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Non-Neoplastic Gastric Lesions

Dr Sampurna Roy MD

 

 

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1. Menetrier's disease (hyperplastic or hypertrophic gastropathy, giant rugal hypertrophy):

Characterized by hypertrophic rugae (1-3 cm in height).

Site: Proximal greater curvature of the stomach or generalized in the body and fundus.

Histological features: Foveolar hyperplasia, glandular atrophy.

Elongated, tortuous, dilated gastric pits are lined by mucous secreting cells.

Pits extend to the mucosa where they became cystic.

Some cystically dilated glands extend into the submucosa, producing gastritis cystica profunda.

Lamina propria edematous, infiltrated by smooth muscle  fibers.

Further reading:

- The natural history of hypertrophic gastropathy (Menetrier's disease). Report of a case with 16 year follow up and review of 120 cases from the literature.

-
Hyperplastic gastropathy. Clinicopathologic correlation.  

- Menetrier's disease:  a form of hypertrophic gastropathy or gastritis?
 

 


2. Gastric Varices : 

Patients with cirrhosis and portal hypertension.

Surround the cardioesophageal junction.

In portal hypertensive gastropathy there is mucosal and submucosal capillary and venous ectasia.

Other features: ulceration, erosion, multiple petechiae.

Further reading:

- Endovascular management of gastric varices.

- Gastric variceal bleed in a patient without liver cirrhosis: an unusual cause of haematemesis.

 


3. Gastric Diverticulum:

Subcardial region.

Anatomically weak area.

Outpouching of the full thickness of gastric wall.

Food impaction and occasionally haemorrhage occurs.

Further reading:
 

- Gastric diverticulum. A case report with long-term follow-up and a review of the literature.

- An unusual case of gastric diverticulosis. 

- Stomach diverticula and their clinical significance.


4. Bezoars: 

Foreign bodies in the stomach. (Trichobezoar : Hair.  Phytobezoar:  Vegetable matter).

Visit: Rapunzel Syndrome- A scary,hairy tale !


5. Dieulafoy lesion (calibre persistent artery):

Middle aged & elderly men.

On lesser curve of the stomach within 6 cm of gastro-esophageal junction.

Histologically, abnormal, large muscular artery , 1.5 mm in diameter, run  through submucosa and approach mucosa. Superficial erosion often present.

Further reading:

- Gastric hemorrhage due to ruptured arteriovenous malformation (Dieulafoy's disease).

Multiple arterial caliber persistence resulting in hematomas and fatal rupture of the gastric wall.

- Fatal rupture of gastric aneurysm.

 


6. Angiodysplasia :

Dilated , distorted and dysplastic vessels lined by endothelium. 

Small amount of smooth muscle fibre maybe present. 

The vessels have an abnormal distribution and aberrant morphology.

Vascular channels are separated from the gastric lumen by single layer of endothelial cells.

 

Further reading:

- Selective embolization for massive upper gastrointestinal bleeding deriving from gastric angiodysplasia.

- Gastric angiodysplasia in a hereditary hemorrhagic telangiectasia type 2 patient.

-Comparison of argon plasma coagulation in management of upper gastrointestinal angiodysplasia and gastric antral vascular ectasia hemorrhage.

 


7. Gastric Amyloid :

Rare lesion. Clinically present as gastric polyps or enlarged folds. Differential diagnosis: Elastosis and elastofibromatous changes.

Further reading:

-Gastric amyloidosis: clinicopathological correlations in 79 cases from a single institution.

-Elastosis and elastofibromatous change in the gastrointestinal tract: a clinicopathologic study of 13 cases and a review of the literature.

-Laceration of gastric mucosa associated with dialysis-related amyloidosis.

-A case report of localized gastric amyloidosis.

- Localised primary amyloidosis of stomach presenting with gastric haemorrhage.  

-Amyloid tumors of the gastrointestinal tract.A report of two cases and review of the literature.  

 


8. Gastric xanthoma/ xanthelasma

                                                   


9. Gastric Antral Vascular Ectasia (GAVE) "watermelon stomach".

Telangiectatic lesions on the  parallel longitudinal rugal folds of the antrum. Endoscopically: Distinctive parallel, intensely red stripes.

Histological features: Stripes correspond to markedly dilated tortuous mucosal capillaries. Vessels contain fibrin thrombi. Fibrohyalinosis with fibromuscular hyperplasia of the lamina propria  may be present.

Further reading:

-Histopathologic changes are not specific for diagnosis of gastric antral vascular ectasia (GAVE) syndrome: a review of the pathogenesis and a comparative image analysis morphometric study of GAVE syndrome and gastric hyperplastic polyps.

- Gastric antral vascular ectasia (watermelon stomach)-an enigmatic and often-overlooked cause of gastrointestinal bleeding in the elderly.

- An unusual cause of upper GI bleeding: gastric antral vascular ectasia.

- Gastric antral vascular ectasia (watermelon stomach) in a patient with Sjögren's syndrome.

- Gastric antral vascular ectasia.

- Gastric antral vascular ectasia. A histologic and morphometric study of "the watermelon stomach" 

 

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Gastric Pathology - Home Page

 

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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