Granulomatous Gastritis

Definition

• Gastric inflammation containing granulomas

Diagnostic Criteria

• Granulomas usually superficial
• May be seen to be transmural on resection specimens
• Usually non-necrotic
• Variable acute and chronic inflammation
• May be focal or diffuse
• Most common in antrum
• Various causes – should be ruled out and addressed in report
• Crohn disease is most common cause of cases
• Diagnosis usually already known from intestinal evaluation
• Sarcoidosis may present without thoracic disease
• Role of Helicobacter is controversial
  • Some report it as the most common cause after above excluded
• Foreign body reaction
• Polarization may help to exclude
• May be due to drugs, including antacids
• Infection must always be ruled out
• Mycobacteria
• Fungi
• Parasites
• Common variable immunodeficiency
• Rare granulomas in stomach
• Granulomas may be seen adjacent to gastric neoplasms
• Isolated, idiopathic – very rare, if it exists at all
  • Has been termed Isolated Granulomatous Gastritis (IGG)
  • Primarily reported in adults
• Endoscopic appearance ranges from non-specific minor changes to thickened mucosal folds with outlet obstruction

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

Original posting : September 9, 2009

Classification / Lists

Gastritis / Gastropathy

• Reactive gastropathy / chemical gastritis
  • Includes most acute gastritis
  • Various causes including:
    • Alcohol
    • NSAIDS and other drugs
    • Bile and/or duodenal contents (alkaline) reflux
      • Frequently post-surgical
• Chronic gastritis and chronic active gastritis
  • Non-atrophic, predominantly antral
    • Includes Helicobacter-associated chronic active gastritis
    • Late stages may have multi-focal atrophy
  • Atrophic, fundic
    • Autoimmune
• Other drug related gastritis
  • Iron
    • Stainable iron crystalline material present
  • Aluminum based antacids (gastric mucosal calcinosis)
    • Small, pink, partially calcified. refractile crystals
  • Kayexalate
    • Rhomboid or triangular, non-polarizable basophilic crystals
  • Chemotherapy
  • See excellent reviews
    • Parfitt and Driman, Hum Pathol 2007, 38:927
    • Srivastava and Lauwers, Histopathol 2007, 50:15
• Hypertrophic/hyperplastic gastritis
  • Menetrier disease
  • Zollinger Ellison syndrome
• Special types
  • Collagenous
  • Lymphocytic
  • Eosinophilic gastroenteritis
  • Granulomatous
• Vascular
  • Gastric vascular antral ectasia (GAVE)
  • Portal hypertensive gastropathy
  • Ischemic
• Infectious
  • Helicobacter
  • Viral
  • Fungal
  • Parasitic

Bibliography

• Shapiro JL, Goldblum JR, Petras RE. A clinicopathologic study of 42 patients with granulomatous gastritis. Is there really an "idiopathic" granulomatous gastritis? Am J Surg Pathol. 1996 Apr;20(4):462-70.
• Maeng L, Lee A, Choi K, Kang CS, Kim KM. Granulomatous gastritis: a clinicopathologic analysis of 18 biopsy cases. Am J Surg Pathol. 2004 Jul;28(7):941-5.
• 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.