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Stomach

Normal histology

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 25 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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Layers:
● Mucosa
● Submucosa (with Meissner plexus)
● Muscularis propria (outer longitudinal layer, Auerbach/myenteric plexus, inner circular layer, innermost oblique layer)
● Serosa

Mucosal protection against autodigestion:
(a) mucus secretion: mucus is relatively impermeable to H+; also fluid with acid or pepsin exits gastric glands as “jets” and penetrates surface mucus layer without contacting surface epithelial cells
(b) bicarbonate secretion creates pH neutral microenvironment adjacent to cell surface
(c) intercellular tight junctions prevent back-diffusion of H+; disruptions are quickly repaired
(d) rich blood flow supplies bicarbonate and nutrients and removes acid
(e) muscularis mucosa limits injury; if intact, repair occurs in hours/days vs. weeks if not intact

Mucosal components
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Gastric mucosa has two compartments:
  1. Superficial foveolar compartment, relatively uniform throughout, consists of surface epithelial / foveolar cells lining the entire mucosal surface and pits
  2. Deep glandular compartment, varying composition and thickness in different regions containing gastric glands

● The gastric mucosa is very metabolically active
● The entire mucosa is replaced every 2 to 8 days (varies by source)
● Mucous neck cells at the base of foveola are progenitors of surface epithelium and gastric glands, mitotically active, site of gastric carcinogenesis
● Ratio of foveola to gland volume differs by region: cardia/antrum: 50/50; fundus: 25/75

Micro images
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Histology of entire stomach

Cardia

General
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● Branching mucous glands without parietal cells
● May have cysts within glands
● Variable length of 0 to 15 mm
● May be metaplastic epithelium due to reflux (Am J Surg Pathol 2002;26:1207, Am J Surg Pathol 2002;26:1032, Am J Surg Pathol 2001;25:1188, Am J Surg Pathol 2000;24:402, Am J Surg Pathol 2000;24:344, Arch Pathol Lab Med 2003;127:451)

Micro images
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Area adjacent to squamocolumnar junction, cardiac mucosa

Fundus

General
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● Also known as oxyntic mucosa
● Straight glands composed of tightly packed chief cells, parietal cells, endocrine cells, mucus cells
● Higher ratio of glands to foveola than antrum
● Region of fundic mucosa shrinks with age (termed pyloric metaplasia)

Micro images
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Fundic mucosa

Antrum

General
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● Branching mucus glands, cytoplasm may be bubbly, vacuolated, granular or glassy
● Sometimes ciliated in Japanese patients (Jpn J Cancer Res 1986;77:282, case report in American patient at Am J Surg Pathol 1988;12:786)
● May contain small aggregates of lymphocytes without germinal centers

Micro images
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Antral/pyloric mucosa

Parietal cells

General
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● Primarily in fundus/body
● Eosinophilic due to abundant mitochondria, produce acid via H+/K+ ATPase pump
● Also secrete intrinsic factor which binds luminal Vitamin B12
● Stimulated by vagus nerve, binding of gastrin receptor by gastrin from antral cells, binding of H2 receptor by histamine from enterochromaffin-like cells
● Histamine is the most important pathway

Micro images
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Parietal cells

Chief cells

General
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● Fundus/body
● Basophilic cytoplasm due to abundant rough endoplasmic reticulum
● Release pepsinogen I and II, which are activated by low luminal pH to pepsin

Endocrine cells

General
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● Scattered in fundus/body (produce histamine, are enterochromaffin-like), more prominent in antral glands
● Produce gastrin (G cells), serotonin (enterochromaffin cells), somatostatin (D cells)
● Often have clear cytoplasm

Micro images
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Gastrin immunostain

Enterochromaffin-like (ECL) cells

General
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● Non-peptide secreting endocrine cell of gastric fundus/body mucosa
● Represent 30% of endocrine cells
● Release histamine in response to gastrin produced by G cells
● Long term gastrin stimulation causes ECL hyperplasia

Mucous cells

General
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● Produce neutral (PAS positive) mucin, usually not acidic mucins
● Lightly eosinophilic or clear cytoplasm and bubbly

Ganglion cells

General
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● Associated with Meissner and Auerbach plexuses

Micro images
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Neural bundle with ganglion cells should not be mistaken for infiltrating tumor cells

Negative stains
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● CDX2 (except in areas of intestinal metaplasia)

End of Stomach > Normal histology

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