Lymphocytic Gastritis

Definition

• Pronounced lymphocytic infiltration in gastric surface epithelium

Alternate/Historical Names

• Chronic erosive gastritis
• Varioliform gastritis

Diagnostic Criteria

• Prominent intraepithelial lymphocyte infiltration
  • T cell phenotype
    • Usually CD8+
  • ≥25 lymphocytes per 100 epithelial cells
  • Lymphoepithelial lesions, if present, are small, ≤3 lymphocytes
• Lymphocytes fill lamina propria
  • Neutrophils can be seen
• Foveolar hyperplasia, usually mild
• Variable degeneration of surface and foveolar epithelium
• Severe cases have nodular targetoid and eroded lesions along proximal rugae
  • Termed “varioliform gastritis”
• May result in atrophy
• May be associated with:
  • Collagenous gastritis
  • Celiac disease
    • Predominantly antral
  • Helicobacter
    • Predominantly in body mucosa or diffuse
  • Crohn disease
  • HIV infection
  • Lymphoma
• Endoscopic appearance ranges from normal to nodular targetoid erosions (varioliform) to giant mucosal folds resembling hypertrophic gastritis

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

Original posting : September 9, 2009

Differential Diagnosis

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

• 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.
• Müller H, Volkholz H, Stolte M. Healing of lymphocytic gastritis by eradication of Helicobacter pylori. Digestion. 2001;63(1):14-9.
• Hayat M, Arora DS, Wyatt JI, O'Mahony S, Dixon MF. The pattern of involvement of the gastric mucosa in lymphocytic gastritis is predictive of the presence of duodenal pathology. J Clin Pathol. 1999 Nov;52(11):815-9.
• Wu TT, Hamilton SR. Lymphocytic gastritis: association with etiology and topology. Am J Surg Pathol. 1999 Feb;23(2):153-8.
• Srivastava A, Lauwers GY. Pathology of non-infective gastritis.Histopathology. 2007 Jan;50(1):15-29.