Menetrier Disease

Definition

• Massive gastric foveolar hyperplasia involving the full thickness of the mucosa

Diagnostic Criteria

• Foveolar hyperplasia of gastric body
  • Foveolae corkscrew shaped and may be cystically dilated
    • May extend into submucosa
  • Produces giant gastric folds
• Atrophy of oxyntic glands
  • Decreased acid secretion
• Mucous cells extend to the base of the glands
• Variable edema
• Mixed inflammatory infiltrate, usually mild
• Hypertrophic muscularis mucosae may extend into lamina propria
• Intestinal metaplasia may occur late in disease
• Granulomas may occur late in disease
• Antrum spared in adults, involved in children
• Pediatric cases associated with Cytomegalovirus
  • Present in blood, urine, stomach

Clinical

• Decreased acid production
• Hypoproteinemia, hypoabuminemia, peripheral edema
• GI bleeding
• Adults – chronic, insidious onset
• Children – sudden onset
  • Often self-limited

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

Original posting : September 9, 2009

Differential Diagnosis

Superficial biopsies showing foveolar hyperplasia may appear identical to:
• Reflux gastropathy
• Localized hyperplasia adjacent to other lesions
• Hyperplastic polyps
• Cronkhite-Canada polyps
• Full thickness specimens and clinical and endoscopic correlation are required to demonstrate the extent of foveolar hyperplasia and atrophy of oxyntic glands or the presence of a discrete polyp

Cronkhite-Canada Syndrome, Gastric Involvement	Menetrier Disease
Hair, nail, skin pigmentation changes present	No associated extra-GI lesions
Colorectal polyps very common	Not associated with colorectal polyps

On biopsy, the polyps and polypoid mucosa in some cases are indistinguishable and both are associated with protein losing enteropathy

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.
• Eisenstat DD, Griffiths AM, Cutz E, Petric M, Drumm B. Acute cytomegalovirus infection in a child with Ménétrier's disease Gastroenterology. 1995 Aug;109(2):592-5.
• Srivastava A, Lauwers GY. Pathology of non-infective gastritis.Histopathology. 2007 Jan;50(1):15-29.