Vesoulis Z, Lozanski G, Ravichandran P, Esber E
Department of Pathology, Summa Health Systems, Akron, Ohio 44304, USA.
Mod Pathol. 2000 May;13(5):591-6. doi: 10.1038/modpathol.3880101.
Collagenous gastritis is rare; there are only four previous case reports. Histologic features seem to overlap with the other "collagenous enterocolitides"; however, pathologic criteria are not yet established for the diagnosis of collagenous gastritis. We describe an additional case of ostensible collagenous gastritis in a patient who initially presented with celiac sprue and subsequently developed colonic manifestations of mucosal ulcerative colitis. Endoscopic biopsies of the stomach revealed deposition of patchy, very thick bandlike subepithelial collagen in gastric antral mucosa, focal superficial epithelial degeneration, numerous intraepithelial lymphocytes, and a dense lamina propria lymphoplasmacytic infiltrate. Image analysis evaluation of gastric antral biopsies demonstrated a mean thickness of subepithelial collagen of 27.07 micron. Morphologic comparison was made with age-matched control groups of 10 patients who had normal gastric mucosal biopsies and 10 patients who had "chronic" gastritis, which revealed mean subepithelial collagen measures of 1.37 micron and 1.19 micron, respectively. We compared these morphologic findings with those of all previous case reports of collagenous gastritis and propose a pathologic definition based on the limited combined data. It seems that subepithelial collagen is dramatically thickened in reported cases of collagenous gastritis, with a cumulative mean measure of 36.9 micron. It is also apparent from this and previous reports that the thickened subepithelial collagen is accompanied by a chronic or chronic active gastritis and sometimes intraepithelial lymphocytes and surface epithelial damage. Recently described associations of lymphocytic gastritis, sprue, and lymphocytic colitis as well as collagenous and lymphocytic colitis suggest a common pathogenesis that empirically may include collagenous gastritis in the same disease spectrum. We propose that collagenous gastritis can be confidently identified by using analogous defined features of collagenous colitis: subepithelial collagen more than 10 micron in a patchy distribution, lamina propria lymphoplasmacytic infiltrates, intraepithelial lymphocytes, and surface epithelial damage. Collagenous gastritis also seems to have the same spectrum of associated clinical findings as collagenous colitis, including frequent coexistence of celiac sprue, watery diarrhea syndrome, and female predominance.
胶原性胃炎较为罕见，此前仅有4例病例报告。其组织学特征似乎与其他“胶原性小肠结肠炎”重叠；然而，胶原性胃炎的诊断病理标准尚未确立。我们描述了另外1例疑似胶原性胃炎的病例，该患者最初表现为乳糜泻，随后出现了黏膜溃疡性结肠炎的结肠表现。胃内镜活检显示胃窦黏膜有散在、非常厚的带状上皮下胶原沉积，局灶性浅表上皮变性，大量上皮内淋巴细胞，以及固有层密集的淋巴浆细胞浸润。胃窦活检的图像分析评估显示上皮下胶原的平均厚度为27.07微米。与10例胃黏膜活检正常的年龄匹配对照组和10例“慢性”胃炎患者进行形态学比较，结果显示上皮下胶原的平均测量值分别为1.37微米和1.19微米。我们将这些形态学发现与之前所有胶原性胃炎病例报告的结果进行了比较，并根据有限的综合数据提出了一个病理定义。在已报道的胶原性胃炎病例中，上皮下胶原似乎显著增厚，累积平均测量值为36.9微米。从本报告和之前的报告中也可以明显看出，增厚的上皮下胶原伴有慢性或慢性活动性胃炎，有时还伴有上皮内淋巴细胞和表面上皮损伤。最近描述的淋巴细胞性胃炎、口炎性腹泻和淋巴细胞性结肠炎以及胶原性和淋巴细胞性结肠炎之间的关联提示了一种共同的发病机制，根据经验，这种机制可能在同一疾病谱中包括胶原性胃炎。我们建议，可以通过使用与胶原性结肠炎类似的明确特征来可靠地识别胶原性胃炎：上皮下胶原呈散在分布且厚度超过10微米、固有层淋巴浆细胞浸润、上皮内淋巴细胞以及表面上皮损伤。胶原性胃炎似乎也具有与胶原性结肠炎相同的一系列相关临床表现，包括乳糜泻、水样腹泻综合征常同时存在以及女性居多。
