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Pathology of Lymphocytic


Dr Sampurna Roy MD


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Lymphocytic gastritis is associated with coeliac disease (specially antral prdominant gastritis) and non-coeliac small intestinal intraepithelial lymphocytosis with malabsorption.

- Lymphocytic gastritis is also associated with Helicobacter pylori infection (specially corpus predominant lymphocytic gastritis).

- Eradication of Helicobacter pylori plays an important role in the treatment of lymphocytic gastritis.

- In the severe form lymphocytic gastritis is diagnosed as varioliform gastritis.

Endoscopic features : Enlarged mucosal folds, multiple, discrete mucosal nodules or plaques with central umbilications , erosions or apthoid ulcers and surrounding hyperemia.

Microscopic features: 

-Intraepithelial T cells (CD8  positive) in the surface and superficial pit epithelium.

-Intraepithelial lymphocytes are scattered rather than in clusters.

-The glands are spared. The pits have a corrugated dilated appearance.

-There should be atleast 25 lymphocytes/100 epithelial cells to make a diagnosis.

-The intraepithelial lymphocytes create a vacuolated  or clear cell appearance (subnuclear region).

Differential diagnosis:

Pathologists should be able to distinguish lymphocytic gastritis from  B-cell lymphoepithelial lesions seen in MALT lymphomas.   

Visit: Gastric Lymphoma   

[ According to Nielsen et al -

Lymphocytic gastritis is not a distinct clinicopathologic entity, but a morphologic pattern of gastric injury that can be secondary to a variety of underlying etiologies.

When restricted to cases with lymphocytosis alone, Lymphocytic gastritis is strongly associated with celiac disease and not with active Helicobacter pylori  infection.

However, cases that also show significant neutrophilic infiltrate should be regarded as "active chronic gastritis" and are often associated with Helicobacter pylori infection.

A morphologic diagnosis of Lymphocytic gastritis should prompt clinical and serologic workup to exclude underlying celiac disease ]


Further reading:

Lymphocytic gastritis showing concomitant occurrence of both CD4 + and CD8 + T-cells among epithelial cells.

Lymphocytic gastritis is not associated with active Helicobacter pylori infection.

Lymphocytic gastritis and  protein losing gastropathy. 

Varioliform gastritis: frequency and relationship with lymphocytic gastritis.  

The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of of duodenal pathology.

Effects of Helicobacter pylori eradication on the natural history of lymphocytic gastritis. 

Lymphocytic gastritis: association with etiology and topology.

Lymphocytic gastritis and coeliac disease: evidence of a positive association.

Lymphocytic gastritis: a study of its frequency and review of the literature. 

Lymphocytic gastritis and associated small bowel disease: a diffuse lymphocytic gastroenteropathy? 

Lymphocytic gastritis, gastric adenocarcinoma,  primary  gastric lymphoma. 

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Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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