GI Path Online
Reporting of Gastric Biopsies
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gastric biopsies for non-neoplastic conditions:
1. Endoscopic evidence of chronic gastritis or peptic ulcer.
(Remember - Normal endoscopic finding does not necessarily rule out histological gastritis).
2. Patients with non-ulcer dyspepsia to assess the Helicobacter pylori status.
3. Grading of gastritis.
4. Report other forms of gastritis.
5. Further biopsy is indicated to assess healing and to differentiate between regenerative changes and true dysplasia.
Biopsy sites to
assess H. pylori associated gastritis:
- Two biopsies from middle antrum (on lesser and greater curvature, 2-3 cm from pylorus).
- Two biopsies from body (lesser curvature and middle of greater curvature).
- One biopsy from the incisura angulus.
A systematic approach is necessary for
reporting gastric biopsies suspected of having inflammatory lesions.
Good communication between endoscopist and pathologist is necessary.
Gastroenterologist and pathologist should jointly design a tissue submission form.
A diagram of the stomach is useful. The endoscopist can indicate the
lesion on the diagram.
- Age and sex
- Clinical impression
- Endoscopic findings
- Site is crucial. Example- Gastritis of antrum and pangastritis have different clinical connotations and risk potential. ( Antral gastritis associated with duodenal ulcer. Pangastritis with gastric ulcer/cancer ). Metaplasia in body type mucosa and loss of specialised cells (due to inflammation) can cause it to look as antral mucosa.
- History of intake of drugs (Example: NSAIDS)
- History of pernicious anaemia
- History of immunosuppression - The history prompts the pathologist to carefully examine the biopsy for infection (eg. cytomegalovirus).
- Relevant surgical operation.
- Family history of gastric carcinoma or familial adenomatous polyposis
- Results of previous gastric biopsies
Assessment of the biopsy :
- Type of mucosa included in the biopsy. In gastritis, antral and corpus biopsies are to be assessed separately.
- Biopsy > Normal or Abnormal
or Diffuse lesion
(ie. involve surface epithelium, glandular component or stroma., or all
i) Type (acute, chronic, mixed, lymphocytic, plasmacytic, eosinophilic).
ii) Site (surface epithelium, pits, stroma,
Ratio altered due to i) too much stroma
ii) loss of normal mucosal component iii) due to increased cellularity.
i) pit expansion, ii) glandular expansion,
iii) expansion by inflammatory infiltrate, iv) abnormal cellular
Note whether the glands are lined up parallel to each other . Branching
and irregularity noted in chemical gastritis & Menetrier's disease.
PAS- Highlight Candida albicans or other fungi.
AB/PAS- Intestinal metaplasia is demonstratrated.
High iron diamine/alcian blue- To classify the type of intestinal metaplasia on the basis of mucin type.
Cresyl fast violet, Gimenez, Giemsa, half Gram, toluidene blue, Warthin
- To demonstrate Helicobacter pylori
To demonstrate specific inclusions (CMV , herpes virus)
Anti H. pylori
Not used routinely. ( Used when organisms are few in number)
1. Chronic inflammation:
Increase in lymphocytes and plasma cells
in the lamina propria .
4. Intestinal metaplasia:
Grading: Mild: Less than 1/3rd of mucosa involved
Moderate: 1/3rd - 2/3rd " "
Severe: More than 2/3rd " "
Grading: Mild colonisation: Scattered organisms covering less than 1/3rd of the surface.
Moderate: 1/3rd - 2//3rd of the surface
Severe: Large clusters or continuous layer over more than 2/3rd of the surface.
Gastric mucosal atrophy: interobserver consistency
using new criteria for classification and grading.
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