Stomach
General
Histology


Topic Completed: 28 May 2020

Minor changes: 15 July 2020

Copyright: 2003-2020, PathologyOutlines.com, Inc.

PubMed Search: Histology[TI] stomach[TI]

Kelsey E. McHugh, M.D.
Thomas P. Plesec, M.D.
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Cite this page: McHugh KE, Plesec TP. Histology. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachnormalhistology.html. Accessed August 8th, 2020.
Definition / general
  • A review of the normal constituents of the gastric wall, with a focus on the gastric mucosa, its compartments, its cell types and their cellular products
Essential features
  • Anatomic regions: cardia, fundus, body, antrum / pylorus
  • Layers: mucosa, submucosa, muscularis propria, subserosa, serosa
  • Cell types: mucous cells, parietal cells, chief cells, endocrine cells
  • Cardia and antrum: mucinous glands
  • Body and fundus: oxyntic glands
Physiology
  • General functions: digestion, motility, microbial defense (Statpearls: Physiology, Stomach [Accessed 28 May 2020])
  • Digestive system organ that receives contents from the esophagus via the gastroesophageal sphincter and empties its contents into the duodenum via the pyloric sphincter
    • Partially digests food boluses received from the esophagus
      • Mechanical digestion: back and forth churning by inner oblique layer of muscularis propria
      • Chemical digestion: acidic milieu breaks down proteins and kills food derived microbes
        • Parietal cells secrete hydrochloric acid (HCl), which maintains acidic pH of stomach and denatures proteins
        • Chief cells secrete pepsinogen, which breaks down proteins when activated to pepsin by the acidic environment
        • Microenvironment of the stomach is largely regulated by enteroendocrine cell hormone secretion and vagus nerve innervation
    • Empties chyme (partially digested food) into the duodenum
      • Gastric emptying largely facilitated by the inner circular and outer longitudinal layers of muscularis propria
        • Smooth muscle contractions (peristalsis) are controlled by the interstitial cells of Cajal (J Physiol 2006;571:1)
      • Majority of nutrient absorption will occur in small bowel
Diagrams / tables

Contributed by Kelsey E. McHugh, M.D.
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Anatomic regions

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Layers of gastric wall

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Gastric mucosa

Clinical images

Contributed by Kelsey E. McHugh, M.D.
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Gastric body with unremarkable rugal folds

Gross description
  • A malleable gastric wall with pink, smooth, glistening serosa and pink-tan velvety mucosa arranged in coarse rugal folds which are more prominent in the body and fundus, whereas antral mucosa is more flat (Am J Surg Pathol 1986;10:48)
Gross images

Contributed by Kelsey E. McHugh, M.D.
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Formalin fixed gastric body

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Formalin fixed gastric rugal folds


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Total gastrectomy anatomic regions

Microscopic (histologic) description
  • Layers:
    • Mucosa (with muscularis mucosae)
    • Submucosa (with Meissner plexus)
    • Muscularis propria (outer longitudinal layer, Auerbach / myenteric plexus, inner circular layer, innermost oblique layer)
    • Subserosa
    • Serosa (Am J Surg Pathol 1986;10:48)
  • Anatomic regions:
    • Cardia: variable length extending from 1 - 15 mm (average 5 mm) (Am J Surg Pathol 2002;26:1207)
    • Body (corpus) and fundus: known as oxyntic mucosa
      • Tightly packed glands acid and enzyme secreting glands
      • Ratio of pit to gland volume, 25:75
      • Parietal cells and chief cells are the glandular constituents
      • Can have interspersed mucin cells, especially in glandular isthmus / neck
      • Corpus antrum boundary moves proximally with age due to reduction of oxyntic mucosal volume
    • Antrum / pylorus: distal 3 - 4 cm
      • Loosely packed mucous secreting glands
      • Ratio of pit to gland volume, 50:50
      • Usually no cystic dilatation of glands
      • G cells are an endocrine cell unique to this anatomic region
      • Proximal extent along the lesser curvature exceeds that along the greater curvature (Gastroenterology 1972;63:584)
  • Components of gastric mucosa:
    • Gastric pits: surface invaginations that function as conduits of secretions; entirely lined by surface mucous (foveolar) cells regardless of anatomic region (Am J Surg Pathol 1986;10:48)
    • Gastric glands: synthesize acids, enzymes and mucins; constituents and their products vary depending on anatomic region of the stomach
  • Gastric cell types
    • Mucous cells
      • Secrete bicarbonate rich mucus that coats and lubricates the gastric surface
        • Serves protective function against autodigestion
      • Surface (foveolar) epithelium contains cytoplasmic neutral mucins
        • Lightly eosinophilic apical mucin cap
      • Mucous glands contain cytoplasmic neutral and acidic mucin (Arch Pathol 1968;85:580)
        • Lightly eosinophilic to clear bubbly / vacuolated cytoplasm
        • Lack an apical mucin cap
      • All mucous cells have round, basally oriented nuclei
    • Parietal cells
      • Produce hydrochloric acid via H+ / K+ -ATPase pump (Varela: Histology, Parietal Cells, 2019)
        • Hydrochloric acid maintains gastric acidity (pH 1.5 to 3.5), which:
          • Activates pepsinogen to active pepsin enzyme
          • Kills food derived bacteria
          • Facilitates food digestion
          • Promotes absorption of minerals (e.g. phosphate, calcium, iron)
      • Produce intrinsic factor, which is critical for vitamin B12 absorption in small bowel (Varela: Histology, Parietal Cells, 2019)
      • Secretion highly regulated by extrinsic and intrinsic neuroendocrine system (Physiol Rev 2020;100:573)
        • Stimulators of gastric acid secretion include:
          • Vagus nerve (via acetylcholine neurotransmitter)
          • Gastrin hormone
            • Hypergastrinemia can be induced by glucocorticoids
          • Histamine
          • Grehlin
        • Inhibitors of gastric acid secretion include:
          • Somatostatin
          • Pharmacologic agents (e.g. proton pump inhibitors)
      • Relatively large, triangular cells with eosinophilic cytoplasm due to abundant mitochondria
      • Centrally placed nuclei with evenly distributed chromatin
      • Predominantly occupy the superficial half of body / fundic glands
    • Chief cells
      • Produce pepsinogen I and II propeptides (Gastroenterology 1992;102:699)
        • Activated to pepsin enzyme via high acidity (low pH) environment
      • Cuboidal cells with basophilic to amphophilic cytoplasm due to abundant rough endoplasmic reticulum
      • Predominantly occupy the basal half of corpus glands
    • Endocrine cells
      • Generally inconspicuous, round cells with clear cytoplasm
      • Typically fewer than 20 endocrine cells per gland
      • Cell types include: (Regul Pept 2000;93:31)
        • G cells: produce gastrin
          • Limited to the gastric antrum
        • D cells: produce somatostatin
          • Distributed throughout whole stomach
        • Enterochromaffin (EC) cells: produce serotonin
          • Distributed throughout whole stomach
        • Enterochromaffin-like (ECL) cells: produce histamine (Int J Mol Sci 2019;20:E2444)
          • Limited to the gastric body and fundus
          • Secrete histamine in response to gastrin produced by G cells
          • Represent 30% of all endocrine cells
          • Long term gastrin stimulation causes enterochromaffin-like cell hyperplasia (e.g. in atrophic gastritis)
        • X cells: produce grehlin (Int J Pept 2010;2010:945056)
          • Limited to the gastric body and fundus
      • Concentrated within mucous neck region in antrum / pylorus
        • 50% G cells, 30% enterochromaffin cells, 15% D cells, 5% other
      • Scattered throughout oxyntic glands in body and fundus
        • Majority enterochromaffin-like cells; minority enterochromaffin cells, X cells, D cells
  • Gastric mucosa - general:
    • There are no visibly (grossly or microscopically) distinct boundaries between mucosal zones / anatomic regions (Am J Surg Pathol 1986;10:48)
    • Gastric mucosa is very metabolically active
    • Gastric surface epithelium is normally replaced every 4 - 8 days (Gastroenterology 1977;72:962)
    • Gastric parietal and chief cells turn over more slowly: every 1 - 3 years (J Natl Cancer Inst 1969;42:9)
    • Undifferentiated stem cells are concentrated in the isthmus / neck of gastric glands throughout the entire stomach
    • Lamina propria provides structural support (Am J Surg Pathol 1986;10:48)
      • Structural components: reticulin, collagen and elastin fibers; capillaries and arterioles; nerve fibers; few smooth muscle fibers
      • Cell types: fibroblasts, histiocytes, plasma cells, lymphocytes; occasional mast cells and eosinophils
    • Lymphoid tissue is sparse in lamina propria (Hum Pathol 1993;24:577)
      • Superficial lamina propria with small numbers of lymphocytes (B cells > T cells) and plasma cells
      • Can see small lymphoid aggregates (no germinal centers) in gastric antrum immediately superficial to muscularis mucosae
      • Intraepithelial lymphocytes absent or sparse
    • Lymphatic channels are present within gastric mucosa, generally immediately superficial to muscularis mucosae
    • Gastric mucosa protects itself against autodigestion / high acidity (Physiol Rev 1993;73:823)
      • 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 (Am J Physiol Gastrointest Liver Physiol 2017;313:G599)
      • Bicarbonate secretion creates pH neutral microenvironment adjacent to cell surface
      • Intercellular tight junctions prevent back diffusion of H+ and disruptions are quickly repaired
      • Rich blood flow supplies bicarbonate and nutrients and removes acid
      • Muscularis mucosae limits injury; if intact, mucosal repair occurs in hours / days versus weeks if not intact
Microscopic (histologic) images

Contributed by Kelsey E. McHugh, M.D.
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Gastric wall layers

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Oxyntic mucosa

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Antral mucosa

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Gastrin immunostain

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Cardia mucosa

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Parietal and chief cells


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Gastric pits

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Pseudo-signet ring cell artifact

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Distended foveolar cells

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PAS / AB in distended foveolar cells

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Neuroendocrine cells in gastric antrum

Virtual slides

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Unremarkable gastric body

Cytology description
  • Mucous cells: tightly cohesive columnar cells with basal round to ovoid nuclei in orderly, honeycombed sheets
    • Usually the predominant cell type
  • Chief cells: small cuboidal cells with round, smooth nuclei, fine nuclear chromatin and basophilic cytoplasmic granules in honeycombed sheets
    • Comparable in appearance to pancreatic or salivary acinar cells
  • Parietal cells: pyramidal to flask shaped cells with round nuclei, coarse nuclear chromatin and abundant intensely eosinophilic cytoplasm
    • Larger than chief cells
Cytology images

Contributed by Kelsey E. McHugh, M.D.
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Surface foveolar epithelium

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Parietal cells

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Chief cells

Positive stains
Sample pathology report
  • Stomach, cardia, biopsy:
    • Gastric cardia mucosa with no significant diagnostic alteration
    • No evidence of Helicobacter pylori microorganisms
  • Stomach, body / fundus, biopsy:
    • Gastric oxyntic mucosa with no significant diagnostic alteration
    • No evidence of Helicobacter pylori microorganisms
  • Stomach, antrum, biopsy:
    • Gastric antral mucosa with no significant diagnostic alteration
    • No evidence of Helicobacter pylori microorganisms
Board review style question #1

    Which gastric cell type, pictured above, produces intrinsic factor, an integral glycoprotein in the luminal absorption of vitamin B12?

  1. Chief cells
  2. Endocrine cells
  3. Enterochromaffin-like cells
  4. Mucous cells
  5. Parietal cells
Board review answer #1
E. Parietal cells

Comment Here

Reference: Normal histology
Board review style question #2
    The Meissner plexus is located within which layer of the stomach?

  1. Mucosa
  2. Muscularis propria
  3. Serosa
  4. Submucosa
  5. Subserosa
Board review answer #2
D. Submucosa

Comment Here

Reference: Normal histology
Board review style question #3
    Which of the following ratios most accurately described the gastric pit to gastric gland ratio within the corpus (body / fundus) of the stomach?

  1. 10:90
  2. 25:75
  3. 50:50
  4. 75:25
  5. 90:10
Board review answer #3
B. 25:75

Comment Here

Reference: Normal histology
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