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  • Surgical Pathology Criteria
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    Autoimmune Atrophic Gastritis

    Definition

    • Atrophic gastritis accompanied by anti-parietal cell and anti-intrinsic factor antibodies

    Alternate / Historical Names

    • Autoimmune metaplastic atrophic gastritis
    • Type A gastritis

    Diagnostic Criteria

    • Requires a biopsy from the body for diagnosis
    • Atrophic gastritis largely restricted to the gastric body
      • Antrum usually normal but may show focal inflammation and atrophy
    • During active phase, there is a lymphocytic and plasma cell infiltrate
      • Centered in the deep lamina propria of the body
      • Typically sparse in cases with advanced atrophy
    • In chronic phase, there is markedly thinned mucosa composed largely of foveolae
      • Atrophy of oxyntic glands
        • Destruction and loss of both parietal and chief cells
        • Usually extensive but need not be complete
        • Results in pseudopyloric metaplasia
      • Intestinal metaplasia is usually extensive
    • Gastric endocrine cell proliferations frequently associated
      • Occurs in body, not in antrum
      • May begin early in disease
      • (G cell hyperplasia occurs in antrum)
        • (There are no G cells in the body)
    • Anti-parietal cell and anti-intrinsic factor antibodies
      • Pernicious anemia may develop in longstanding cases
        • May take years for body stores of vitamin B12 to be depleted
    • Low prevalence of Helicobacter

    Robert V Rouse MD
    Department of Pathology
    Stanford University School of Medicine
    Stanford CA 94305-5342

    Original posting : September 9, 2009

    Differential Diagnosis

    • Helicobacter associated chronic gastritis can result in antral atrophy with or without intestinal metaplasia that is indistinguishable from the atrophic body mucosa of autoimmune gastritis
      • Endocrine cell hyperplasia is not typical of Helicobacter
      • Clinicopathologic correlation with knowledge of the location of the biopsy is necessary for the distinction

    Clinical

    • Rare
    • Frequently results in
      • Achlorhydria
      • Hypergastrinemia
      • Vitamin B12 deficiency
      • Iron deficiency
      • Loss of pepsin
    • Associated with development of intestinal type gastric adenocarcinoma
      • Risk is very low in USA
      • Risk significantly increased only in regions with a high endemic risk of gastric carcinoma

    Bibliography

    • Noffsinger A, Fenoglio-Preiser CM, Maru D, Gilinisky N.  Gastrointestinal Diseases, AFIP Atlas of Nontumor Pathology, First Series, Fascicle 5, 2007.
    • Owen DA. Gastritis and carditis. Mod Pathol. 2003 Apr;16(4):325-41.
    • Srivastava A, Lauwers GY. Pathology of non-infective gastritis.Histopathology. 2007 Jan;50(1):15-29.
    Printed from Surgical Pathology Criteria: http://surgpathcriteria.stanford.edu/
    © 2009  Stanford University School of Medicine