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Stomach

Hypertrophic gastropathy and enlarged mucosal folds

Menetrierís disease


Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 13 October 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● A hyperplastic gastropathy described by Menetrier in 1888 as polyadenomes en nappe
● Giant mucosal folds involving fundus and body, usually (not always) spares antrum

Clinical features
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● 75% men
● Mean age 30-50ís; chronic and severe
● Children: uncommon; often have CMV or other infection, peripheral eosinophilia
● Peripheral edema present due to mucosal protein loss, variable weight loss, diarrhea
● Low acid production even after stimulation
● Likely due to excessive transforming growth factor alpha with increased signalling of EGFR
● Grossly and radiologically resembles Zollinger-Ellison syndrome

Treatment
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● Children: self-limited
● Adults: may require partial gastrectomy; monoclonal antibody therapy may be helpful (Clin Gastroenterol Hepatol 2005;3:654)

Gross description
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● Usually affects greater curvature of stomach
● Markedly hypertrophic gastric folds resembling cerebral convolutions
● Abrupt transition to normal mucosa

Gross images
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Menetrier's disease

Micro description
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● Marked foveolar hyperplasia, tortuous (corkscrew) and cystically dilated foveolar glands
● May extend into muscularis mucosa
● Atrophic glandular compartment
● Edematous and mildly inflamed lamina propria, may have increased intraepithelial lymphocytes

Differential diagnosis
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● Lymphoma and carcinoma
● Varioliform gastritis (hypertrophic lymphocytic gastritis); clinicopatholgic correlation is necessary
● CMV (Am J Gastroenterol 2001;96:223)


Localized Menetrierís disease

General
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● Rare localized hyperplastic gastropathy, associated with stomach adenocarcinoma (Am J Surg Pathol 1997;21:1334)
● Symptoms: upper abdominal discomfort, loss of appetite, weight loss, anemia, occasionally hypoproteinemia

Gross description
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● Circumscribed area of giant folds, well demarcated from surrounding normal-appearing mucosa
● Usually in body or antrum

Micro description
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● Increase in epithelial cell mass of mucous cells with long, sometimes cystically dilated foveola, mild inflammatory infiltrate

End of Stomach > Hypertrophic gastropathy and enlarged mucosal folds > Menetrierís disease


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