Helicobacter gastritis

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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 acute gastritis, 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:

Epidemiologic associations - Helicobacter infections are associated with:[1]

Note:

  • Historically, Helicobacter was grouped with Campylobacter.[2]
    • This is why it is the rapid urease test, sometimes done at endoscopy, is also known as the Campylobacter-like organism test, abbreviated CLO test.

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.[3]
    • Helicobacter heilmannii:[4]
      • Corkscrew appearance.
  • Inflammation - usually moderate chronic active.

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.[5]
  • 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.[6]

DDx:

Images

www:

Helicobacter heilmannii

Stains

IHC

  • Helicobacter pylori IHC stain +ve.

Note:

  • Reportly also stains Helicobacter heilmannii.[4]

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Body

Stomach, Biopsy:
- Body-type gastric mucosa with moderate chronic active inflammation 
  and abundant HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

IELs in duodenum

A. Duodenum, Biopsy:
- Small bowel mucosa with increased intraepithelial lymphocytes, villous
  architecture and crypt architecture within normal limits, see comment.
- NEGATIVE for acute duodenitis.
- NEGATIVE for dysplasia.

B. Stomach, Biopsy:
- Body-type gastric mucosa with moderate chronic active inflammation 
  and abundant HELICOBACTER-LIKE ORGANISMS.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

COMMENT:
There are approximately 45 lymphocytes/100 enterocytes. Increased intraepithelial lymphocytes (IELs) is a nonspecific finding. IELs are seen in celiac disease and inflammatory bowel disease; however, may be explained by the Helicobacter-like organisms found in the stomach. Clinical correlation is suggested.
Alternate comment
Comment:
Focally, there are approximately 50 lymphocytes/100 enterocytes. Increased intraepithelial
lymphocytes is a nonspecific finding that may be seen in a number of conditions, including
infections (e.g. Helicobacter gastritis), and autoimmune disorders (e.g. Crohn's disease, celiac disease). In this case, it may be explained by the Helicobacter-like organisms found in the stomach. Clinical correlation is suggested.

Block letters

STOMACH, BIOPSY:
- BODY-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Antrum

Stomach, Antrum, Biopsy:
     - Antral-type gastric mucosa with abundant HELICOBACTER-LIKE ORGANISMS, 
       and moderate chronic active inflammation.
     - NEGATIVE for intestinal metaplasia.
     - NEGATIVE for dysplasia and NEGATIVE for malignancy.
Alternate
Stomach, Biopsy:
- Antral-type gastric mucosa with moderate chronic active inflammation.
- Abundant Helicobacter-like organisms present.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
Block letters
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH MODERATE CHRONIC ACTIVE INFLAMMATION.
- ABUNDANT HELICOBACTER-LIKE ORGANISMS PRESENT.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

IM present

Stomach, Biopsy:
- Antral-type gastric mucosa with:
-- Focal intestinal metaplasia.
-- Abundant Helicobacter-like organisms.
-- Moderate chronic active gastritis.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.
Block letters
STOMACH, BIOPSY:
- ANTRAL-TYPE GASTRIC MUCOSA WITH:
-- FOCAL INTESTINAL METAPLASIA.
-- ABUNDANT HELICOBACTER-LIKE ORGANISMS.
-- MODERATE CHRONIC ACTIVE INFLAMMATION.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

H. heilmannii

Stomach, Biopsy:
- Antral-type gastric mucosa with moderate chronic active inflammation.
- Abundant Helicobacter-like organisms present.
- NEGATIVE for intestinal metaplasia.
- NEGATIVE for dysplasia and NEGATIVE for malignancy.

Comment:
The Helicobacter-like organisms have an appearance similar to crinkle cut French fries; this suggests the organisms are H. heilmannii.

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

References

  1. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 814. ISBN 0-7216-0187-1.
  2. Ciortescu, I.; Stan, M.. "[Helicobacter pylori--friend or foe?].". Rev Med Chir Soc Med Nat Iasi 114 (3): 619-24. PMID 21243784.
  3. Mobley, HLT.; Mendz, GL.; Hazell, SL.; Andersen, LP.; Wadström, T.. Basic Bacteriology and Culture. PMID 21290743. http://www.ncbi.nlm.nih.gov/books/NBK2444/.
  4. 4.0 4.1 Singhal, AV.; Sepulveda, AR. (Nov 2005). "Helicobacter heilmannii gastritis: a case study with review of literature.". Am J Surg Pathol 29 (11): 1537-9. PMID 16224223.
  5. Maaroos HI, Kekki M, Villako K, Sipponen P, Tamm A, Sadeniemi L (October 1990). "The occurrence and extent of Helicobacter pylori colonization and antral and body gastritis profiles in an Estonian population sample". Scand. J. Gastroenterol. 25 (10): 1010-7. PMID 2263873.
  6. Kwan, CP.; Tytgat, GN. (Nov 1995). "Antral G-cell hyperplasia: a vanishing disease?". Eur J Gastroenterol Hepatol 7 (11): 1099-1103. PMID 8680911.
  7. URL: http://gut.bmj.com/content/58/12/1669.extract. Accessed on: 2 March 2012.