Gastritis: Difference between revisions
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Inflammation of the [[stomach]]: | Inflammation of the [[stomach]]: | ||
==Microscopy evaluation== | ==Microscopy evaluation== | ||
[[File:Updated Sydney System for visual classification of gastritis.png|thumb|340px|Updated Sydney System for visual classification of gastritis.<ref name=Carrasco/>]] | |||
Look for chronic or acute gastritis. If either is present, still look for the other. | |||
===Chronic gastritis=== | |||
*'''Chronic gastritis'''<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachchronicgastritis.html|title=Stomach - Gastritis - Chronic gastritis|author=Elliot Weisenberg|website=PathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref> | |||
[[File:Histopathology of mucosal plasma cell infiltrate in chronic gastritis.jpg|thumb|Mucosal plasma cell infiltrate in '''mild chronic gastritis'''.]] | |||
:*Presence of '''plasma cells''', '''lymphocytes''', and occasionally lymphoid '''follicles'''. Scattered single plasma cells and lymphocytes is normal, and the threshold is subjective, but one definition of chronic gastritis is when seeing chronic inflammation at 4x magnification (as increased dots separating glands)<ref>{{cite web|url=Gastritis: A Pattern Based Approach|author=Lysandra Voltaggio, Johns Hopkins Department of Pathology|website=Arizona Society of Pathologists|date=2018-10-31}}</ref> Eosinophils and neutrophils may be present. | |||
:*'''Reduced mucin''' in the cytoplasm | |||
:*'''Enlargement''' of nuclei and nucleoi | |||
:*'''Subnuclear vacuolation''' in antral glands or pits (which is PAS negative) | |||
:*'''Intestinal metaplasia''': with partial replacement of the mucosa of the antrum and body with metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells. | |||
<gallery mode=packed heights=210> | |||
File:Histopathology of antral mucosa with atrophy.png|In '''intestinal metaplasia''' (seen at bottom of this antral mucosa), also look for '''atrophy''' as pictured.<ref name=Carrasco/><ref group=notes>The combination of atrophy and gastritis helps the clinician to potentially make a diagnosis of atrophic gastritis.</ref> | |||
File:Histopathology of fundic mucosa with atrophy.png|Extensive atrophy of oxyntic glands in fundus/corpus causes '''pseudo-pyloric metaplasia'''.<ref name=Carrasco/> | |||
</gallery> | |||
When gastritis is present, especially if relatively superficial, also evaluate as a [[stomach biopsy for Helicobacter pylori|stomach biopsy for '''Helicobacter pylori''']]. | |||
===Acute gastritis=== | |||
[[File:Histopathology of mild active gastritis, annotated.jpg|thumb|230px|Histopathology of '''mild active gastritis''', with intraepithelial neutrophils (white arrows) as well as in lamina propria (black arrows).]] | [[File:Histopathology of mild active gastritis, annotated.jpg|thumb|230px|Histopathology of '''mild active gastritis''', with intraepithelial neutrophils (white arrows) as well as in lamina propria (black arrows).]] | ||
*'''Mild acute gastritis:'''<ref name=PathologyOutlinesAcute>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachacutegastritis.html|title=Stomach - Gastritis - Acute gastritis|author=Elliot Weisenberg|website=pathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref> | *'''Mild acute gastritis:'''<ref name=PathologyOutlinesAcute>{{cite web|url=https://www.pathologyoutlines.com/topic/stomachacutegastritis.html|title=Stomach - Gastritis - Acute gastritis|author=Elliot Weisenberg|website=pathologyOutlines}} Topic Completed: 1 August 2012. Minor changes: 31 August 2020</ref> | ||
:*Modest '''edema''' of lamina propria | :*Modest '''edema''' of lamina propria | ||
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:*Fibrinopurulent luminal '''exudate''' | :*Fibrinopurulent luminal '''exudate''' | ||
:*Nearby epithelium may show '''regenerative''' changes | :*Nearby epithelium may show '''regenerative''' changes | ||
===Microscopy report=== | ===Microscopy report=== | ||
Revision as of 13:49, 23 September 2021
Author:
Mikael Häggström [note 1]
Inflammation of the stomach:
Microscopy evaluation
Look for chronic or acute gastritis. If either is present, still look for the other.
Chronic gastritis
- Chronic gastritis[2]
- Presence of plasma cells, lymphocytes, and occasionally lymphoid follicles. Scattered single plasma cells and lymphocytes is normal, and the threshold is subjective, but one definition of chronic gastritis is when seeing chronic inflammation at 4x magnification (as increased dots separating glands)[3] Eosinophils and neutrophils may be present.
- Reduced mucin in the cytoplasm
- Enlargement of nuclei and nucleoi
- Subnuclear vacuolation in antral glands or pits (which is PAS negative)
- Intestinal metaplasia: with partial replacement of the mucosa of the antrum and body with metaplastic goblet cells of intestinal morphology, absorptive cells and Paneth cells.
-
Extensive atrophy of oxyntic glands in fundus/corpus causes pseudo-pyloric metaplasia.[1]
![In intestinal metaplasia (seen at bottom of this antral mucosa), also look for atrophy as pictured.[1][notes 1]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_antral_mucosa_with_atrophy.png){kind=link}
![Extensive atrophy of oxyntic glands in fundus/corpus causes pseudo-pyloric metaplasia.[1]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_fundic_mucosa_with_atrophy.png){kind=link}
When gastritis is present, especially if relatively superficial, also evaluate as a stomach biopsy for Helicobacter pylori.
Acute gastritis
- Mild acute gastritis:[4]
- Modest edema of lamina propria
- Vascular congestion
- Scattered neutrophils
- Mucosal hemorrhage
- Intact epithelium
-
Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit micoabscess.[1]
![Early acute superficial gastritis: Marked neutrophilic infiltrates appear in the mucous neck region and lamina with a pit micoabscess.[1]](/index.php?title=Special:Upload&wpDestFile=Histopathology_of_early_acute_superficial_gastritis.png){kind=link}
- Moderate to severe acute gastritis:[4]
- Loss of superficial epithelium above the muscularis mucosa
- Hemorrhage
- Variable infiltrate with neutrophils
- Fibrinopurulent luminal exudate
- Nearby epithelium may show regenerative changes
Microscopy report
Chronic gastritis without neutrophils is preferably also termed "non-active".
Example:
| (Gastric, biopsy:) Mild chronic non-active gastritis, non-specific. Negative for Helicobacter pylori organisms on H&E slide. |
Notes
- ↑ The combination of atrophy and gastritis helps the clinician to potentially make a diagnosis of atrophic gastritis.
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ 1.0 1.1 1.2 1.3 Carrasco G, Corvalan AH (2013). "Helicobacter pylori-Induced Chronic Gastritis and Assessing Risks for Gastric Cancer.
". Gastroenterol Res Pract 2013: 393015. doi:. PMID 23983680. PMC: 3745848. Archived from the original. .
Figures - available via license: Creative Commons Attribution 3.0 Unported - ↑ Elliot Weisenberg. Stomach - Gastritis - Chronic gastritis. PathologyOutlines. Topic Completed: 1 August 2012. Minor changes: 31 August 2020
- ↑ Error on call to Template:cite web: Parameters url and title must be specifiedLysandra Voltaggio, Johns Hopkins Department of Pathology (2018-10-31). . Arizona Society of Pathologists.
- ↑ 4.0 4.1 Elliot Weisenberg. Stomach - Gastritis - Acute gastritis. pathologyOutlines. Topic Completed: 1 August 2012. Minor changes: 31 August 2020
Image sources