Lymphocytic gastritis

Author: Elliot Weisenberg, M.D. (see Authors page)

Revised: 1 August 2018, last major update August 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: lymphocytic gastritis[title]
Cite this page: Weisenberg, E. Lymphocytic gastritis. website. Accessed November 14th, 2018.
Definition / general
  • Uncommon, characterized by lymphocytosis of foveolar and surface epithelium (25+ lymphocytes per 100 surface epithelial cells) and chronic inflammation in lamina propria
  • A nonspecific inflammatory pattern
  • First described in 1988 (Gut 1988;29:1258)
  • Incidence the same in men and women, ususally diagnosed in 6th decade
  • Associated with celiac disease (present in 1/3 of these patients, both have similar severity in children, Am J Surg Pathol 1996;20:865, Am J Surg Pathol 1999;23:153), varioliform gastritis (varioliform lymphocytic gastritis), Ménétrier disease, lymphocytic or collagenous colitis, rarely with Helicobacter pylori (HP) gastritis (present in 4% of these patients)
  • Less commonly with Crohn's disease, HIV, lymphoma, esophageal carcinoma, inflammatory polyp
  • Patients with varioliform lymphocytic gastritis often suffer weight loss and anorexia, may have protein losing enteropathy
  • Endoscopy: normal (low grade) or nodules, erosions and large folds (more severe disease, also known as varioliform gastritis); most severe form may resemble Ménétrier disease, although a relationship has been postulated in some cases (Pathol Res Pract 2000;196:125)
  • Treat underlying celiac disease (gluten free diet) or H. pylori infection
Gross description
  • Antral (celiac disease) or corpus (H. pylori infection) involvement
Microscopic (histologic) description
  • Increased lymphocytes in surface and foveolar epithelium, as well as lamina propria
  • 25+ lymphocytes per 100 epithelial cells is minimum
  • Most cases have 30 - 65 lymphocytes/100 epithelial cells
  • Lymphocytes are small and round without atypia, most are T cells
  • May have clear halo (artifact)
  • CD8+ T cells in stomach (similar to celiac disease) when associated with celiac disease
  • High number of granzyme B positive (activated cytotoxic) T cells in nonceliac disease-associated lymphocytic gastritis (Am J Surg Pathol 1998;22:450)
  • Lymphoepithelial lesions are rare, no active gland destruction
  • Lymphocytes most numerous in varioliform gastritis (large folds due to foveolar hyperplasia, not considered Ménétrier disease)
Differential diagnosis
  • MALT lymphoma: expanded lamina propria, dense collection of monocytoid cells larger than small lymphocytes, may be plasmacytoid, have Dutcher bodies; also intraepithelial lymphocytes, infiltration of muscularis mucosa; lymphoepithelial lesions usually contain 3+ cells; often active gland destruction; B cell origin vs. T cell for lymphocytic gastritis