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Pathology of Autoimmune

Gastritis (Type A)

Dr  Sampurna Roy  MD

 

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Also known as Type A gastritis is limited to corpus-fundus mucosa.

Characteristic features:

- Patient usually presents with pernicious anaemia.

- Diffuse atrophy of parietal and chief cell mass.

- Hypo or achlorhydria , hypergastrinemia, decreased pepsinogen levels.

- Associated with  antibodies to parietal cells, intrinsic factor and gastrin receptor.

- Cobalamin deficiency eventually leads  to pernicious anaemia.

- May develop gastric polyps.

- Increased risk of developing gastric carcinoma.

Gross appearance :

Pathology located in the gastric corpus. Severe atrophy of the cell coats including muscle. Mucosa thinned out with pebbled appearance.

Microscopic features: 

Early stage:  Mononuclear cells consisting of lymphocytes and plasma cells in the lamina propria.  Usually located around fundic glands and infiltration of the glands by lymphocytes. Glandular destruction is present. Focal mucous neck cell hyperplasia

Florid stage:  Parietal and chief cell atrophy. Increased lymphocytic infiltration. Focal intestinal metaplasia.

End stage:  Fundic mucosa is completely replaced by pyloric or intestinal glands.

Other features:

In patients with pernicious anaemia the superficial gastric epithelium may appear megaloblastic.

Focal pancreatic metaplasia is sometimes present.

G-cell hyperplasia in the antrum

Hypergastrinaemia leads to hyperplasia of corpus enterochromaffin cells (ECL cells), causing first linear, then nodular lesions and eventually multiple microcarcinoids and carcinoid tumours.

In cases of co-existing helicobacter pylori infection, histological features of both Type A and Type B gastritis are present.

Visit : Chronic gastritis Acute Gastritis     

 

Further reading:

Diagnosis and classification of autoimmune gastritis.

Pathology and differential diagnosis of chronic, noninfectious gastritis.

Autoimmune atrophic gastritis--pathogenesis, pathology and management.

Autoimmune gastritis. A clinicopathologic study of 25 cases.

Pancreatic acinar cell metaplasia in autoimmune gastritis.

Oxyntic mucosa pseudopolyps: a presentation of atrophic gastritis. 

Autoimmune gastritis: Distinct histological  and immunohistochemical  findings before complete loss of oxyntic glands. 

Atrophic body gastritis: distinct features associated with Helicobacter pylori infection. 

The histopathological spectrum of Type A gastritis.  

Active autoimmune gastritis without total atrophy of the glands. 

Gastric endocrine cell hyperplasia and carcinoid tumous in atrophic gastritis type A.

 

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Gastric Pathology - Home Page

  

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

 


 

 

 

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