Portal hypertensive gastropathy
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Portal hypertensive gastropathy, abbreviated PHG, is a benign pathology of the stomach caused by high blood pressure in the portal system.
General
- Due to portal hypertension.
- Usually secondary to liver cirrhosis which is typically due to alcoholism.
- Reported in approximately 65% of cirrhotics with portal hypertension in one paper.[1]
- Usually secondary to liver cirrhosis which is typically due to alcoholism.
Gross
Features:[2]
- Mosaic-like pattern.
- May be referred to as snakeskin-like pattern.[3]
- Usu. body of stomach.
- +/-Red spots.
Note:
- May mimic eosinophilic gastritis.[3]
Images
PHG. (WC/Samir)
Microscopic
Features:[4]
- Dilated capillaries in the submucosa (prominent) and to a lesser extent in the lamina propria - key feature.
Notes:
- May be associated with hyperplastic-like polyps.[5]
- Subepithelial granulation tissue and vascular proliferation.
- Findings in mucosal biopsies are often nonspecific, i.e. not diagnostic.[4]
DDx:
- Gastric antral vascular ectasia - have thrombi in the dilated blood vessels.
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STOMACH, BIOPSY: - ANTRAL-TYPE AND BODY-TYPE GASTRIC MUCOSA WITH PROMINENT CAPILLARIES AND MODERATE CHRONIC INACTIVE INFLAMMATION. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: No fibrin thrombi are seen. The findings are compatible with portal hypertension. Clinical correlation is required.
Hyperplastic-like polyp
POLYP, STOMACH, BIOPSY: - HYPERPLASTIC-LIKE POLYP WITH PROMINENT VESSELS, EDEMA AND AN ERODED SURFACE WITH GRANULATION TISSUE FORMATION, SEE COMMENT. - NEGATIVE FOR HELICOBACTER-LIKE ORGANISMS. - NEGATIVE FOR INTESTINAL METAPLASIA. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY. COMMENT: The polyp is consistent with the type described by Lam et al. in a set of individuals with portal hypertension. (Eur J Gastroenterol Hepatol 23 (12): 1245-9.)
See also
References
- ↑ Mesihovic, R.; Prohic, D.; Gribajcevic, M.; Vanis, N.; Gornjakovic, S.; Sarac, A. (2004). "Portal hypertensive gastropathy (PHG).". Med Arh 58 (6): 377-9. PMID 15648238.
- ↑ Thuluvath, PJ.; Yoo, HY. (Dec 2002). "Portal Hypertensive gastropathy.". Am J Gastroenterol 97 (12): 2973-8. doi:10.1111/j.1572-0241.2002.07094.x. PMID 12492178.
- ↑ 3.0 3.1 Sikanderkhel, S.; Luthra, M.; Chavalitdhamrong, D. (Jan 2012). "Snakeskin-like pattern mimicking portal hypertensive gastropathy in patient with eosinophilic gastritis.". Dig Endosc 24 (1): 53. doi:10.1111/j.1443-1661.2011.01155.x. PMID 22211417.
- ↑ 4.0 4.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 120-1. ISBN 978-0443066573.
- ↑ Lam, MC.; Tha, S.; Owen, D.; Haque, M.; Chatur, N.; Gray, JR.; Yoshida, EM. (Nov 2011). "Gastric polyps in patients with portal hypertension.". Eur J Gastroenterol Hepatol 23 (12): 1245-9. doi:10.1097/MEG.0b013e32834c15cf. PMID 22002002.