Which histologic features help determine etiology of acute gastritis?

Updated: Jun 13, 2019
  • Author: Mohammad Wehbi, MD; Chief Editor: BS Anand, MD  more...
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Answer

The main histologic feature of CMV infection is cytomegalic cells with intranuclear inclusions. Viral cultures, immunocytochemistry, and in situ hybridization can further aid in establishing the diagnosis.

The main histologic feature of C albicans infection is yeast forms in a biopsy specimen.

The main histologic feature of tuberculosis is necrotizing granulomas.

The main histologic feature of histoplasmosis is the presence of nonnecrotizing granulomas containing the organisms. The diagnosis of histoplasmosis requires a positive culture result from the gastric mucosal biopsy specimen.

In ulcero-hemorrhagic gastritis, the epithelium appears eroded with edema and hemorrhage with typically little inflammation. In severe cases, the lumen of the stomach may be coated with fibropurulent exudates and the lamina propria may be replaced by eosinophilic hyaline material.

In iron-induced gastritis, erosions, foveolar hyperplasia, or even hyperplastic-type polyps can be detected. Iron has been associated with infarctlike necrosis given its corrosive properties. Iron stains can highlight the golden brown pigment in tissue samples, but these are often easily visible. Of note, such findings should be differentiated from glandular siderosis seen in systemic iron overload or hemochromatosis.

Histologic features of chemotherapy-induced gastritis may include atypical epithelial cells with bizarre features at the base of the glands, limited mitoses, and pleomorphic nuclei. These characteristics may make it difficult to differentiate from an adenocarcinoma.

The findings at histology of radiation-induced gastritis include nuclear karyorrhexis (destructive fragmentation of the nucleus of a dying cell) and cytoplasmic eosinophilia of the gastric pit epithelium during the first 10 days following treatment, followed by mucosal edema, congestion, submucosal collagen bundle swelling, fibrin deposition, and telangiectasia. If extensive, hemorrhage and ulceration may be evident.

In eosinophilic gastritis, a prominent eosinophilic infiltrate is present in the gastric wall or epithelium. Distribution can be patchy, so multiple biopsy specimens should be obtained during endoscopy.


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