Christine Yeh Hachem, MD; Hala El-Zimaity, MD Series Editor: Richard Goodgame, MD


September 27, 2007


The correct diagnosis is lymphocytic gastritis. Figure 11 is a low-power view of the gastric body. It shows infiltration of the mucosa with inflammatory cells and the profound separation of the deep gastric glands (atrophy; arrow). Figure 12 is a higher-power view of the same area, showing that the infiltrating cells are normal-appearing, small lymphocytes. The cells are not only present in the lamina propria between the glands, but are infiltrating the epithelial lining cells of the surface epithelium (arrow) and the deeper glands. The number of lymphocytes in the surface and foveolar epithelium per 100 epithelial cell nuclei is greater than 75. The lymphocytes are small and round with no nuclear atypia. The clear halo around the nuclei of some of the lymphocytes (arrow) is a common fixation artifact. Figure 13 shows a similar area of the stomach but is stained with the T-cell stain CD3. The intraepithelial lymphocytes are almost all T cells, as is seen in lymphocytic gastritis. This means that the patient does not have H pylori-related B-cell lymphoma. Figure 14 shows a representative biopsy from one of the polypoid lesions. There is marked corkscrewing of the deep gastric glands (foveolar hyperplasia; white arrow), as has been described in some cases of lymphocytic gastritis and Ménétrièr's disease. However, a higher-power view (Figure 15) shows the prominent lymphocytes typical of lymphocytic gastritis that are not seen in Ménétrièr's disease or reactive gastropathy.


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