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Pathology of Granulomatous


Dr Sampurna Roy MD  



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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

-   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



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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