4-related sialadenitis]].<ref name=pmid31760789>{{cite journal |authors=Thompson LDR |title=IgG4-Related Sialadenitis |journal=Ear Nose Throat J |volume= |issue= |pages=145561319890153 |date=November 2019 |pmid=31760789 |doi=10.1177/0145561319890153 |url=}}</ref>


===Images===
===Image===
<gallery>
<gallery>
Image: Metaplastic atrophic gastritis - body -- very low mag.jpg | MAG (body) - very low mag.
Image:Chronic_sialadenitis.jpg | Chronic sialadenitis. (WC/Nephron)
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==
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===
<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.
 
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>
</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>
**Findings may be seen in hypergastrinemia and nodular enterochromaffin cell-like (ECL) hyperplasia.


==Sign out==
==Sign out==
<pre>
<pre>
STOMACH, BIOPSY:
SUBMANDIBULAR GLAND, RIGHT, EXCISION:
- SEVERE CHRONIC ACTIVE GASTRITIS WITH EXTENSIVE INTESTINAL METAPLASIA.
- CHRONIC SIALOADENITIS.
- NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS.
- SIALOLITHIASIS.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.
- TWO BENIGN LYMPH NODES.
- NEGATIVE FOR MALIGNANCY.
</pre>


COMMENT:
====Micro====
Parietal cells are not apparent on the H&E stained sections. Immunostains show  
The sections show submandibular salivary gland with a mild patchy mixed mononuclear cell
rows of Chromogranin A positive cells and a lack of gastrin staining.
infiltrate, fibrosis and a large benign calcification. No zonal necrosis is identified.
Significant nuclear atypia is not identified.


These findings suggest an autoimmune gastritis; correlation with blood work
=====Alternate=====
is suggested.
The sections show a salivary gland with a patchy mixed mononuclear cell infiltrate and fibrosis. Significant nuclear atypia is not identified. Plasma cells are not prominent. Germinal centres are present.
</pre>


==See also==
==See also==
*[[Stomach]].
*[[Salivary gland]].
*[[Gastritis]].
**[[Chronic gastritis]].
*[[Anemia]].


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Stomach]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Salivary gland]]
Michael
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