Difference between revisions of "Autoimmune metaplastic atrophic gastritis"

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{{ 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    = 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
| Micro      = corpus predominant inflammation - usu. moderate or severe, loss of parietal cells, increased G cells in the antrum
| Subtypes  =
| Subtypes  =
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| ClinDDx    = diffuse chronic gastritis
| 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> is a rare pathology of the [[stomach]].  It is closely associated with '''pernicious anemia'''.
'''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>
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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 67: 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:

Latest revision as of 18:31, 22 April 2024

Autoimmune metaplastic atrophic gastritis
Diagnosis in short

Atrophic gastritis (body) without appreciable parietal cells. H&E stain.

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][4]

  • Parietal cells: anti-parietal cell antibody (APCA).
  • Intrinsic factor: intrinsic factor blocking antibody (IFBA).

Others:

  • Gastrin level (increased).[5]
    • Normal < 100 pg/mL.[6]

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:[7]

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

Images

Body

Antrum

www

Sign out

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.

Listing the blood work

If not already done, correlation with blood work (anti-parietal cell antibody, intrinsic factor blocking antibody, gastrin) and clinical findings is recommended.

Block letters

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. Salinas M, Flores E, López-Garrigós M, Leiva-Salinas C (February 2020). "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". Clin Chem Lab Med 58 (3): 424–429. doi:10.1515/cclm-2019-0749. PMID 31714882.
  5. 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.
  6. URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/8512. Accessed on: 14 August 2012.
  7. 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.
  8. 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.