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Stomach

Gastritis

Lymphocytic gastritis


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 5 August 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Uncommon, characterized by lymphocytosis of foveolar and surface epithelium (25+ lymphocytes per 100 surface epithelial cells) and chronic inflammation in lamina propria
● A non-specific 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’s 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 description
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● Normal (low grade) or nodules, erosions and large folds (more severe disease, also known as varioliform gastritis)
● Most severe form may resemble Menetrier’s disease, although a relationship has been postulated in some cases (Pathol Res Pract 2000;196:125)

Treatment
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● Treat underlying celiac disease (gluten free diet) or H. pylori infection

Endoscopic images
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Endoscopic appearances of varioliform gastritis

Gross description
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● Antral (celiac disease) or corpus (H. pylori infection) involvement

Micro description
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● 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 Menetrier’s disease)

Micro images
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Large number of intraepithelial lymphocytes


MALT lymphoma (for comparison)

Differential diagnosis
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● 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

End of Stomach > Gastritis > Lymphocytic gastritis


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