Difference between revisions of "Autoimmune metaplastic atrophic gastritis"

From Libre Pathology
Jump to navigation Jump to search
(+images)
(One intermediate revision by the same user not shown)
Line 1: Line 1:
 
{{ Infobox diagnosis
 
{{ Infobox diagnosis
 
| Name      = {{PAGENAME}}
 
| Name      = {{PAGENAME}}
| Image      =  
+
| Image      = Metaplastic atrophic gastritis - body -- intermed mag.jpg
| Width      =
+
| Width      = Metaplastic atrophic gastritis - body of stomach. [[H&E stains]].
 
| Caption    =  
 
| Caption    =  
 
| Micro      = corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum
 
| Micro      = corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum
Line 62: Line 62:
 
*[[Gastric neuroendocrine tumour]].
 
*[[Gastric neuroendocrine tumour]].
 
*[[Intestinal metaplasia of the stomach]] with chronic inflammation.
 
*[[Intestinal metaplasia of the stomach]] with chronic inflammation.
 +
 +
===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 - body - chromogranin A -- very low mag.jpg | MAG - chromogranin A - very low 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.
 +
 +
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>
  
 
==IHC==
 
==IHC==
Line 69: Line 97:
 
**+ve in antrum.
 
**+ve in antrum.
  
Images:
+
===Images===
 +
<gallery>
 +
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>
 +
 
 +
====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.

Revision as of 20:56, 23 May 2020

Autoimmune metaplastic atrophic gastritis
Diagnosis in short

LM corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum
LM DDx chronic gastritis, intestinal metaplasia of the stomach, gastric neuroendocrine tumour
Site stomach

Prevalence uncommon
Blood work antibodies to parietal cells & intrinsic factor, macrocytic anemia, increased gastrin level
Endoscopy erythema - corpus only
Clin. DDx diffuse chronic gastritis

Autoimmune metaplastic atrophic gastritis, also autoimmune gastritis[1] (abbreviated AIG), is a rare pathology of the stomach. It is closely associated with pernicious anemia.

General

  • Pathology: loss of parietal cells, gastric atrophy.
  • Lab: classically considered to have macrocytic anemia; however, normocytic and microcystic more common.[2]
  • Etiology: autoimmune.

Diagnosis based on serology for antibodies to:[3]

  • Parietal cells.
  • Intrinsic factor.

Others:

  • Gastrin level (increased).[4]
    • Normal < 100 pg/mL.[5]

Note:

  • Parietal cells produce intrinsic factor (important for vitamin B12 absorption) and hydrogen chloride, i.e. stomach acid.

Gross

  • Erythema - corpus involved, antrum spared.

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.

Notes:

DDx:

Images

IHC

Features:[6]

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

Images

www

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.

See also

References

  1. 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.
  2. Hershko, C.; Ronson, A.; Souroujon, M.; Maschler, I.; Heyd, J.; Patz, J. (Feb 2006). "Variable hematologic presentation of autoimmune gastritis: age-related progression from iron deficiency to cobalamin depletion.". Blood 107 (4): 1673-9. doi:10.1182/blood-2005-09-3534. PMID 16239424.
  3. Oh, R.; Brown, DL. (Mar 2003). "Vitamin B12 deficiency.". Am Fam Physician 67 (5): 979-86. PMID 12643357.
  4. 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.
  5. URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512. Accessed on: 14 August 2012.
  6. 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.
  7. 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.