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Pathology of Granulomatous

Gastritis

Dr Sampurna Roy MD  


GI Path Online- Home Page Gastric Pathology - Home Page

August  2015

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)

 

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Granulomatous Reaction Pattern of the Skin

Granuloma Annulare

Necrobiosis Lipoidica

Necrobiotic Xanthogranuloma   

Rheumatoid Nodule

Lupus Vulgaris

Cutaneous Sarcoidosis

The final diagnosis of granulomatous gastritis is based on morphological findings and detailed clinical history and laboratory data.                    

Clinicians must provide the following clinical details to the pathologist -  History of immunosuppression, intake of drugs, past history of tuberculosis, sarcoidosis, Crohn's etc.

Macrosopically there is thickening of the gastric wall (Differential Diagnosis: Infiltrating carcinoma).

- Differential Diagnosis:

1. Infectious conditions: Tuberculosis, syphilis, histoplasmosis, mycobacterial infection.

2. Associated with malignancies:  Gastric carcinoma, lymphoma.

3. Foreign body granuloma:  Food granuloma, suture granuloma .

4. Miscellaneous: Crohn's,  sarcoidosis, chronic granulomatous disease of childhood, allergic granulomatosis and vasculitis, Whipple's disease.

-  Tuberculosis: 

Usually the antrum is affected.

Gross- Thickened wall, shallow ulcers.

Microscopically- Confluent caseating granuloma. Acid fast organisms are
demonstrated.

-   Syphilis:    

Gross: Starts as erosive or ulcerative lesion.

In later stage the stomach is shrunken and fibrotic (leather-bottle).

Perivascular cuffing;

Dense plasmacytic infiltrate;

Glandular destruction;

Demonstration of spirochetes by silver stains.

-    Crohn's:    

Usually located in the Gastric antrum.

In florid condition the following features may be present:

- Transmural inflammation

- Pit abscess

- Lymphoid aggregates and prominent  lymphoid follicles.       

- Ulcers

- Sarcoid like granuloma

-   Miscellaneous:  

Multiple granulomas are observed in  sarcoidosis, Whipple's disease and vasculitis-associated cases.     

                        

" A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an "idiopathic" granulomatous gastritis?Am J Surg Pathol. 1996 Apr;20(4):462-70.

(a) in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or sarcoidosis could be established;

(b) the background inflammatory pattern was helpful in suggesting a diagnostic category for granulomatous gastritis;

(c) granulomatous gastritis is not associated with H. pylori per se; however, if known cases of Crohn's disease and sarcoidosis are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out; and

(d) IGG, if it exists, is extremely rare. "

                                                      

Further reading:

Granulomatous gastritis and Helicobacter pylori infection.

An unusual cause of granulomatous gastritis in an elderly patient: Helicobacter pylori.

Disseminated sarcoidosis presenting as granulomatous gastritis: a clinical review of the gastrointestinal and hepatic manifestations of sarcoidosis.

Isolated granulomatous gastritis showing discoloration of lesions after Helicobacter pylori eradication.

Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases.

Granulomatous gastritis. Apropos of 2 cases.

Histology of the stomach and duodenum in Crohn's disease.

High frequency of helicobacter negative gastritis in patients with Crohn's disease.

Granulomatous gastritis: a morphological and diagnostic approach.

Gastric syphilis. Primary diagnosis by gastric biopsy: report of four cases.

Granulomatous gastritis and Whipple's disease.

 


GI Path Online- Home Page Gastric Pathology - Home Page

Normal Histology of Esophagus

An approach to the reporting of esophageal biopsies

Benign tumours and tumour -like conditions of esophagus.

 1. Squamous papilloma of the esophagus

 2.Inflammatory fibroid polyp of the esophagus

 3. Leiomyoma of the esophagus

 4. Granular cell tumour of the esophagus

 5. Esophageal cysts 

 6. Glycogenic acanthosis 

Reporting of esophageal resection specimens

Squamous epithelial dysplasia  including squamous cell carcinoma in-situ of the esophagus

Small cell carcinoma of the esophagus 

Drug related lesions of the gastrointestinal tract.

 

An outline of the anatomy and normal histology of the  stomach for pathologists.

Reporting of gastric biopsies (non-neoplastic gastric lesions).

Pathology and pathogenesis of peptic ulcer.

Acute Gastritis 

Chronic Gastritis

Helicobacter pylori  associated (TypeB)  Gastritis 

Autoimmune Gastritis (Type A) 

Reactive /Reflux/ Chemical Gastritis (Type C)

Lymphocytic Gastritis

Collagenous Gastritis

Granulomatous Gastritis

Eosinophilic Gastritis

Gastric Xanthoma/ Xanthelasma

Other Non-Neoplastic Gastric Lesions


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